Lung cancer ranks the first cancer-related morbidity and mortality in China. With the development and penetration of imaging technology, increasing small pulmonary peripheral Nodules (SPPNs) have been detected. However, precise location and diagnosis of SPPNs is still a tough problem for clinical diagnosis and treatment in department of thoracic surgery. With the development of electromagnetic navigation bronchoscopy (ENB), it provides a novel minimally invasive method for the diagnosis and treatment of SPPNs. In this review, we summarized the application and progress of ENB in preoperative positioning, diagnosis, and local treatment, then, discussed the clinical application of ENB in the hybrid operating room.
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Bronchoscopy/methods* ; Electromagnetic Phenomena ; Humans ; Lung Neoplasms/surgery* ; Multiple Pulmonary Nodules/diagnosis* ; Thoracic Surgery

Objective: To provide scientific evidence for early lung cancer screening, to analyze the incidence of pulmonary nodules among petroleum company staffs in Sichuan-Chongqing Area. Methods: In January 2021 , 6002 petroleum company staffs in Sichuan-Chongqing Area which scanned by low-dose spiral computed tomography (LDCT) of chest in medical examination center in 2020 were retrospectively collected as objects. Their imaging and clinical data were collected. χ(2) test was used to analyze the differences in the detection rates of lung nodules and suspected lung cancer nodules among workers in petroleum company staffs of different genders, ages and types of work. Results: Among the 6002 objects, 3853 (64.2%) were male and 2149 (35.8%) were female, with an average age of (47.25±12.13) years old. A total of 431 cases (7.2%) of pulmonary nodules and 57 cases (0.9%) of suspected lung cancer nodules were detected. 45 cases were followed up with surgical treatment, and 41 cases (91.1%) of lung cancer were diagnosed by postoperative pathology. There were significant differences in the detection rates of pulmonary nodules and suspected lung cancer nodules between different age groups (χ(2)=51.23, 18.81 , P<0.001). The detection rates of pulmonary nodules in the age groups 51-60 years old and ≥61 years old were higher than those in the age groups≤40 years old and 41-50 years old (P<0.05). The detection rate of suspected lung cancer nodules in the age group≥ 61 years old was higher than those in the age groups≤40 years old, 41-50 years old and 51-60 years old (P< 0.05) . And the detection rate of suspected lung cancer pulmonary nodules in oil workers was higher than that of ordinary workers (P<0.05) . Among female objects, the detection rate of pulmonary nodules in oil workers was higher than that in ordinary workers (χ(2)=8.09, P=0.004) . The detection rate of pulmonary nodules in oil workers aged ≥61 years old was higher than ordinary workers (χ(2)=37.94, P<0.001) . Among male objects, the detection rate of suspected lung cancer pulmonary nodules in oil workers was higher than that in ordinary workers (χ(2)=8.42, P=0.004) . The detection rates of suspected lung cancer pulmonary nodules in oil workers aged 51-60 years old and ≥61 years old groups were higher than those of ordinary workers (χ(2)=4.70, 8.74; P=0.030, 0.003) . Conclusion: LDCT is suitable for early lung cancer screening for petroleum company staffs. During the clinical screening process, LDCT should be used as a routine physical examination item for petroleum workers older than 51 years old.
Adult ; Early Detection of Cancer/methods* ; Female ; Humans ; Lung Neoplasms/diagnosis* ; Male ; Mass Screening/methods* ; Middle Aged ; Multiple Pulmonary Nodules/diagnostic imaging* ; Petroleum ; Retrospective Studies ; Tomography, Spiral Computed

BACKGROUND: The detection of pulmonary nodules is a key step to achieving the early diagnosis and therapy of lung cancer. Deep learning based Artificial intelligence (AI) presents as the state of the art in the area of nodule detection, however, a validation with clinical data is necessary for further application. Therefore, the aim of this study is to evaluate the performance of AI in the detection of malignant and non-calcified nodules in chest CT. METHODS: Two hundred chest computed tomography (CT) data were randomly selected from a self-built nodule database from Tianjin Medical University General Hospital. Both the pathology confirmed lung cancers and the nodules in the process of follow-up were included. All CTs were processed by AI and the results were compared with that of radiologists retrieved from the original medical reports. The ground truths were further determined by two experienced radiologists. The size and characteristics of the nodules were evaluated as well. The sensitivity and false positive rate were used to evaluate the effectiveness of AI and radiologists in detecting nodules. The McNemar test was used to determine whether there was a significant difference. RESULTS: A total of 889 non-calcified nodules were determined by experts on chest CT, including 133 lung cancers. Of them, 442 nodules were less than 5 mm. The cancer detection rates of AI and radiologists are 100%. The sensitivity of AI on nodule detection was significantly higher than that of radiologists (99.1% vs 43%, P<0.001). The false-positive rate of AI was 4.9 per CT and decreased to 1.5 when nodules less than 5 mm were excluded. CONCLUSIONS AI achieves the detection of all malignancies and improve the sensitivity of pulmonary nodules detection beyond radiologists, with a low false positive rate after excluding small nodules.
Artificial Intelligence ; Deep Learning ; Humans ; Lung Neoplasms ; diagnosis ; diagnostic imaging ; Multiple Pulmonary Nodules ; diagnosis ; diagnostic imaging ; Tomography, X-Ray Computed

BACKGROUND: Mathematical predictive model is an effective method for preliminarily identifying the malignant pulmonary nodules. As the epidemiological trend of lung cancer changes, the detection rate of ground-glass-opacity (GGO) like early stage lung cancer is increasing rapidly, timely and proper clinical management can effectively improve the patients' prognosis. Our study aims to establish a novel predictive model of malignancy for non-solid pulmonary nodules, which would provide an objective evidence for invasive procedure and avoid unnecessary operation and the consequences. METHODS: We retrospectively analyzed the basic demographics, serum tumor markers and imaging features of 362 cases of non-solid pulmonary nodule from January 2013 to April 2018. All nodules received biopsy or surgical resection, and got pathological diagnosis. Cases were randomly divided into two groups. The modeling group was used for univariate analysis and logistic regression to determine independent risk factors and establish the predictive model. Data of the validation group was used to validate the predictive value and make a comparison with other models. RESULTS: Of the 362 cases with non-solid pulmonary nodule, 313 (86.5%) cases were diagnosed as AAH/AIS, MIA or invasive adenocarcinoma, 49 cases were diagnosed as benign lesions. Age, serum tumor markers CEA and Cyfra21-1, consolidation tumor ratio value, lobulation and calcification were identified as independent risk factors. The AUC value of the ROC curve was 0.894, the predictive sensitivity and specificity were 87.6%, 69.7%, the positive and negative predictive value were 94.8%, 46.9%. The validated predictive value is significantly better than that of the VA, Brock and GMUFH models. CONCLUSIONS Proved with high predictive sensitivity and positive predictive value, this novel model could help enable preliminarily screening of "high-risk" non-solid pulmonary nodules before biopsy or surgical excision, and minimize unnecessary invasive procedure. This model achieved preferable predictive value, might have great potential for clinical application.
Adenocarcinoma ; blood ; diagnosis ; surgery ; Adult ; Aged ; Biomarkers, Tumor ; blood ; Carcinoembryonic Antigen ; blood ; Female ; Humans ; Logistic Models ; Lung Neoplasms ; blood ; diagnosis ; surgery ; Male ; Middle Aged ; Models, Theoretical ; Multiple Pulmonary Nodules ; blood ; diagnosis ; surgery ; Prognosis ; ROC Curve ; Retrospective Studies

Adrenal Cortex Hormones ; metabolism ; Adrenergic beta-2 Receptor Agonists ; metabolism ; Humans ; Multiple Pulmonary Nodules ; diagnosis ; metabolism ; pathology ; Pulmonary Disease, Chronic Obstructive ; diagnosis ; metabolism ; pathology ; World Health Organization

Pulmonary extraintestinal manifestation is rare in Crohn's disease and has been reported in only a few cases. Despite the presence of pulmonary abnormalities in a significant proportion of patients with inflammatory bowel disease, there are only few case reports, due to complicated diagnosis and low recognition by clinicians. Currently, treatment guidelines for pulmonary Crohn's disease have not been established. There are some case reports of pulmonary Crohn's disease that achieved remission after infliximab treatment. Clinical and radiological remission of pulmonary extraintestinal involvement in Crohn's disease after adalimumab therapy has not been reported yet. Here, we report one case of lung involvement of Crohn's disease, which shows radiological and clinical remission after adalimumab treatment.
Adalimumab* ; Crohn Disease* ; Diagnosis ; Humans ; Inflammatory Bowel Diseases ; Infliximab ; Lung ; Multiple Pulmonary Nodules

Sarcoidosis is a multi-organ disease with various clinical manifestations. The lung is the most common site of manifestation; however, unusual findings may delay the correct diagnosis of sarcoidosis. Here we report a case of 32-year-old man with 4-month history of neck mass. Radiological findings revealed multiple pulmonary parenchymal nodules, with initial biopsy results of his neck lymph node showing chronic granuloma with focal necrosis. The patient was treated with anti-tuberculosis medications, but the size of the nodules did not change. Biopsy was performed from one of his pulmonary nodules, which revealed chronic granuloma without necrosis. Therefore, the patient was diagnosed with sarcoidosis. We present a case of sarcoidosis with multiple lung parenchymal nodules that is uncommon in Korea, with an aim to alert physicians of such unusual presentations.
Adult ; Biopsy ; Diagnosis ; Granuloma ; Humans ; Korea ; Lung* ; Lymph Nodes ; Multiple Pulmonary Nodules ; Neck ; Necrosis ; Sarcoidosis*

The aim of this study was to propose an algorithm for three-dimensional projection onto convex sets (3D POCS) to achieve super resolution reconstruction of 3D lung computer tomography (CT) images, and to introduce multi-resolution mixed display mode to make 3D visualization of pulmonary nodules. Firstly, we built the low resolution 3D images which have spatial displacement in sub pixel level between each other and generate the reference image. Then, we mapped the low resolution images into the high resolution reference image using 3D motion estimation and revised the reference image based on the consistency constraint convex sets to reconstruct the 3D high resolution images iteratively. Finally, we displayed the different resolution images simultaneously. We then estimated the performance of provided method on 5 image sets and compared them with those of 3 interpolation reconstruction methods. The experiments showed that the performance of 3D POCS algorithm was better than that of 3 interpolation reconstruction methods in two aspects, i.e., subjective and objective aspects, and mixed display mode is suitable to the 3D visualization of high resolution of pulmonary nodules.
Algorithms ; Humans ; Imaging, Three-Dimensional ; Lung ; pathology ; Multiple Pulmonary Nodules ; diagnosis ; Tomography, X-Ray Computed

Cough ; etiology ; Female ; Hemangioendothelioma, Epithelioid ; complications ; diagnosis ; Humans ; Lung Neoplasms ; complications ; diagnosis ; Middle Aged ; Multiple Pulmonary Nodules ; etiology

Low-grade endometrial stromal sarcoma (ESS) is an uncommon gynecologic malignancy of mesodermal origin. Pulmonary metastasis of low-grade ESS can occur years and decades after the treatment of the primary disease. Low-grade ESS is frequently mistaken as benign uterine neoplasm like uterine leiomyoma, which can potentially lead to a misdiagnosis. We present a case of a 42-year-old woman with low-grade ESS, that initially presented as an incidental lung mass with multiple pulmonary nodules, seven years after an uterine myomectomy. A 6.9x5.8 cm-sized intrapelvic mass suspected of uterine origin was discovered while searching for potential extrathoracic primary origin. A pelviscopy and simultaneous thoracoscopic lung biopsy were conducted for pathologic diagnosis. Finally, the diagnosis was confirmed as low-grade ESS with lung metastasis based on the histopathologic examination with immunohistochemical stain, which was showed positive for CD10 and hormone receptor markers (estrogen and progesterone receptors) in both pelvic and lung specimens.
Adult ; Biopsy ; Diagnosis ; Diagnostic Errors ; Female ; Humans ; Leiomyoma ; Lung* ; Mesoderm ; Multiple Pulmonary Nodules* ; Neoplasm Metastasis ; Progesterone ; Sarcoma, Endometrial Stromal* ; Uterine Myomectomy ; Uterine Neoplasms