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[PMID]:29192886
[Au] Autor:Zhang W; Song Y; Chen Y; Ma J; Sun J; Zhao J
[Ti] Título:Limited-Range Few-View CT: Using Historical Images for ROI Reconstruction in Solitary Lung Nodules Follow-up Examination.
[So] Source:IEEE Trans Med Imaging;36(12):2569-2577, 2017 Dec.
[Is] ISSN:1558-254X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Repeated CT scans are known to increase the risk of cancer; thus, it is paradoxical to use multiple follow-up CT scans to monitor the development of a lung nodule and conduct early treatment of the nodule. In the case of a solitary lung nodule, regional scanning and region of interest (ROI) reconstruction are likely to restore the internal area at the nodule. A limited-range few-view CT is proposed in this paper for lung nodule follow-ups with extremely reduced X-radiation. For a planned scanning of an ROI, where a solitary lung nodule is positioned, a limited-range few-view CT can be employed, and thus, less tissue is exposed to X-radiation per view. An ROI reconstruction method is also proposed that makes full use of the former standard lung scan. The experimental results show that the nodule size and shape are preserved. In the case of a 40-mm ROI, the number of exposed X-rays can be reduced by 99.6% for a circular scan and 99.9% for a 3-D scan.
[Mh] Termos MeSH primário: Processamento de Imagem Assistida por Computador/métodos
Neoplasias Pulmonares/diagnóstico por imagem
Interpretação de Imagem Radiográfica Assistida por Computador/métodos
Nódulo Pulmonar Solitário/diagnóstico por imagem
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Algoritmos
Seres Humanos
Dose de Radiação
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1109/TMI.2017.2766101


  2 / 3402 MEDLINE  
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[PMID]:29267317
[Au] Autor:Hassan T; Thiberville L; Hermant C; Lachkar S; Piton N; Guisier F; Salaun M
[Ad] Endereço:Department of Respiratory Care, Thoracic Oncology, and Respiratory Intensive Care & CIC-CRB U1404, Rouen University Hospital, Rouen, France.
[Ti] Título:Assessing the feasibility of confocal laser endomicroscopy in solitary pulmonary nodules for different part of the lungs, using either 0.6 or 1.4 mm probes.
[So] Source:PLoS One;12(12):e0189846, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Malignant solitary pulmonary nodules (SPN) have become more prevalent, with upper lobes predilection. Probe-based confocal laser endomicroscopy (pCLE) provides in-vivo imaging of SPN. However, the stiffness of the 1mm confocal probe (AlveoFlex) causes difficult accessibility to the upper lobes. A thinner 600µm probe designed for bile duct exploration (CholangioFlex) has the potential to reach the upper lobes. OBJECTIVES: To examine the accessibility of malignant SPNs in all segments of the lungs using either the 0.6mm or 1.4 mm probe and to assess the quality and inter observer interpretation of SPN confocal imaging obtained from either miniprobes. METHODS: Radial(r)-EBUS was used to locate and sample the SPN. In-vivo pCLE analysis of the SPN was performed using either CholangioFlex (apical and posterior segments of the upper lobes) or AlveoFlex (other segments) introduced into the guide sheath before sampling. pCLE features were compared between the two probes. RESULTS: Fourty-eight patients with malignant SPN were included (NCT01931579). The diagnostic accuracy for lung cancer using r-EBUS coupled with pCLE imaging was 79.2%. All the SPNs were successfully explored with either one of the probes (19 and 29 subjects for CholangioFlex and AlveoFlex, respectively). A specific solid pattern in the SPN was found in 30 pCLE explorations. Comparison between the two probes found no differences in the axial fibers thickness, cell size and specific solid pattern in the nodules. Extra-alveolar microvessel size appeared larger using CholangioFlex suggesting less compression effect. The kappa test for interobserver agreement for the identification of solid pattern was 0.74 (p = 0.001). CONCLUSION: This study demonstrates that pCLE imaging of SPNs is achievable in all segments of both lungs using either the 0.6mm or 1.4mm miniprobe.
[Mh] Termos MeSH primário: Microscopia Confocal/métodos
Nódulo Pulmonar Solitário/patologia
[Mh] Termos MeSH secundário: Idoso
Estudos de Viabilidade
Feminino
Seres Humanos
Masculino
Microscopia Confocal/instrumentação
Meia-Idade
Variações Dependentes do Observador
Projetos Piloto
Alvéolos Pulmonares/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189846


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[PMID]:28466009
[Au] Autor:Han G; Liu X; Soomro NQ; Sun J; Zhao Y; Zhao X; Zhou C
[Ad] Endereço:Beijing Key Laboratory of Intelligent Information Technology, School of Computer Science and Technology, Beijing Institute of Technology, Beijing, China.
[Ti] Título:Empirical Driven Automatic Detection of Lobulation Imaging Signs in Lung CT.
[So] Source:Biomed Res Int;2017:3842659, 2017.
[Is] ISSN:2314-6141
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Computer-aided detection (CAD) of lobulation can help radiologists to diagnose/detect lung diseases easily and accurately. Compared to CAD of nodule and other lung lesions, CAD of lobulation remained an unexplored problem due to very complex and varying nature of lobulation. Thus, many state-of-the-art methods could not detect successfully. Hence, we revisited classical methods with the capability of extracting undulated characteristics and designed a sliding window based framework for lobulation detection in this paper. Under the designed framework, we investigated three categories of lobulation classification algorithms: template matching, feature based classifier, and bending energy. The resultant detection algorithms were evaluated through experiments on LISS database. The experimental results show that the algorithm based on combination of global context feature and BOF encoding has best overall performance, resulting in 1 score of 0.1009. Furthermore, bending energy method is shown to be appropriate for reducing false positives. We performed bending energy method following the LIOP-LBP mixture feature, the average positive detection per image was reduced from 30 to 22, and 1 score increased to 0.0643 from 0.0599. To the best of our knowledge this is the first kind of work for direct lobulation detection and first application of bending energy to any kind of lobulation work.
[Mh] Termos MeSH primário: Neoplasias Pulmonares/diagnóstico por imagem
Pulmão/diagnóstico por imagem
Nódulo Pulmonar Solitário/diagnóstico por imagem
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Seres Humanos
Pulmão/fisiopatologia
Neoplasias Pulmonares/diagnóstico
Neoplasias Pulmonares/patologia
Reconhecimento Automatizado de Padrão
Intensificação de Imagem Radiográfica
Interpretação de Imagem Radiográfica Assistida por Computador
Nódulo Pulmonar Solitário/diagnóstico
Tórax/diagnóstico por imagem
Tórax/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1155/2017/3842659


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[PMID]:29298331
[Au] Autor:Burgard CA; Gaass T; Bonert M; Bondesson D; Thaens N; Reiser MF; Dinkel J
[Ad] Endereço:Department of Clinical Radiology, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany.
[Ti] Título:Detection of artificial pulmonary lung nodules in ultralow-dose CT using an ex vivo lung phantom.
[So] Source:PLoS One;13(1):e0190501, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To assess the image quality of 3 different ultralow-dose CT protocols on pulmonary nodule depiction in a ventilated ex vivo-system. MATERIALS AND METHODS: Four porcine lungs were inflated inside a dedicated chest phantom and prepared with n = 195 artificial nodules (0.5-1 mL). The artificial chest wall was filled with water to simulate the absorption of a human chest. Images were acquired with a 2x192-row detector CT using low-dose (reference protocol with a tube voltage of 120 kV) and 3 different ULD protocols (respective effective doses: 1mSv and 0.1mSv). A different tube voltage was used for each ULD protocol: 70kV, 100kV with tin filter (100kV_Sn) and 150kV with tin filter (150kV_Sn). Nodule delineation was assessed by two observers (scores 1-5, 1 = unsure, 5 = high confidence). RESULTS: The diameter of the 195 detected artificial nodules ranged from 0.9-21.5 mm (mean 7.84 mm ± 5.31). The best ULD scores were achieved using 100kV_Sn and 70 kV ULD protocols (4.14 and 4.06 respectively). Both protocols were not significantly different (p = 0.244). The mean score of 3.78 in ULD 150kV_Sn was significantly lower compared to the 100kV_Sn ULD protocol (p = 0.008). CONCLUSION: The results of this experiment, conducted in a realistic setting show the feasibility of ultralow-dose CT for the detection of pulmonary nodules.
[Mh] Termos MeSH primário: Modelos Animais de Doenças
Imagens de Fantasmas
Dose de Radiação
Nódulo Pulmonar Solitário/diagnóstico por imagem
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Animais
Interpretação de Imagem Radiográfica Assistida por Computador
Suínos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180206
[Lr] Data última revisão:
180206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190501


  5 / 3402 MEDLINE  
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[PMID]:29173763
[Au] Autor:Wang X; Leader JK; Wang R; Wilson D; Herman J; Yuan JM; Pu J
[Ad] Endereço:Department of Radiology, Peking University Third Hospital, Beijing, China.
[Ti] Título:Vasculature surrounding a nodule: A novel lung cancer biomarker.
[So] Source:Lung Cancer;114:38-43, 2017 Dec.
[Is] ISSN:1872-8332
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To investigate whether the vessels surrounding a nodule depicted on non-contrast, low-dose computed tomography (LDCT) can discriminate benign and malignant screen detected nodules. MATERIALS AND METHODS: We collected a dataset consisting of LDCT scans acquired on 100 subjects from the Pittsburgh Lung Screening study (PLuSS). Fifty subjects were diagnosed with lung cancer and 50 subjects had suspicious nodules later proven benign. For the lung cancer cases, the location of the malignant nodule in the LDCT scans was known; while for the benign cases, the largest nodule in the LDCT scan was used in the analysis. A computer algorithm was developed to identify surrounding vessels and quantify the number and volume of vessels that were connected or near the nodule. A nonparametric receiver operating characteristic (ROC) analysis was performed based on a single nodule per subject to assess the discriminability of the surrounding vessels to provide a lung cancer diagnosis. Odds ratio (OR) were computed to determine the probability of a nodule being lung cancer based on the vessel features. RESULTS: The areas under the ROC curves (AUCs) for vessel count and vessel volume were 0.722 (95% CI=0.616-0.811, p<0.01) and 0.676 (95% CI=0.565-0.772), respectively. The number of vessels attached to a nodule was significantly higher in the lung cancer group 9.7 (±9.6) compared to the non-lung cancer group 4.0 (±4.3) CONCLUSION: Our preliminary results showed that malignant nodules are often surrounded by more vessels compared to benign nodules, suggesting that the surrounding vessel characteristics could serve as lung cancer biomarker for indeterminate nodules detected during LDCT lung cancer screening using only the information collected during the initial visit.
[Mh] Termos MeSH primário: Vasos Sanguíneos/diagnóstico por imagem
Neoplasias Pulmonares/diagnóstico por imagem
Pulmão/diagnóstico por imagem
Neovascularização Patológica/diagnóstico por imagem
Nódulo Pulmonar Solitário/irrigação sanguínea
Nódulo Pulmonar Solitário/diagnóstico por imagem
[Mh] Termos MeSH secundário: Idoso
Algoritmos
Biomarcadores Tumorais
Vasos Sanguíneos/crescimento & desenvolvimento
Vasos Sanguíneos/patologia
Detecção Precoce de Câncer/métodos
Feminino
Seres Humanos
Pulmão/patologia
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Neovascularização Patológica/patologia
Interpretação de Imagem Radiográfica Assistida por Computador
Estudos Retrospectivos
Nódulo Pulmonar Solitário/patologia
Tomografia Computadorizada por Raios X/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers, Tumor)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:29173759
[Au] Autor:Zanon M; Pacini GS; de Souza VVS; Marchiori E; Meirelles GSP; Szarf G; Torres FS; Hochhegger B
[Ad] Endereço:Department of Clinical Medicine, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050170, Brazil; Medical Imaging Research Lab, LABIMED, Department of Radiology, Pavilhão Pereira Filho Hospital, Irmandade Santa Casa de Misericórdia de Porto Alegre, Av. I
[Ti] Título:Early detection of lung cancer using ultra-low-dose computed tomography in coronary CT angiography scans among patients with suspected coronary heart disease.
[So] Source:Lung Cancer;114:1-5, 2017 Dec.
[Is] ISSN:1872-8332
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To assess whether an additional chest ultra-low-dose CT scan to the coronary CT angiography protocol can be used for lung cancer screening among patients with suspected coronary artery disease. METHODS: 175 patients underwent coronary CT angiography for assessment of coronary artery disease, additionally undergoing ultra-low-dose CT screening to early diagnosis of lung cancer in the same scanner (80kVp and 15mAs). Patients presenting pulmonary nodules were followed-up for two years, repeating low-dose CTs in intervals of 3, 6, or 12 months based on nodule size and growth rate in accordance with National Comprehensive Cancer Network guidelines. RESULTS: Ultra-low-dose CT identified 71 patients with solitary pulmonary nodules (41%), with a mean diameter of 5.50±4.00mm. Twenty-eight were >6mm, and in 79% (n=22) of these cases they were false positive findings, further confirmed by follow-up (n=20), resection (n=1), or biopsy (n=1). Lung cancer was detected in six patients due to CT screening (diagnostic yield: 3%). Among these, four cases could not be detected in the cardiac field of view. Most patients were in early stages of the disease. Two patients diagnosed at advanced stages died due to cancer complications. The addition of the ultra-low-dose CT scan represented a radiation dose increment of 1.22±0.53% (effective dose, 0.11±0.03mSv). CONCLUSIONS: Lung cancer might be detected using additional ultra-low-dose protocols in coronary CT angiography scans among patients with suspected coronary artery disease.
[Mh] Termos MeSH primário: Angiografia por Tomografia Computadorizada/métodos
Doença das Coronárias/diagnóstico por imagem
Detecção Precoce de Câncer/métodos
Neoplasias Pulmonares/diagnóstico por imagem
Tórax/diagnóstico por imagem
Tomografia Computadorizada por Raios X/métodos
[Mh] Termos MeSH secundário: Idoso
Doença das Coronárias/complicações
Doença das Coronárias/patologia
Feminino
Seres Humanos
Neoplasias Pulmonares/patologia
Masculino
Programas de Rastreamento
Meia-Idade
Nódulos Pulmonares Múltiplos/diagnóstico por imagem
Nódulos Pulmonares Múltiplos/epidemiologia
Prevalência
Estudos Prospectivos
Dose de Radiação
Nódulo Pulmonar Solitário/diagnóstico por imagem
Nódulo Pulmonar Solitário/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:28470104
[Au] Autor:Belanger AR; Akulian JA
[Ad] Endereço:Division of Pulmonary and Critical Care, Section of Interventional Pulmonology, University of North Carolina at Chapel Hill, NC, USA.
[Ti] Título:An update on the role of advanced diagnostic bronchoscopy in the evaluation and staging of lung cancer.
[So] Source:Ther Adv Respir Dis;11(5):211-221, 2017 05.
[Is] ISSN:1753-4666
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Lung cancer remains a common and deadly disease. Many modalities are available to the bronchoscopist to evaluate and stage lung cancer. We review the role of bronchoscopy in the staging of the mediastinum with convex endobronchial ultrasound (EBUS) and discuss emerging role of esophageal ultrasonography as a complementary modality. In addition, we discuss advances in scope technology and elastography. We review the bronchoscopic methods available for the diagnosis of peripheral lung nodules including radial EBUS and navigational bronchoscopy (NB) with a consideration of the basic methodologies and diagnostic accuracies. We conclude with a discussion of the comparison of the various methodologies.
[Mh] Termos MeSH primário: Broncoscopia/métodos
Endossonografia/métodos
Neoplasias Pulmonares/diagnóstico
[Mh] Termos MeSH secundário: Técnicas de Imagem por Elasticidade/métodos
Seres Humanos
Neoplasias Pulmonares/patologia
Mediastino
Estadiamento de Neoplasias
Nódulo Pulmonar Solitário/diagnóstico
Nódulo Pulmonar Solitário/patologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180110
[Lr] Data última revisão:
180110
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1177/1753465817695981


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[PMID]:29195577
[Au] Autor:Wu G; Consunji M; Nelson RA; Yeung K; Sun C; Kim JY; Raz DJ
[Ad] Endereço:Division of Thoracic Surgery, City of Hope, Duarte, California. Electronic address: geena.wu@mihs.org.
[Ti] Título:Perspectives on Managing Solitary Pulmonary Nodules: A Survey of Primary Care Physicians.
[So] Source:Semin Thorac Cardiovasc Surg;29(3):391-405, 2017 Autumn.
[Is] ISSN:1532-9488
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Primary care physicians (PCPs) may be involved in the evaluation of solitary pulmonary nodules (SPNs) detected through lung cancer screening. Little is known about their perspectives on the management or the referral of SPN. Using the American Medical Association's Physician Masterfile, we randomly surveyed 1384 PCPs between January and October 2015 with an 18% response rate. A subset analysis was performed on SPN management and referral practices of PCP. These results and those relating to practice characteristics were compared between family practice and internal medicine physicians. Responders and nonresponders did not differ by demographic characteristics. A total of 137 (55.5%) PCPs reported feeling confident in managing the workup of imaging-detected SPN. However, only 53 PCPs (21.3%) were inclined to manage the evaluation and follow-up of SPN. There was no significant difference between family practice and internal medicine physicians with regard to years in practice, size of practice, or referral to specialists. Family practitioners and internists similarly disagreed or were neutral to self-managing SPN (P = 0.60). Internists were twice as likely to express confidence as family practitioners (odds ratio 1.95, 95% confidence interval 1.09-3.48). Among all PCPs, 75.4% would refer management of these patients to a pulmonologist, 28.9% to a surgeon, and 24.2% to an oncologist. Confidence did not predict lung cancer screening practices. Although more than half of PCPs expressed confidence in the workup of SPN, most preferred referral to specialists. Additional research is needed to understand barriers to PCP management of incidental SPN in the effort to facilitate lung cancer screening.
[Mh] Termos MeSH primário: Neoplasias Pulmonares/terapia
Médicos de Atenção Primária
Padrões de Prática Médica
Avaliação de Processos (Cuidados de Saúde)
Nódulo Pulmonar Solitário/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Atitude do Pessoal de Saúde
Competência Clínica
Feminino
Pesquisas sobre Serviços de Saúde
Conhecimentos, Atitudes e Prática em Saúde
Disparidades em Assistência à Saúde
Seres Humanos
Modelos Logísticos
Neoplasias Pulmonares/diagnóstico por imagem
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Razão de Chances
Médicos de Atenção Primária/psicologia
Encaminhamento e Consulta
Nódulo Pulmonar Solitário/diagnóstico por imagem
Nódulo Pulmonar Solitário/patologia
Especialização
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171226
[Lr] Data última revisão:
171226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171203
[St] Status:MEDLINE


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[PMID]:27776726
[Au] Autor:Migliaro M; Ballard DH; Takalkar A; Thomas-Ogunniyi JO; Previgliano CH; Gonzalez-Toledo E
[Ad] Endereço:Department of Surgery, Louisiana State University Health Shreveport, Shreveport, Louisiana.
[Ti] Título:Synchronous Primary Lung Cancer With Adenocarcinoma and Squamous Cell Carcinoma in the Right Upper Lobe.
[So] Source:Am J Med Sci;352(4):427, 2016 Oct.
[Is] ISSN:1538-2990
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Adenocarcinoma/diagnóstico por imagem
Carcinoma de Células Escamosas/diagnóstico por imagem
Neoplasias Pulmonares/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adenocarcinoma/complicações
Carcinoma de Células Escamosas/complicações
Feminino
Seres Humanos
Neoplasias Pulmonares/complicações
Meia-Idade
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
Radiografia Torácica
Fumar
Nódulo Pulmonar Solitário/complicações
Nódulo Pulmonar Solitário/diagnóstico por imagem
Perda de Peso
[Pt] Tipo de publicação:CASE REPORTS; LETTER
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171218
[Lr] Data última revisão:
171218
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


  10 / 3402 MEDLINE  
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[PMID]:28746152
[Au] Autor:Predina JD; Newton AD; Keating J; Barbosa EM; Okusanya O; Xia L; Dunbar A; Connolly C; Baldassari MP; Mizelle J; Delikatny EJ; Kucharczuk JC; Deshpande C; Kularatne SA; Low P; Drebin J; Singhal S
[Ad] Endereço:*Center for Precision Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA †Division of Thoracic Surgery, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA ‡Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA §Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA ¶Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA ||Pathology and Laboratory Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA **Department of Chemistry, and Purdue Institute for Drug Discovery, Purdue University, West Lafayette, IN ††On Target Laboratories, West Lafayette, IN.
[Ti] Título:Intraoperative Molecular Imaging Combined With Positron Emission Tomography Improves Surgical Management of Peripheral Malignant Pulmonary Nodules.
[So] Source:Ann Surg;266(3):479-488, 2017 09.
[Is] ISSN:1528-1140
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine if intraoperative molecular imaging (IMI) can improve detection of malignant pulmonary nodules. BACKGROUND: 18-Fluorodeoxyglucose positron emission tomography (PET) is commonly utilized in preoperative assessment of patients with solid malignancies; however, false negatives and false positives remain major limitations. Using patients with pulmonary nodules as a study model, we hypothesized that IMI with a folate receptor targeted near-infrared contrast agent (OTL38) can improve malignant pulmonary nodule identification when combined with PET. METHODS: Fifty patients with pulmonary nodules with imaging features suspicious for malignancy underwent preoperative PET. Patients then received OTL38 before pulmonary resection. During resection, IMI was utilized to evaluate known pulmonary nodules and identify synchronous lesions. Tumor size, PET standardized uptake value, and IMI tumor-to-background ratios were compared for known and synchronous nodules via paired and unpaired t tests, when appropriate. Test characteristics of PET and IMI with OTL38 were compared. RESULTS: IMI identified 56 of 59 (94.9%) malignant pulmonary nodules identified by preoperative imaging. IMI located an additional 9 malignant lesions not identified preoperatively. Nodules only detected by IMI were smaller than nodules detected preoperatively (0.5 vs 2.4 cm; P < 0.01), but displayed similar fluorescence (tumor-to-background ratio 3.3 and 3.1; P = 0.50). Sensitivity of IMI and PET were 95.6% and 73.5% (P = 0.001), respectively; and positive predictive values were 94.2% and 89.3%, respectively (P > 0.05). Additionally, utilization of IMI clinically upstaged 6 (12%) subjects and improved management of 15 (30%) subjects. CONCLUSIONS: These data suggest that combining IMI with PET may provide superior oncologic outcomes for patients with resectable lung cancer.
[Mh] Termos MeSH primário: Adenocarcinoma/diagnóstico por imagem
Cuidados Intraoperatórios/métodos
Neoplasias Pulmonares/diagnóstico por imagem
Imagem Molecular/métodos
Pneumonectomia
Tomografia por Emissão de Pósitrons/métodos
Nódulo Pulmonar Solitário/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adenocarcinoma/cirurgia
Adulto
Idoso
Meios de Contraste
Feminino
Fluordesoxiglucose F18
Seres Humanos
Neoplasias Pulmonares/cirurgia
Masculino
Meia-Idade
Projetos Piloto
Cuidados Pré-Operatórios
Compostos Radiofarmacêuticos
Sensibilidade e Especificidade
Nódulo Pulmonar Solitário/cirurgia
Espectroscopia de Luz Próxima ao Infravermelho
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Nm] Nome de substância:
0 (Contrast Media); 0 (Radiopharmaceuticals); 0Z5B2CJX4D (Fluorodeoxyglucose F18)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171214
[Lr] Data última revisão:
171214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1097/SLA.0000000000002382



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