Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; Humans ; Lung ; diagnostic imaging ; Lung Neoplasms ; diagnostic imaging ; Perfusion Imaging ; Radiotherapy, Intensity-Modulated ; methods ; Tomography, Emission-Computed, Single-Photon ; methods

Non-small cell lung cancer (NSCLC) can be detected with enlarged lymph nodes on imaging, but their benignity and malignancy are difficult to determine directly, making it difficult to stage the tumor and design radiotherapy target volumes. The clinical diagnosis of malignant lymph nodes is often based on the short diameter of lymph nodes ≥1 cm or the maximum standard uptake value ≥2.5, but the sensitivity and specificity of these criteria are too low to meet the clinical needs. In recent years, many advances have been made in diagnosing benign and malignant lymph nodes using other imaging parameters, and with the development of radiomics, deep learning and other technologies, models of mining the image information of enlarged lymph node regions further improve the diagnostic accuracy. The purpose of this paper is to review recent advances in imaging-based diagnosis of benign and malignant enlarged lymph nodes in NSCLC for more accurate and noninvasive assessment of lymph node status in clinical practice.
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Humans ; Carcinoma, Non-Small-Cell Lung/pathology* ; Diagnostic Imaging ; Lung Neoplasms/pathology* ; Lymph Nodes/pathology* ; Sensitivity and Specificity

OBJECTIVETo compare the diagnostic efficacies of 64-MDCT and 3.0-T MRI in determining the T stage of non-small cell lung cancer (NSCLC).

METHODSApproval from the institutional ethics committee and informed consent from patients were obtained before the study started. 40 patients with NSCLC proved by pathology were enrolled in the study. All the 40 patients underwent non-enhanced MRI, enhanced MRI, and enhanced MDCT. Their T stages were preliminarily evaluated according to these imaging manifestations by 3 groups of experienced chest radiologists respectively, and correlated with that of postoperative pathology using the Kappa test. The diagnostic efficacies of these three imaging modalities for determining the T stage of NSCLC were compared using the McNemar test.

RESULTSThe preoperative diagnostic accuracy rate for the T stage of NSCLC was 85.0% (34 of 40) by non-enhanced MRI, 87.5% (35 of 40) by enhanced MRI, and 80.0% (32 of 40) by enhanced CT, showing no significant differences between the non-enhanced MRI and enhanced CT, enhanced MRI and enhanced CT, and non-enhanced MRI and enhanced MRI for determining the T stage of NSCLC (P>0.05).

CONCLUSIONSCompared with the enhanced MDCT, non-enhanced MRI and enhanced MRI provide slightly superior diagnostic efficacy for the preoperative T staging of NSCLC. For the patients with intolerance to contrast medium on MDCT scan, 3.0T MRI may be an alternative for determining the preoperative T stage of NSCLC.

Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; pathology ; Contrast Media ; Humans ; Lung Neoplasms ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Multidetector Computed Tomography ; Neoplasm Staging ; Preoperative Period

Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; surgery ; Follow-Up Studies ; Humans ; Lung Neoplasms ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Postoperative Period ; Tomography, X-Ray Computed

OBJECTIVETo investigate the structural characteristics and clinical significance of two-dimensional tumor microvascular architecture phenotype (2D-TMAP) in non-small cell lung cancer (NSCLC).

METHODSThirty surgical specimens of NSCLC were collected. The sections of the tumor tissues corresponding to the slice of CT perfusion imaging were selected to construct the 2D-TMAP expression. Spearman correlation analysis was used to examine the relation between the 2D-TMAP expression and the clinicopathological features of NSCLC.

RESULTSA heterogeneity was noted in the 2D-TMAP expression of NSCLC. The microvascular density (MVD) in the area surrounding the tumor was higher than that in the central area, but the difference was not statistically significant. The density of the microvessels without intact lumen was significantly greater in the surrounding area than in the central area (P=0.030). The total MVD was not correlated to tumor differentiation (r=0.042, P=0.831). The density of the microvessels without intact lumen in the surrounding area was positively correlated to degree of tumor differentiation and lymph node metastasis (r=0.528 and 0.533, P=0.041 and 0.028, respectively), and also to the expressions of vascular endothelial growth factor (VEGF), ephrinB2, EphB4, and proliferating cell nuclear antigen (PCNA) (r=0.504, 0.549, 0.549, and 0.370; P=0.005, 0.002, 0.002, and 0.048, respectively). The degree of tumor differentiation was positively correlated to PCNA and VEGF expression (r=0.604 and 0.370, P=0.001 and 0.048, respectively), but inversely to the integrity of microvascular basement membrane (r=-0.531, P=0.033).

CONCLUSIONThe 2D-TMAP suggests the overall state of the micro-environment for tumor growth. The 2D-TMAP of NSCLC regulates angiogenesis and tumor cell proliferation through a mesh-like structure, and better understanding of the characteristics and possible mechanism of 2D-TMAP expression can be of great clinical importance.

Adult ; Aged ; Capillaries ; ultrastructure ; Carcinoma, Non-Small-Cell Lung ; blood supply ; diagnostic imaging ; Female ; Humans ; Lung Neoplasms ; blood supply ; diagnostic imaging ; Male ; Middle Aged ; Tomography, Spiral Computed

BACKGROUND AND OBJECTIVEThe aim of this study is to explore the reproducibility of volume-based quantitative measurement of non-small cell lung cancer (NSCLC) perfusion at 64-slice CT.

METHODSFourteen patients with proved advanced NSCLC were enrolled in this dynamic first pass volume-based CT perfusion (CTP) study (8x5 mm collimation), and they underwent the second scan within 24 h. According to the longest diameters, those patients were classified to <3 cm and >3 cm groups, and each group had 7 patients. Intradclass correlation coefficient (ICC) and Bland-Altman statistics were used to evaluate the reproducibility of CTP imaging.

RESULTSIn both groups of advanced NSCLC, the reproducibility with BF, BV, and PS values were good (ICC > 0.75 for all), but mean transit time (MTT) values. For advanced NSCLC (<3 cm), repeatability coefficient (RC) values with blood flow (BF), blood volume (BV), MT and permeability surface area product (PS) values were 56%, 45%, 114%, and 78%, respectively, and the 95% change intervals of RC were -39%-53%, -29%-62%, -83%-145%, and -57%-98%, respectively. For advanced NSCLC (>3 cm), those values were 46%, 30%, 59%, and 33%, respectively, and the 95% change intervals of RC were -48%-45%, -33%-26%, -54%-64%, and -18%-48%.

CONCLUSIONThere is greater reproducibility of tumor size >3 cm than that of < or =3 cm. BF and BV could be addressed for reliable clinical application in antiangiogenesis therapeutic monitoring with advanced NSCLC patients.

Adult ; Aged ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; Male ; Middle Aged ; Reproducibility of Results ; Tomography, X-Ray Computed ; methods

Non-small cell lung cancer (NSCLC) accounts for about 85% of lung cancer, with a 5-year survival rate of less than 15%-19%, and more than 80% of the patients with lung cancer have progressed to advanced stage (Stage IIIb-IV) when they are clearly diagnosed. The comprehensive treatment mainly based on chemotherapy as the primary form is now considered as the major therapy method for advanced NSCLC without actionable driver gene mutations. Pemetrexed plus platinum doublet as well as single-agent pemetrexed are respectively the first-line major regimens recommended by guidelines and the second-line optional regimens. Yet the third-line treatment or beyond in advanced NSCLC is not evidence-based but conducted based on patients' previous medications, which is one of the most commonly used clinical methods. As pemetrexed is a multi-target chemotherapy drug with high efficiency but low toxicity, pemetrexed re-challenge strategy in advanced NSCLC is also a reasonable choice. We report one effective individual case that adopted pemetrexed re-challenge strategy in advanced NSCLC for three times, and at the same time conduct the relevant literature review.
Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; drug therapy ; Female ; Humans ; Lung Neoplasms ; diagnostic imaging ; drug therapy ; Middle Aged ; Pemetrexed ; administration & dosage ; Positron Emission Tomography Computed Tomography

Tumor-node-metastasis (TNM) staging system is the most important basis for making therapeutic decisions and predicting prognosis of lung cancer patients. The metabolic parameters including standardized uptake value (SUV), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by ¹⁸F-fluorodeoxyglucose-positron emission tomography (¹⁸F-FDG PET/CT) associate with tumor aggressiveness and can provide additional prognostic information. A new staging methodology combines the conventional cTNM with the metabolic tumor burden quantified from the PET images is a better predictor of overall survival with superior stratifying power may help oncologists to make better treatment plans. ¹⁸F-FDG PET/CT image texture analysis, as an emerging research tool, is used to quantify the spatial heterogeneity of radioactive uptake in tumors, thereby to explore the biological characteristics of the tumor. This article reviews developments in evaluating the ¹⁸F-FDG PET/CT metabolic parameters and its role as a prognostic factor for non-small cell lung cancer.
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Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; metabolism ; Fluorodeoxyglucose F18 ; Humans ; Image Processing, Computer-Assisted ; Lung Neoplasms ; diagnostic imaging ; metabolism ; Positron Emission Tomography Computed Tomography ; methods ; Prognosis

To develop a radiomics signature based on CT image features to estimate the expression level of Ki-67 in non-small cell lung cancer (NSCLC).
 Methods: A total of 108 NSCLC patients, who underwent non-enhanced and contrast-enhanced CT scan in our hospital from January 2014 to November 2017, were retrospectively analyzed. They were confirmed by histopathological examination and undergone Ki-67 expression level test within 2 weeks after CT examination. The non-enhanced and contrast-enhanced CT three-dimensional structural images of the lesions were manually delineated by MaZda software, and the texture features of the region of interest were extracted. Combination of feature selection and classification methods were used to build radiomics signatures, and the classification were assessed using misclassification rates. The MaZda software provides texture feature selection methods including mutual information (MI), Fisher coefficients (Fisher), classification error probability combined with average correlation coefficients (POE+ACC), and Fisher+POE+ACC+MI (FPM), and texture feature analysis including raw data analysis (RDA), principal component analysis (PCA), linear classification analysis (LDA) and nonlinear classification analysis (NDA).
 Results: Among the 108 patients, 50 cases were at high levels of Ki-67 expression and 58 cases were at low levels of Ki-67 expression, respectively. The differences of gender, age and pathological type between the two groups were statistically significant (P<0.05). The radiomics signature built by FPM feature selection combined with NDA feature analysis based on non-enhanced CT images achieved the best performance for predicting the level of Ki-67 with a misclassification rate of 14.81%. However, radiomics signature based on contrast-enhanced CT images did not reduce the misclassification rate.
 Conclusion: The radiomics signature based on conventional CT image texture features is helpful to predict the expression of Ki-67 in NSCLC lesions, which can provide a non-invasive technique for assessing the invasiveness and prognosis for NSCLC.
Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; Gene Expression Regulation, Neoplastic ; Humans ; Ki-67 Antigen ; genetics ; Lung Neoplasms ; diagnostic imaging ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed

OBJECTIVE: To validate the value of dual energy CT (DECT) in the differentiation of mediastinal metastatic lymph nodes from non-metastatic lymph nodes in non-small cell lung cancer (NSCLC). METHODS: In the study, 57 surgically confirmed NSCLC patients who underwent enhanced DECT scan within 2 weeks before operation were enrolled. Two radiologists analyzed the CT images before operation. All mediastinal lymph nodes with short diameter≥5 mm on axial images were included in this study. The morphological parameters [long-axis diameter (L), short-axis diameter (S) and S/L of lymph nodes] and the DECT parameters [iodine concentration (IC), normalized iodine concentration (NIC), slope of spectral hounsfield unit curve (λHU) and effective atomic number (Zeff) in arterial and venous phase] were measured. The differences of morphological parameters and DECT parameters between metastatic and non-metastatic lymph nodes were compared. The parameters with significant difference were analyzed by the Logistic regression model, then a new predictive variable was established. Receiver operator characteristic (ROC) analyses were performed for S, NIC in venous phase and the new predictive variable. RESULTS: In 57 patients, 49 metastatic lymph nodes and 938 non-metastatic lymph nodes were confirmed by surgical pathology. A total of 163 mediastinal lymph nodes (49 metastatic, 114 non-metastatic) with S≥5 mm were detected on axial CT images. The S, L and S/L of metastatic lymph nodes were significantly higher than those of non-metastatic lymph nodes (P < 0.05). The DECT parameters of metastatic lymph nodes were significantly lower than those of non-metastatic lymph nodes (P < 0.05). The best single morphological parameter for differentiation between metastatic and nonmetastatic lymph nodes was S (AUC, 0.752; threshold, 8.5 mm; sensitivity, 67.4%; specificity, 73.7%; accuracy, 71.8%). The best single DECT parameter for differentiation between metastatic and nonmetastatic lymph nodes was NIC in venous phase (AUC, 0.861; threshold, 0.53; sensitivity, 95.9%; specificity, 70.2%; accuracy, 77.9%). Multivariate analysis showed that S and NIC were independent predictors of lymph node metastasis. The AUC of combined S and NIC in the venous phase was 0.895(sensitivity, 79.6%; specificity, 87.7%; accuracy, 85.3%), which were significantly higher than that of S (P < 0.001) and NIC (P=0.037). CONCLUSIONS The ability of quantitative DECT parameters to distinguish mediastinal lymph node metastasis in NSCLC patients is better than that of morphological parameters. Combined S and NIC in venous phase can be used to improve preoperative diagnostic accuracy of metastatic lymph nodes.
Carcinoma, Non-Small-Cell Lung/diagnostic imaging* ; Humans ; Lung Neoplasms/diagnostic imaging* ; Lymph Nodes ; Lymphatic Metastasis ; Mediastinum ; Tomography, X-Ray Computed