Humans ; Printing ; methods ; ROC Curve ; Solitary Pulmonary Nodule ; pathology

The incidence and mortality of lung cancer rank first among all malignant tumors in China. With the popularization of high resolution computed tomography (CT) in clinic, chest CT has become an important means of clinical screening for early lung cancer and reducing the mortality of lung cancer. Imaging findings of early lung adenocarcinoma often show partial solid nodules with ground glass components. With the development of imaging, the relationship between the imaging features of some solid nodules and their prognosis has attracted more and more attention. At the same time, with the development of 3D-reconstruction technology, clinicians can improve the accuracy of diagnosis and treatment of such nodules.This article focuses on the traditional imaging analysis of partial solid nodules and the imaging analysis based on 3D reconstruction, and systematically expounds the advantages and disadvantages of both.
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Adenocarcinoma of Lung/pathology* ; Humans ; Image Processing, Computer-Assisted ; Lung Neoplasms/pathology* ; Solitary Pulmonary Nodule/pathology* ; Tomography, X-Ray Computed

BACKGROUND AND OBJECTIVESolitary pulmonary nodules (SPN) is a knotty problem in clinical work. The clinical manifestation and pathological features of SPN in sizes may be obviously different. The aim of this study is to analyze the relationship between the diameters and clinicopathologic characteristics of SPN.

METHODS390 patients (212 male, 178 female, ranging from 17 years to 86 years, median age 57.1 years) with SPN who were postoperatively diagnosed by pathology between Jan. 2000 and Jun. 2009 are enrolled to this study. In these cases, the number of SPN diameters which are smaller than 0.5 cm (including 0.5 cm) (group A) is 16, between 0.5 cm and 1 cm (including 1 cm, not including 0.5 cm) (group B) is 58, between 1 cm and 2 cm (group C) is 163, and between 2 cm and 3 cm (group D) is 153. The clinical manifestation, and postoperative pathological characters are analyzed in various diameter ranges.

RESULTSAll procedures were carried out securely, including tumor enucleation (n = 20), wedge resection (n = 153), lobectomy (n = 217). There are 130 benign cases (33.3%) and 260 malignant cases (66.7%). 58.5% SPN are detected incidently with no symptoms. There is an increasing incidence of clinical symptoms as the increasing diameter of SPN. All the cases are divided into 4 groups, the prevalence of malignant are separated 43.7% (group A), 50.0% (group B), 63.2% (group C), 79.1% (group D). The diameter of SPN is positively correlated with incidence of malignancy (chi2 = 22.535, P < 0.001). Single factor analysis and Logistic regression analysis show the diameter of SPN is an independent risk factor of malignant pathology (OR = 1.922, P < 0.001). Fourteen patients in all of the SPN were followed up by 2 years or more before operation, and 10 of them turn out to be malignant at last. In the 14 patients, 7 cases were found not enlarged by CT scan, and 3 of them (42.9%) were malignant.

CONCLUSIONThe diameter of SPN is highly associated with clinical symptoms, and is a significant risk factor to predict pathology. Early diagnosis and treatment is so important for patients with SPN.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Lung Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Solitary Pulmonary Nodule ; pathology ; surgery

Due to emphasis on early screening for lung cancer, the detection rate of multiple ground glass opacities (GGOs) on computed tomography (CT) image increases in recent years, and research on multifocal adenocarcinomas presented by GGOs has been thriving. It is more common in women and non-smokers and has excellent prognosis both in patients with natural history and after surgery. These clinical features suggest that it is likely to be a distinct disease entity. From the perspective of molecular genetics, lesions in the same individual are likely to have distinct clonal features. Therefore, genetic heterogeneity is the most prominent feature of multifocal pulmonary adenocarcinomas with GGOs. The genetic heterogeneity is expected to assist the diagnosis of multifocal pulmonary adenocarcinoma and intrapulmonary metastasis, and also suggests that genetic testing of the GGO lesions is of great therapeutic significance. Some GGO lesions may harvest the similar clonal feature, which provide new evidence for the theory of spread through air spaces (STAS).
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Adenocarcinoma ; diagnostic imaging ; genetics ; pathology ; Adenocarcinoma of Lung ; Humans ; Lung Neoplasms ; diagnostic imaging ; genetics ; pathology ; Retrospective Studies ; Solitary Pulmonary Nodule ; diagnostic imaging ; genetics ; pathology ; Tomography, X-Ray Computed

OBJECTIVE: We wanted to evaluate the usefulness of the computer-aided detection (CAD) system for detecting pulmonary nodules in real clinical practice by using the CT images. MATERIALS AND METHODS: Our Institutional Review Board approved our retrospective study with a waiver of informed consent. This study included 166 CT examinations that were performed for the evaluation of pulmonary metastasis in 166 patients with colorectal cancer. All the CT examinations were interpreted by radiologists and they were also evaluated by the CAD system. All the nodules detected by the CAD system were evaluated with regard to whether or not they were true nodules, and they were classified into micronodules (MN, diameter < 4 mm) and significant nodules (SN, 4 < or = diameter < or = 10 mm). The radiologic reports and CAD results were compared. RESULTS: The CAD system helped detect 426 nodules; 115 (27%) of the 426 nodules were classified as true nodules and 35 (30%) of the 115 nodules were SNs, and 83 (72%) of the 115 were not mentioned in the radiologists' reports and three (4%) of the 83 nodules were non-calcified SNs. One of three non-calcified SNs was confirmed as a metastatic nodule. According to the radiologists' reports, 60 true nodules were detected, and 28 of the 60 were not detected by the CAD system. CONCLUSION: Although the CAD system missed many SNs that are detected by radiologists, it helps detect additional nodules that are missed by the radiologists in real clinical practice. Therefore, the CAD system can be useful to support a radiologist's detection performance.
Colorectal Neoplasms/*pathology ; *Diagnosis, Computer-Assisted ; Female ; Humans ; Lung Neoplasms/*radiography/secondary ; Male ; Middle Aged ; Retrospective Studies ; Solitary Pulmonary Nodule/*radiography/secondary ; *Tomography, X-Ray Computed

We report a case of inadvertent hoarseness after surgery for primary pulmonary amyloidosis. A 55-year-old male was transferred to our facility due to a lung mass. Chest computed tomography revealed a solitary pulmonary nodule. Positron emission tomography-computed tomography showed fluorodeoxyglucose uptake in the main mass and in the mediastinal lymph nodes. To confirm the pathology of the mass, wedge resection and thorough lymph node dissection were performed via video-assisted thoracic surgery (VATS). No complications except for hoarseness were observed; hoarseness developed soon after surgery and lasted for 3 months. The main mass was diagnosed as amyloidosis, but this was not found in the lymph nodes. In conclusion, VATS wedge resection for peripheral amyloidosis is a feasible and safe procedure. However, mediastinal lymph node dissection is not recommended unless there is evidence of a clear benefit.
Amyloidosis* ; Electrons ; Hoarseness ; Humans ; Lung ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Diseases* ; Male ; Middle Aged ; Pathology ; Solitary Pulmonary Nodule ; Thoracic Surgery, Video-Assisted ; Thorax

OBJECTIVETo assess the value of (18)F-FDG PET/CT in the diagnosis of solitary nodular-type bronchoalveolar carcinoma (BAC).

METHODSThe clinical and radiographic data were analyzed retrospectively in 30 patients with pathologically confirmed solitary nodular-type BAC who underwent (18)F-FDG PET/CT examinations between August, 2005 and December, 2006. The morphological and radioactive findings of the lesions were reviewed, and the maximum standard uptake values (SUVmax) were measured. The diagnostic accuracy of PET, PET/CT, and HRCT were analyzed.

RESULTSThe (18)F-FDG SUV was markedly lower in BAC than in other well differentiated adenocarcinoma. In 19 of the BAC cases, PET showed a SUVmax of no less than 2.5, demonstrating positive changes. Of the total of 30 cases, 5 had ground glass opacity (GGO) changes, 3 exhibited mixed nodules with GGO changes around the lesions, and 22 cases presented with solid nodules. HRCT showed that BAC located often in the superior lobes of the bilateral lungs, mostly below the pleura in the surrounding lung field; the lesions were patchy or nodular with irregular shapes, showing lobulation in 22 cases, spiculation in 15 cases, pleural indentation in 21 cases, and vacuolar changes in 4 cases. The diagnostic accuracy of PET, PET/CT and HRCT for solitary nodular-type BAC was 36.67%, 93.33%, and 93.33%, respectively.

CONCLUSIONThe SUVmax of BAC provides only limited value for defining the nature of the lesions, but can serve as a general reference for assessing the disease activity. PET/CT, which allows both functional and imaging assessment, can be a valuable modality to reduce the misdiagnosis rate of BAC.

Carcinoma ; diagnosis ; Fluorodeoxyglucose F18 ; Humans ; Lung ; pathology ; Lung Neoplasms ; diagnosis ; Positron-Emission Tomography ; Retrospective Studies ; Solitary Pulmonary Nodule ; diagnosis ; Tomography, X-Ray Computed

OBJECTIVE: This study was designed to evaluate follow-up results in terms of patient prognosis for malignant pulmonary nodules depicted as pure ground-glass opacity (GGO) lesion observed at high-resolution CT (HRCT). MATERIALS AND METHODS: Surgical removal for malignant GGO nodules was accomplished in 58 patients (26 men, 32 women; mean age, 57 years; age range, 29-78 years). Patient prognoses were assessed by patient clinical status and the presence of changes in nodule size determined after a follow-up HRCT examination. Differences in patient prognoses were compared for nodule number, size, surgical method, change in size before surgical removal, and histopathological diagnosis by use of Fisher's exact test and Pearson's chi-squared test. RESULTS: Of the 58 patients, 40 patients (69%) were confirmed to have a bronchioloalveolar carcinoma (BAC) and 18 patients (31%) were confirmed to have an adenocarcinoma with a predominant BAC component. Irrespective of nodule size, number, treatment method, change in size before surgical removal and histopathological diagnosis, neither local recurrence nor a metastasis occurred in any of these patients as determined at a follow-up period of 24 months (range; 12-65 months). Of 14 patients with multiple GGO nodules, all of the nodules were resected without recurrence in six patients. In the remaining eight patients, the remaining nodules showed no change in size in seven cases and a decrease in size in one case as determined after a follow-up CT examination. CONCLUSION: Prognoses in patients with pure GGO malignant pulmonary nodules are excellent, and not significantly different in terms of nodule number, size, surgical method, presence of size change before surgical removal and histopathological diagnosis.
Adenocarcinoma/pathology/radiography/surgery ; Adenocarcinoma, Bronchiolo-Alveolar/pathology/radiography/surgery ; Adult ; Female ; Humans ; Lung Neoplasms/pathology/*radiography/surgery ; Male ; Middle Aged ; Multiple Pulmonary Nodules/pathology/*radiography/surgery ; Prognosis ; Solitary Pulmonary Nodule/pathology/*radiography/surgery ; *Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo explore the CT features of ground-glass nodules (GGN) including preinvasive lesions [atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS)], minimally invasive adenocarcinoma (MIA) and invasive adenocarcinoma (IAC).

METHODSNinety-seven GGN lesions confirmed by operation pathology were included in this study. The lesions were divided into three groups: preinvasive lesion group (24 cases), MIA group (39 cases), IAC group (34 cases). The lesion size, 3-dimensional ratio, 2-dimensional ratio in axial images, lesion density, shape, speculation, lobulation, air-containing space and pleural indentation on the preoperative CT images in the three groups were analyzed and compared with pathological results. The data were statistically analyzed using SPSS 17.0.

RESULTSAll preinvasive lesions presented as pure GGN on CT image, most showed round-like shape, clear and smooth border. MIA presented as pure GGN or mixed GGN on CT image, most showed round-like shape, with a clear and smooth border. IAC most presented as mixed GGN on CT image, often showed irregular shape. Speculation, lobulation, air-containing space and pleural indentation displayed gradually increasing from preinvasive lesions to MIA and IAC. There were statistically significant differences in lesion size, CT density, shape, air-containing space, speculation, pleural indentation and long diameter of solid component between the MIA and IAC groups (P < 0.05 for all). There were statistically significant differences in CT density values and long diameters of solid component of the lesions between the preinvasive lesion group and MIA group (P < 0.05). The AUC of solid component of the preinvasive lesion group and MIA group was 0.705, and that of the MIA and IAC groups was 0.814.

CONCLUSIONComprehensive analysis of the CT image features of GGNs, especially the solid component in the lesions, may help to the preoperative and differential diagnosis of preinvasive lesions, MIA and IAC.

Adenocarcinoma ; diagnostic imaging ; pathology ; Adult ; Aged ; Diagnosis, Differential ; Female ; Humans ; Hyperplasia ; Lung ; diagnostic imaging ; pathology ; Lung Neoplasms ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Neoplasm Invasiveness ; Precancerous Conditions ; diagnostic imaging ; pathology ; Solitary Pulmonary Nodule ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

OBJECTIVE: To investigate the relation between multi-slice spiral CT pulmonary perfusion imaging and the cavity of microvessel in lung cancer. METHODS: Altogether 36 patients with malignant nodules who underwent multi-slice spiral CT perfusion scan were examined.The perfusion parameters were collected and compared with the microvessel density (MVD), the incomplete lumen MVD, and the differentiation of non-small cell lung cancer (NSCLC). The patients were divided into a hyper-perfusion group and a hypo-perfusion group by the value of perfusion parameters. The maturity of microvessel and the degree of differentiation in NSCLC between the 2 groups was analyzed. RESULTS: Blood flow (BF), blood volume (BV), and peak enhancement image(PEI) of the malignant nodules were (39.7±11.5) mL/(100 mg.min), (8.6±3.8)mL/100 g, and (20.1±8.6)HU, respectively. There was a positive correlation between PEI and MVD(r=0.645,P<0.01), and a negative correlation between BF and MVD(r=-0.280,P=0.048). There were negative correlations of BF, BV, PEI with the incomplete lumen MVD (P<0.05). BF had the highest correlation coefficient(r=-0.882,P<0.01).The incomplete lumen MVD of the hyper-perfusion group was significantly lower than that of hypo-perfusion group (P<0.05),but there was no significant difference in MVD between the 2 groups. There were negative correlations of BF, BV,PEI with the degree of differentiation (P<0.05). BF had the highest correlation coefficient(r=-0.751,P<0.01). CONCLUSION Multi-slice spiral CT pulmonary perfusion imaging is helpful to evaluate the degree of differentiation and status of angiogenesis in lung cancer, and its basis is the cavity of microvessel.
Capillaries ; pathology ; Carcinoma, Non-Small-Cell Lung ; blood supply ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Female ; Humans ; Lung Neoplasms ; blood supply ; diagnostic imaging ; pathology ; Male ; Neovascularization, Pathologic ; diagnostic imaging ; Solitary Pulmonary Nodule ; blood supply ; diagnostic imaging ; pathology ; Tomography, Spiral Computed ; methods