Objective To observe the value of residual neural network(ResNet)-101-feature pyramid network(FPN)model based on CT for differentiating benign and malignant lung nodules.Methods Totally 2 040 lung nodules in 2 000 patients were retrospectively enrolled,including 1 150 benign and 890 malignant nodules.The nodules were divided into training set(n=1 632)and test set(n=408)at the ratio of 8∶2,the former including 881 benign and 751 malignant ones,while the latter including 269 benign and 139 malignant ones,respectively.Taken ResNet-101 as the backbone network,combined with FPN,a classification model was established based on chest CT,and the efficiency of this model alone and combined with evaluation of physicians for differentiating benign and malignant lung nodules were evaluated.Results Among 269 benign lung nodules in test set,ResNet-101-FPN model alone correctly diagnosed 214 nodules(214/269,79.55%),while combined with evaluation of physicians correctly diagnosed 230 ones(230/269,85.50%).For 139 malignant nodules in test set,ResNet-101-FPN model alone correctly diagnosed 124 nodules(124/139,89.21%),while combined with evaluation of physicians correctly diagnosed 131 ones(131/139,94.24%).The sensitivity,accuracy and precision of ResNet-101-FPN model combined with evaluation of physicians for distinguishing benign and malignant lung nodules were all higher,while the specificity of the combination was lower than those of ResNet-101-FPN model alone,but the differences were not significant(all P＞0.05).Conclusion ResNet-101-FPN model could be used to distinguish benign and malignant lung nodules based on CT.Combining with evaluation of physicians could improve diagnostic efficiency of this model.

"The Expert Group on Tumor Ablation Therapy of Chinese Medical Doctor Association, The Tumor Ablation Committee of Chinese College of Interventionalists, The Society of Tumor Ablation Therapy of Chinese Anti-Cancer Association and The Ablation Expert Committee of the Chinese Society of Clinical Oncology" have organized multidisciplinary experts to formulate the consensus for thermal ablation of pulmonary subsolid nodules or ground-glass nodule (GGN). The expert consensus reviews current literatures and provides clinical practices for thermal ablation of GGN. The main contents include: (1) clinical evaluation of GGN, (2) procedures, indications, contraindications, outcomes evaluation and related complications of thermal ablation for GGN and (3) future development directions.
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Objective To investigate the CT-guided percutaneous irreversible electroporation (IRE) in treating locally advanced pancreatic cancer (LAPC) and providing guidance for its prevention and treatment. Methods We retrospectively analyzed the clinical and imaging data of 17 patients (17 lesions) of LAPC treated with CT-guided IRE in our hospital from July 2015 to June 2016. Complications were documented and reviewed at day 7,30 and 90 follow up as well as during the procedure. The Clavien?Dindo was used for classification. The reasons that induced complications were summarized and to further discuss the prevention and treatment approaches. Results Of 17 patients, 2 patients suffered a transient tachycardia during the procedure. Eleven patients (65%) showed complications at day 7, of which gradeⅠcomplications occurred in 6 cases, including abdominal pain, nausea, vomiting, or a few of inflammatory exudations around the pancreas; four patients have grade Ⅱ complications, along with portal vein thrombosis;one patient showed grade Ⅲ a complications for retroperitoneal infection. With 30 days follow up, the grade Ⅰ complications disappeared, gradeⅡcomplications have not getting better, while grade Ⅲ a complications have been improved. With 90 days follow up,patients with grade Ⅲ a complications getting better; two patients with grade Ⅱ complications didn't show any changes;2 cases progressed to grade Ⅴ, and died of digestive tract bleeding at 82 days and 98 days after procedure. Conclusion CT-guided irreversible electroporation for treating LAPC is a safe ablation approach. Strict patient selection before procedure and make a reasonable prevention and treatment measures can reduce the complications.

Objective To investigate the complications caused by CT-guided percutaneous radiofrequency ablations (RFA) for lung cancer and analyze the prevention approach. Methods A total of 125 lung cancer patients (142 RFA treatments) in our hospital were enrolled in this study between July 2015 and June 2017. This retrospective study analyzed the reasons and the strategies for preventing the complications. Results One hundred and twenty?five patients underwent RFA treatment for lung lesions. All the operations were successfully completed. During the treatment, 18 patients showed hemorrhage (3 of CTCAE grade 3 hemorrhage); 16 patients showed pneumothorax, among which, 15 patients have chronic obstructive pulmonary disease; 28 patients showed chest pain (23 cases were located under the pleura); 3 patients showed pneumonia;1 patient showed pulmonary abscess, which located in the subpleural space with a maximum diameter of ＞3 cm; 1 patient showed pulmonary embolism, and 1 patient with scald. Complications were attenuated after symptomatic treatment. Conclusion The main reasons of complications of RFA in treating lung cancer were direct injuries caused by punctures, tumors with abundant blood supplement, tumors adjacent to pleura, low scores of lung function, coagulation disorders, and diabetes. The key points for avoiding and reducing complications are preoperative evaluation of patients' basic situations, exclusion of intraoperative avoidable technical risk factors.

Nanoknife (irreversible electroporation) has demonstrated to be a safe and effective approach to tumor ablation,and plays a prominent role in application of treatment of pancreatic carcinoma,specifically locally advanced pancreatic carcinoma (LAPC).The complicated parameters of Nanoknife comparatively is still difficult.The advantage,optimal selection,adequate parameters regarding Nanoknife were reviewed in this article.

Image-guided minimally invasive treatments play an increasingly important role in clinical works.With the progressing of science and technology,image-guided robot technology are mature gradually.It can accomplish parts of clinical minimally invasive treatments,and make up for the deficiencies in the process of surgery.Present situation and application in minimally invasive treatments of image-guided robot system were reviewed in this article.

Objective To explore the efficacy of percutaneous nucleus pulposus atherectomy combined with ozone injection in treatment of lumbar disc herniation.Methods A total of 60 patients with lumbar disc herniation were randomly divided into 3 groups:20 patients were treated by ozone injection (group A),20 patients were treated by percutaneous atherectomy (group B),20 patients were treated by percutaneous atherectomy combined with ozone injection (group C).The changes of visual analogue scale (VAS) and clinical effects in three groups pre-and 1 week,1 month and 3 month postoperation were compared.Intraoperative and postoperative complications were analyzed.Results The VAS of postoperation in three groups were significantly lower than those of preoperation (all P＜0.017).The short term and long term VAS of group C were lower than those of group A and group B (all P＜0.017).But there was no statistically significant difference among three groups of recent and long-term excellent rates (all P＞0.017).related complications were mainly waist pain,lower limb soreness and pain.Conclusion Percutaneous nucleus pulposus atherectomy combined with ozone injection is a safe and effective method,which can improve the curative effect of operation.

Objective To explore the application value of coaxial semi automatic biopsy gun in the biopsy of small pulnonary nodules.Methods A retrospective analysis was performed on 40 patients with small pulmonary nodules who underwent CT guided percutaneous pulmonary nodules biopsy.Taking postoperative pathology diagnosis or imaging follow-up results as gold standard,the accuracy,specificity,sensitivity,intraoperative complications and puncture techniques of biopsy were analyzed.Results All operations were successfully completed.There were 29 malignant lesions and 11 benign lesions confirmed by postoperative pathology diagnosis or imaging follow-up results.The sensitivity,specificity,accuracy rate of puncture biopsy in diagnosis of malignant small pulmonary nodules was 89.65％ (26/29),100％ (11/11),92.50％ (37/40).The main complications were pneumothorax and local hemorrhage.Conclusion Percutaneous biopsy of small pulmonary nodules using coaxial semi-automatic biopsy gun has high accuracy,specificity and sensitivity,is a safe and effective method.

Objective To study the safety and effectiveness of modified radioactive 125I seed implantation in treatment of lung cancer patients with poor lung function. Methods Thirty one lung cancer patients with poor lung function were enrolled into this study. All of them were implanted 125I seed with technology of fan-shaped distribution and coaxial puncture. Brachytherapy planning system(TPS) was used to draw up a preoperative implantation plan. Fan-shaped seed distribution system was used to simulate surgical program, and implantation pitch was 0.5 to 1.0 cm. Real-time adjustment is necessary during surgery. Dose distributions were checked by TPS immediately after implantation. Match peripheral dose(MPD),the dose of 90% tumor volume(D90)and the tumor volume covered by 90% prescription dose(D90)were calculated. Intraoperative and postoperative surgery-related complications were analyzed. All patients were followed up to 6 months, at month 2, 4 and 6 post-procedure, CT scan was performed to evaluate the local control rate of tumors. Results The technical success rate was 100% for placement of the 125I seed. MPD of the tumors was 90 to 140 Gy. D90 was 95 to 146 Gy,median dose was 118 Gy.V90 was 92%to 97%,median dose was 94%. Surgery-related complications included pulmonary hemorrhage(1 patient), pleural cavity hemorrhage (2 patients), pneumothorax(2 patients). The 2-month, 4-month and 6-monthlocal control rates were 31%(10/32), 78%(25/32) and 90%(29/32)respectively. The overall complete remission(CR) rate was18%(6/32), partial response(PR) rate was 72%(23/32), stable disease(SD)rate was6%(2/32), progression disease(PD) rate was 3%(1/32).Acute radiation pneumonitis Grade 0 in 29 patients, Grade Ⅰin 4 patients; advanced radiation pneumonitis:grade 0 in 30 patients and gradeⅠin 3 patients. Conclusions The technology of fan-shaped distribution and coaxial puncture for radioactive 125I seed implantation was safe and effective to treat lung cancer patients with poor lung function.

Objective To investigate the safety and efficacy of treatment with CT-guided percutaneous irreversible electroporation (IRE) of locally advanced pancreatic cancer(LAPC). Methods Patients with unresectable radiographic stage ⅢLAPC were prospectively collected. Comprehensive blood and imaging (CT,MRI,PET-CT) baseline examinations were completed and analyzed preoperatively. Operations were performed under general anesthesia and the needles were inserted under the guidance of CT. Ablative parameters were altered depending on the tumor size, anatomical location, and the number of electrodes. Needle withdrawal combined segmental ablation was chosen and the active electrode exposure length was 1 cm. All the imaging and serological follow-up examinations were performed within 1 to 3 days after procedures, at day 7 postoperatively, 1 and 3 months postoperatively to evaluate the safety and efficacy of IRE(according to modified response evaluation criteria in solid tumours of WHO). Results All the procedures were completed successfully. Immediately postoperative CT and/or MRI images showed all the ablation areas were well-defined and presented low-density necrosis without enhancement. The CT scans at day 7 postoperatively showed all the 14 lesions were drastically necrotized and the surrounding tissues were unharmed. CT and/or MRI scans at 1 month postoperatively revealed hypodense or low signal ablation areas without enhancement and the peritumoral and involved vessels and pancreatic duct were undamaged. All the patients had a CA199 transient rising, but it decreased progressively within 3 days and then markedly decreased at 1 weak and 1 month postoperatively. The laboratory carcino-embryonic antigen was almost within normal lists. Peripancreatic exudation was noted in 3 cases immediately after the procedures. One patient developed retroperitoneal infection. Mesenteric(2 of 4)and portal(2 of 4)venous thrombosis were found on MRI images in 4 patients. One patient had a duodenum stenosis and 1 died from serious gastrointestinal bleeding 2.5 months after IRE(unclear etiopathogenisis). The postoperative 3 months dynamic imaging showed that 4 of 13 reached complete response (CR) ,7 of 13 reached partial response (PR) and 2 of 13 had stable disease (SD). Conclusion CT-guided percutaneous IRE is safe and effective in patients with locally advanced pancreatic cancer.