Percutaneous needle biopsy in single lung patients.

The occurrence of complications such as pneumothorax after a transthoracic needle biopsy is well known. This event may be life threatening in patients with a single aerated lung, thus altering the risk/benefit assessment of the physician when considering whether to attempt an otherwise indicated biopsy. We review our results in 6 single-lung patients who underwent a transthoracic needle biopsy for pulmonary nodules.

CT screening for lung cancer: the value of short-term CT follow-up.

Background: Although CT screening for lung cancer results in a diagnosis of stage I > 80% of the time, benign noncalcified nodules are also found. We recognized that some nodules appeared to represent infectious bronchopneumonia or other inflammatory processes, as they resolved on follow-up CT, sometimes after antibiotic therapy. To determine the extent to which short-term CT radiographic follow-up might shorten the workup of nodules, we reviewed our experience with baseline and annual repeat CT screenings performed subsequent to the original Early Lung Cancer Action Project series.

On measuring the change in size of pulmonary nodules.

The pulmonary nodule is the most common manifestation of lung cancer, the most deadly of all cancers. Most small pulmonary nodules are benign, however, and currently the growth rate of the nodule provides for one of the most accurate noninvasive methods of determining malignancy. In this paper, we present methods for measuring the change in nodule size from two computed tomography image scans recorded at different times; from this size change the growth rate may be established.

Computed tomographic screening for lung cancer: the relationship of disease stage to tumor size.

Background: The relationship of lung cancer stage to tumor diameter has been identified as a prognostic indicator. We report on the stage-size relationship of these asymptomatic, latent lung cancer cases diagnosed by computed tomographic screening.

Methods: Baseline and repeat screening of 28 689 people following the International Early Lung Cancer Action Program regimen of screening has resulted in 464 diagnoses of lung cancer.

CT screening for lung cancer: significance of diagnoses in its baseline cycle.

Purpose: The aim of this study was to assess the significance of Stage I diagnoses of lung cancer in the baseline cycle of screening for this disease, with special reference to the potential for overdiagnosis.

Methods: We reviewed all 69 cases of Stage I lung cancer diagnosis resulting from our baseline CT screening. Among these 69 cases of lung cancer, 24 presented as solid, 30 as part-solid, and 15 as nonsolid nodules.

Bronchioloalveolar carcinoma in small pulmonary nodules: clinical relevance.

Increased use of chest computed tomography (CT) as well as improvements in CT resolution has led to increased detection of subcentimeter pulmonary nodules. Although the majority of these nodules are benign in etiology, a subset will harbor bronchioloalveolar carcinoma. The diagnosis of malignancy in this setting can be challenging to radiologists, surgeons, and occasionally pathologists as well.

CT screening for lung cancer: past and ongoing studies.

It has been widely recognized that the oft-quoted randomized clinical trials (RCTs) of lung cancer screening by chest radiography--studies that were interpreted as showing no benefit--were seriously flawed. We begin by describing the shortcomings of these trials and presenting an analysis of the problems typically encountered in performing RCTs in this area. Screening for lung cancer using computed tomography (CT) has shown that CT offers great superiority over chest radiography in diagnosing small lung cancers in the three studies that performed both CT and chest radiography on all patients.

Evolving concepts in the pathology and computed tomography imaging of lung adenocarcinoma and bronchioloalveolar carcinoma.

Purpose: To review recent advances in pathology and computed tomography (CT) of lung adenocarcinoma and bronchioloalveolar carcinoma (BAC).

Methods: A pathology/CT review panel of pathologists and radiologists met during a November 2004 International Association for the Study of Lung Cancer/American Society of Clinical Oncology consensus workshop in New York. The purpose was to determine if existing data was sufficient to propose modification of criteria for adenocarcinoma and BAC as newly published in the 2004 WHO Classification of Lung Tumors, and to address the pathologic/radiologic concept of diffuse/multicentric BAC.

Stage of lung cancer in relation to its size: part 2. Evidence.

Objective: To assess the relationship between tumor size and disease stage at the time of diagnosis in non-small cell lung cancer.

Methods: From the Surveillance, Epidemiology and End Results registry, we identified all cases of primary non-small cell lung cancer diagnosed prior to autopsy. Among these, we focused on 84,152 cases diagnosed in 1988 or later and documented as to tumor size and disease stage at diagnosis.

Thromboembolic disease detection at indirect CT venography versus CT pulmonary angiography.

Purpose: To assess the incremental increase in thromboembolic disease detection at indirect computed tomographic (CT) venography versus CT pulmonary angiography and to determine the importance of scan interval for indirect CT venography on the basis of thrombus length.

Materials And Methods: Institutional review board approval was obtained, and informed consent was not required. The study included 1590 consecutive patients undergoing CT pulmonary angiography for the suspicion of pulmonary embolism.

Lung cancer screening: simulations of effects of imperfect detection on temporal dynamics.

Purpose: To use a mathematic model to demonstrate effects of imperfect detection on temporal dynamics of radiologic lung cancer screening.

Materials And Methods: Monte Carlo simulations of lung cancer screening programs were performed in subjects at high risk for developing cancer. The effects of detection probabilities, symptomatic presentation of tumors, tumor volume doubling time, and time between screenings were examined.

Estimating the growth rates of primary lung tumours from samples with missing measurements.

A method to estimate the population variability in tumour growth rate using incomplete data was developed. We assume exponential growth and lognormal distribution for the parameter of the growth curve. Estimates of growth rate obtained based on the cases with two measurements, one of which is obtained retrospectively, are biased towards lower growth rate.

CT screening for lung cancer Assessing a regimen's diagnostic performance.

Purpose: The purpose of this study was to characterize the diagnostic performance of a regimen of CT screening for lung cancer.

Methods: Using a common protocol/regimen of screening, 2968 asymptomatic persons at high risk for lung cancer were enrolled in two studies [Early Lung Cancer Action Projects (ELCAP) I and II] for baseline and annual repeat screening. A total of 4538 annual repeat screenings were performed.

State-of-the-art screening for lung cancer: (part 2): CT scanning.

There have been dramatic improvements in technology in the past decade. In conjunction there have also been advances in our clinical knowledge that have led to changes in the screening regimen. These changes are expected to continue in the future as CT scanners continue to improve and knowledge about screening accumulates, and computer-assisted techniques are expected to play an ever more important role.

The effect of tumor size on curability of stage I non-small cell lung cancers.

Objective: The objective of this study was to determine the relationship between tumor size and curability of stage I non-small cell lung cancer.

Methods: From the Surveillance, Epidemiology, and End Results registry 2003, we identified all primary non-small cell lung cancer cases that were diagnosed prior to autopsy. Among these cases, we narrowed the focus to those diagnosed in 1988 or later, and to 7,620 patients who had undergone curative surgical resection.

Lung image database consortium: developing a resource for the medical imaging research community.

To stimulate the advancement of computer-aided diagnostic (CAD) research for lung nodules in thoracic computed tomography (CT), the National Cancer Institute launched a cooperative effort known as the Lung Image Database Consortium (LIDC). The LIDC is composed of five academic institutions from across the United States that are working together to develop an image database that will serve as an international research resource for the development, training, and evaluation of CAD methods in the detection of lung nodules on CT scans. Prior to the collection of CT images and associated patient data, the LIDC has been engaged in a consensus process to identify, address, and resolve a host of challenging technical and clinical issues to provide a solid foundation for a scientifically robust database.

Small pulmonary nodules: reproducibility of three-dimensional volumetric measurement and estimation of time to follow-up CT.

Purpose: To determine reproducibility of volume measurements of small pulmonary nodules on computed tomographic (CT) scans and to estimate critical time to follow-up CT.

Materials And Methods: One hundred fifteen pulmonary nodules for which two thin-section small-field-of-view CT scans were obtained and which were stable during 2-year observation were evaluated. A standard group of 94 nodules (with no or minimal artifact) and an expanded group of 105 nodules (including those with moderate artifacts) were examined.

Managing the small pulmonary nodule discovered by CT.

Objectives: To review the Early Lung Cancer Action Project experience and the medical literature from 1993 to 2003 on detection of the small, noncalcified pulmonary nodule by CT in order to formulate a management algorithm for these nodules.

Design: Prospective noncomparative study of smokers without prior malignancy and a review of the medical literature of CT screening of lung cancer.

Interventions: Chest CT and, where appropriate, CT observation for nodule growth, antibiotics, CT-guided fine-needle aspiration (FNA) biopsy, fiberoptic bronchoscopy, and video-assisted thoracoscopic surgery (VATS).

CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans.

Purpose: To assess the frequency with which a particular, possibly optimal work-up of noncalcified nodules less than 5.0 mm in diameter identified on initial computed tomographic (CT) images at baseline screening leads to a diagnosis of malignancy prior to first annual repeat screening, compared with a possibly optimal work-up of larger nodules.

Materials And Methods: Two series of baseline CT screenings in high-risk people were retrospectively reviewed.

Computerized tomography screening for lung cancer: new findings and diagnostic work-up.

On computerized tomography (CT) screening for lung cancer within the Early Lung Cancer Action Project, both at baseline and repeat screening, we found not only solid but also subsolid nodules, which unlike solid ones do not completely obscure the lung parenchyma. We established that subsolid nodules represent approximately 20% of the nodules shown on screening and that they have a higher frequency of malignancy than solid nodules. Although we found growth of solid nodules to be a reliable indicator of malignancy, growth of subsolid nodules was more difficult to assess.

Three-dimensional segmentation and growth-rate estimation of small pulmonary nodules in helical CT images.

Small pulmonary nodules are a common radiographic finding that presents an important diagnostic challenge in contemporary medicine. While pulmonary nodules are the major radiographic indicator of lung cancer, they may also be signs of a variety of benign conditions. Measurement of nodule growth rate over time has been shown to be the most promising tool in distinguishing malignant from nonmalignant pulmonary nodules.