RESUMEN
OBJECTIVE: To investigate the detection of subsolid nodules (SSNs) on chest CT scans of outpatients before and during the COVID-19 pandemic, as well as to correlate the imaging findings with epidemiological data. We hypothesized that (pre)malignant nonsolid nodules were underdiagnosed during the COVID-19 pandemic because of an overlap of imaging findings between SSNs and COVID-19 pneumonia. METHODS: This was a retrospective study including all chest CT scans performed in adult outpatients (> 18 years of age) in September of 2019 (i.e., before the COVID-19 pandemic) and in September of 2020 (i.e., during the COVID-19 pandemic). The images were reviewed by a thoracic radiologist, and epidemiological data were collected from patient-filled questionnaires and clinical referrals. Regression models were used in order to control for confounding factors. RESULTS: A total of 650 and 760 chest CT scans were reviewed for the 2019 and 2020 samples, respectively. SSNs were found in 10.6% of the patients in the 2019 sample and in 7.9% of those in the 2020 sample (p = 0.10). Multiple SSNs were found in 23 and 11 of the patients in the 2019 and 2020 samples, respectively. Women constituted the majority of the study population. The mean age was 62.8 ± 14.8 years in the 2019 sample and 59.5 ± 15.1 years in the 2020 sample (p < 0.01). COVID-19 accounted for 24% of all referrals for CT examination in 2020. CONCLUSIONS: Fewer SSNs were detected on chest CT scans of outpatients during the COVID-19 pandemic than before the pandemic, although the difference was not significant. In addition to COVID-19, the major difference between the 2019 and 2020 samples was the younger age in the 2020 sample. We can assume that fewer SSNs will be detected in a population with a higher proportion of COVID-19 suspicion or diagnosis.
Asunto(s)
COVID-19 , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Adulto , Humanos , Femenino , Persona de Mediana Edad , Anciano , Neoplasias Pulmonares/patología , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/epidemiología , Nódulos Pulmonares Múltiples/patología , Pandemias , COVID-19/diagnóstico por imagen , COVID-19/epidemiología , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
INTRODUCTION: The study was designed to evaluate the frequency of detection and the characteristics of subsolid nodules (SSNs) in outpatients' chest computed tomography (CT) scans from a private hospital in Southern Brazil. METHODS: A retrospective analysis of all chest CT scans was performed in adult patients from ambulatory care (non-lung cancer screening population) over a thirty-day period. Inclusion criteria were age > 18 years and lung-scanning protocols, including standard-dose high-resolution chest CT (HRCT), enhanced CT, CT angiography, and low-dose chest CT (LDCT). SSNs main features collected were mean diameter, number, density (pure or heterogenous ground glass nodules and part-solid), and localization. TheLungRADS system and the updated Fleischner Society's pulmonary nodules recommendations were used for categorization only for study purposes, although not specifically fitting the population. The presence of emphysema, as well as calcified and solid nodules were also addressed. Statistical analysis was performed using R software, categorial variables are shown as absolute or relative frequencies, and continuous variables as mean and interquartile ranges. RESULTS: Chest computed tomography were performed in 756 patients during the study period (September 2019), and 650 met the inclusion criteria. The IQR for age was 53/73 years; most participants were female (58.3%) and 10.6% had subsolid nodules detected. CONCLUSIONS: The frequency of SSNs detection in patients in daily clinical practice, not related to screening populations, is not negligible. Regardless of the final etiology, follow-up is often indicated, given the likelihood of malignancy for persistent lesions.
Asunto(s)
Nódulos Pulmonares Múltiples , Pacientes Ambulatorios , Adulto , Humanos , Femenino , Persona de Mediana Edad , Masculino , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Nódulos Pulmonares Múltiples/diagnóstico por imagenRESUMEN
PURPOSE: To explore the application value of CT-guided localization using a coil in combination with medical adhesive in sublobar resection. METHODS: The clinical data of 90 patients who had small pulmonary nodules and received thoracoscopic sublobar resection during the period from September 2021 to October 2022 in the Department of Thoracic Surgery, Juxian People's Hospital, Shandong Province, were retrospectively analyzed. RESULTS: The diameters of 95 pulmonary nodules in the 90 patients in the whole group ranged from 0.40 to 1.24 cm, and their distances from the visceral pleura ranged from 0.51 to 2.15 cm. In these patients, percutaneous lung puncture was successfully performed under local anesthesia, through which coils were implanted in the nodules and medical adhesive was injected around the nodules, with a success rate of localization of 100%. Localization complications included 10 cases of asymptomatic pneumothorax, 9 cases of intrapulmonary hemorrhage, 5 cases of severe pain, and 1 case of pleural reaction, all of which required no special treatment. After preoperative localization, the success rate of resection of pulmonary nodules was 100%, and sufficient surgical margins were obtained. CONCLUSION: CT-guided localization using a coil in combination with medical adhesive is a safe, effective, and simple localization method that can meet the requirements of thoracic surgeons for intraoperative localization; for small pulmonary nodules, especially those small-sized and deep-located ground-glass nodules containing few solid mass, this method has important clinical application value, which is a preoperative localization technique worthy of wide application in clinical practice.
Asunto(s)
Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Nódulo Pulmonar Solitario , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/cirugía , Estudios Retrospectivos , Adhesivos , Nódulos Pulmonares Múltiples/cirugía , Tomografía Computarizada por Rayos X/métodosRESUMEN
Los nódulos pulmonares pueden ser variados: sólidos, en vidrio esmerilado; granulo matosos o no granulomatosos; cavitados o no cavitado. Son un hallazgo frecuente en las imágenes de tórax cuando el paciente llega a la consulta. Según sus características y en concordancia con los antecedentes del paciente (historia clínica, exámen físico y resultados de laboratorio) nos orienta a las distintas etiologías: infeccioso, autoinmune u oncológico. Sin embargo, muchas veces es un gran desafío clínico. Se presenta el caso de una paciente joven sin antecedentes que consulta por tos de 3 meses de evolución. En TC de tórax se evidencia masa mediastinal izquierda que desplaza tráquea y nódulos pulmonares bilaterales cavitados. Luego de descartarse etiologías más probables por frecuencia para su edad y forma de manifestación clínica, se arriba al diagnóstico de Linfoma de Hodgkin clásico Esclero Nodular con compromiso extranodal. Enfermedad poco frecuente y en nuestro caso, modo de presentación atípica.
Lung nodules can vary in nature: solid, ground glass, granulomatous or non-granulo matous, cavitary or non-cavitary. They are a common finding in chest imaging when the patient comes to the consultation. According to their characteristics and the patient's history (medical history, physical examination, and laboratory results), they guide us towards different etiologies: infectious, autoimmune, or oncological. However, many times it is a great clinical challenge. We present the case of a young patient with no previous medical history who came to the consultation with a cough of 3 months of evolution. The chest CT showed left mediastinal mass displacing the trachea and bilateral cavitary lung nodules. After ruling out more probable etiologies based on frequency for the patient's age and clinical manifestation, the diagnosis was: classic nodular sclerosing Hodgkin lymphoma with extranodal in volvement. A very rare disease, and in our case, with an atypical form of presentation.
Asunto(s)
Nódulos Pulmonares MúltiplesRESUMEN
Detection of pulmonary nodules on chest x-rays is an important task for radiologists. Previous studies have shown improved detection rates using gray-scale inversion. The purpose of our study was to compare the efficacy of gray-scale inversion in improving the detection of pulmonary nodules on chest x-rays for radiologists and machine learning models (ML). We created a mixed dataset consisting of 60, 2-view (posteroanterior view - PA and lateral view) chest x-rays with computed tomography confirmed nodule(s) and 62 normal chest x-rays. Twenty percent of the cases were separated for a testing dataset (24 total images). Data augmentation through mirroring and transfer learning was used for the remaining cases (784 total images) for supervised training of 4 ML models (grayscale PA, grayscale lateral, gray-scale inversion PA, and gray-scale inversion lateral) on Google's cloud-based AutoML platform. Three cardiothoracic radiologists analyzed the complete 2-view dataset (n=120) and, for comparison to the ML, the single-view testing subsets (12 images each). Gray-scale inversion (area under the curve (AUC) 0.80, 95% confidence interval (CI) 0.75-0.85) did not improve diagnostic performance for radiologists compared to grayscale (AUC 0.84, 95% CI 0.79-0.88). Gray-scale inversion also did not improve diagnostic performance for the ML. The ML did demonstrate higher sensitivity and negative predictive value for grayscale PA (72.7% and 75.0%), grayscale lateral (63.6% and 66.6%), and gray-scale inversion lateral views (72.7% and 76.9%), comparing favorably to the radiologists (63.9% and 72.3%, 27.8% and 58.3%, 19.5% and 50.5% respectively). In the limited testing dataset, the ML did demonstrate higher sensitivity and negative predictive value for grayscale PA (72.7% and 75.0%), grayscale lateral (63.6% and 66.6%), and gray-scale inversion lateral views (72.7% and 76.9%), comparing favorably to the radiologists (63.9% and 72.3%, 27.8% and 58.3%, 19.5% and 50.5%, respectively). Further investigation of other post-processing algorithms to improve diagnostic performance of ML is warranted.
Asunto(s)
Nódulos Pulmonares Múltiples , Radiografía Torácica , Humanos , Rayos X , Radiografía Torácica/métodos , Estudios Retrospectivos , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Redes Neurales de la Computación , RadiólogosRESUMEN
El cáncer pulmonar se establece como la segunda causa de muerte en países desarrollados y en algunos en vías de desarrollo. Su diagnóstico es tardío, sus opciones de resección y su curación aun con terapias adyuvantes son limitadas, lo que incide en la pobre sobrevida a 5 años, es por ello que se necesitan mayores esfuerzos para combatir el hábito del tabaco, principal agente etiológico. Material y Métodos: Se trata de un estudio descriptivo transversal en pacientes adultos atendidos de 01 de enero del 2011 al 31 de diciembre del 2021, ingresados al servicio de cirugía del Hospital San Vicente de Guatemala, con diagnósticos de cáncer pulmonar, masa pulmonar, derrame pleural o nódulo pulmonar solitario. Resultados: Se atendieron 202 pacientes con diagnósticos presuntivos de cáncer pulmonar, no encontrando diferencias significativas en relación al sexo. La edad mayormente afectada se estableció entre los 50 y 70 años. Prevalecieron los estadíos IIIA, IIIB y IV basados en los hallazgos clínicos, tomográficos y transoperatorios y solo al 10% se le sometió a una cirugía de resección pulmonar mayor. Los cánceres de células no pequeñas NSCLC fueron reportados en el 68.7% y el adenocarcinoma fue la variedad más frecuente con el 54.95% sobre el 7.29% del epidermoide. La mortalidad a los treinta días se estableció en 2.97%. Conclusión: El adenocarcinoma pulmonar ocupa el primer lugar en la incidencia de los cánceres pulmonares, desplazando así al carcinoma epidermoide popularizado desde la mitad del siglo pasado. Esta tendencia en el cambio histológico está firmemente asociado a las modificaciones en los hábitos del fumar (AU)
Lung cancer is established as the second cause of death in developed countries and in some developing ones. Its diagnosis is late, its resection options and its cure even with adjuvant therapies are limited, which affects the poor survival at 5 years, which is why greater efforts are needed to combat the tobacco habit, the main etiological agent. Material and Methods: This is a cross-sectional descriptive study in adult patients treated from January 1, 2011 to December 31, 2021, admitted to the surgery service of the Hospital San Vicente de Guatemala, with diagnoses of lung cancer, lung mass, effusion pleural or solitary pulmonary nodule. Results: 202 patients with presumptive diagnoses of lung cancer were treated, finding no significant differences in relation to sex and the most affected age was established between 50 and 70 years. Stages IIIA, IIIB, and IV prevailed based on clinical, tomographic, and intraoperative findings, and only 10% underwent major lung resection surgery. NSCLC non-small cell cancers were reported in 68.7% and adenocarcinoma was the most frequent variety with 54.95% over 7.29% of epidermoid. Thirty-day mortality was established at 2.97%. Conclusion: Pulmonary adenocarcinoma occupies the first place in the incidence of lung cancers, thus displacing squamous cell carcinoma popularized since the middle of the last century. This trend in histological change is strongly associated with changes in smoking habits.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adenocarcinoma del Pulmón/epidemiología , Histología/clasificación , Neoplasias Pulmonares/diagnóstico , Derrame Pleural/complicaciones , Broncoscopía/instrumentación , Técnicas y Procedimientos Diagnósticos , Nódulos Pulmonares Múltiples/diagnóstico por imagenRESUMEN
CASE PRESENTATION: A 72-year-old woman presented to our institution with gradually worsening shortness of breath and bilateral lower extremity edema of 3 weeks' duration. She had associated complaints of cough and intermittent hemoptysis. Her medical history was significant for hypertension and hypothyroidism. She was a former cigarette smoker with a 35 pack-year smoking history. She had no recent travel history and had a pet dog at home. Six months before the current hospitalization, evaluation for cough had revealed mediastinal lymphadenopathy at an outside institution. She underwent evaluation with an endobrachial ultrasound procedure at an outside facility 8 weeks before the current admission. The procedure demonstrated both acute and chronic inflammation, with one specimen showing few atypical cells on cytopathology and no growth on bacterial, fungal, and mycobacterial cultures. She was treated empirically with oral steroids for presumed sarcoidosis. However, this did not result in clinical benefit, and because of progressive symptoms, she presented to our institution.
Asunto(s)
Linfadenopatía , Nódulos Pulmonares Múltiples , Femenino , Humanos , Perros , Animales , Nódulos Pulmonares Múltiples/diagnóstico , Tos/diagnóstico , Diagnóstico Diferencial , Disnea/etiología , Disnea/diagnóstico , Linfadenopatía/diagnóstico por imagen , Linfadenopatía/etiologíaRESUMEN
Diffuse idiopathic hyperplasia of neuroendocrine cells is an extremely rare condition. It is a widespread proliferation of neuroendocrine cells, without primary process justifying it. Usually symptomatic in most cases, asymptomatic forms are also described. We describe three cases, 2 women and 1 man, average age 63 years (range 57-71) who presented with bilateral pulmonary nodules. Average follow-up: one year and three months (range 1 month-3 years). The two women had cough, progressive dyspnea and airflow obstruction in the spirometry, and were treated for asthma and chronic obstructive pulmonary disease, respectively, with little relief of symptoms. The remaining patient consulted for diagnosis of pulmonary nodules of unknown cause and a suspicion of metastatic disease. The biopsies diagnostic were: in the first and third case diffuse idiopathic hyperplasia of euroendocrine cells - tumorlets; and in the second case typical carcinoid tumor and diffuse idiopathic hyperplasia of neuroendocrine cells. The first patient controlled the symptoms with maximum bronchodilator therapy. The second patient presented immediate postoperative severe bronchospasm and respiratory failure which required ventilatory assistance, atrial fibrillation with rapid ventricular response (both signs interpreted as paraneoplastic syndromes) which responded favorably to the empirical octeotride management. The third patient is asymptomatic and in control. The diffuse neuroendocrine cell hyperplasia represents a diagnostic challenge because of the rarity of this condition. Lung biopsy in patients with multiple, bilateral pulmonary nodules and clinical history of cough and progressive dyspnea should be considered to confirm this entity.
La hiperplasia difusa idiopática de células neuroendocrinas es una entidad extremadamente infrecuente caracterizada por una proliferación generalizada de células neuroendocrinas, sin proceso primario que lo justifique, generalmente, aunque también están descriptas formas asintomáticas. Se describen los casos de dos mujeres y un hombre, edad promedio 63 años (rango 57-71) que consultaron por presentar nodulillos pulmonares bilaterales. Promedio de seguimiento: 1 año, 3 meses (rango 1 mes-3 años). Las dos mujeres presentaban tos, disnea progresiva y obstrucción al flujo aéreo en el estudio espirométrico, fueron tratadas por asma y enfermedad pulmonar obstructiva crónica respectivamente con poco alivio de los síntomas. El tercer paciente, varón, consultó por hallazgo incidental en una tomografía de tórax, de nódulos pulmonares, con razonable sospecha de enfermedad metastásica de origen desconocido. En sendas biopsias se diagnosticaron: en el primer y tercer caso hiperplasia neuroendócrina difusa idiopática-tumorlets; y en el segundo caso tumor carcinoide típico e hiperplasia neuroendocrina difusa idiopática. En el primer caso los síntomas se controlaron con tratamiento broncodilatador máximo. La segunda paciente tuvo en el postoperatorio, insuficiencia respiratoria que requirió asistencia respiratoria mecánica y fibrilación auricular con alta respuesta ventricular, interpretados ambos signos como síndromes paraneoplásicos, que respondieron favorablemente a la administración empírica de octeotride. El tercer paciente se halla asintomático y en control. La hiperplasia difusa de células neuroendócrinas representa un desafío diagnóstico. La biopsia pulmonar en pacientes con nodulillos pulmonares múltiples, bilaterales e historia clínica de tos y disnea progresiva debe ser considerada para confirmar esta entidad.
Asunto(s)
Tumor Carcinoide , Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Células Neuroendocrinas , Tumores Neuroendocrinos , Anciano , Tumor Carcinoide/patología , Femenino , Humanos , Hiperplasia/patología , Pulmón/diagnóstico por imagen , Pulmón/patología , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/patología , Células Neuroendocrinas/patología , Tumores Neuroendocrinos/patologíaRESUMEN
BACKGROUND: Adjuvant chemotherapy is indicated for patients with resectable stage II and IIIa non-small cell lung cancer. With the revised definition of T4 tumors with nodules in a different ipsilateral lobe, the survival advantage imparted by adjuvant chemotherapy has yet to be defined. We evaluated the role of adjuvant chemotherapy in patients with T4 disease characterized by additional tumor nodules in a different ipsilateral lobe treated with surgical resection. METHODS: We identified patients with T4 disease and additional tumor nodules in a different ipsilateral lobe treated with surgical resection alone or with adjuvant chemotherapy in the National Cancer Database between 2010 and 2016. The primary outcome was 3-year overall survival (OS). RESULTS: A total of 920 patients with T4 tumors and additional tumor nodules in a different ipsilateral lobe were identified. We excluded patients with lymph node metastases, tumors 4 cm or greater, and local invasion. Of the remaining 373 patients, 152 received surgery and adjuvant multiagent chemotherapy whereas 221 received surgery alone. When adjusted for patient, tumor, and treatment factors, the use of adjuvant chemotherapy was associated with improved 3-year OS compared with surgery alone (hazard ratio = 0.572; 95% confidence interval, 0.348-0.940; P = .03). CONCLUSIONS: Adjuvant chemotherapy in patients with T4 non-small cell lung cancer with additional tumor nodules in a different ipsilateral lobe is associated with improved 3-year OS. Accurate identification of T4 disease is important to define patients in whom adjuvant chemotherapy should be considered. Further prospective study is needed to delineate further the use of adjuvant chemotherapy for this patient population.
Asunto(s)
Antineoplásicos/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/terapia , Neoplasias Pulmonares/terapia , Pulmón/patología , Nódulos Pulmonares Múltiples/terapia , Estadificación de Neoplasias , Neumonectomía/métodos , Anciano , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Quimioterapia Adyuvante/métodos , Femenino , Estudios de Seguimiento , Humanos , Pulmón/cirugía , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidad , Masculino , Nódulos Pulmonares Múltiples/diagnóstico , Nódulos Pulmonares Múltiples/mortalidad , Estudios Prospectivos , Puerto Rico/epidemiología , Tasa de Supervivencia/tendencias , Factores de Tiempo , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: The frequency of cancer and accuracy of prediction models have not been studied in large, population-based samples of patients with incidental pulmonary nodules measuring > 8 mm in diameter. RESEARCH QUESTIONS: How does the frequency of cancer vary by size and smoking history among patients with incidental nodules? How accurate are two widely used models for identifying cancer in these patients? STUDY DESIGN AND METHODS: We assembled a retrospective cohort of individuals with incidental nodules measuring > 8 mm in diameter identified by chest CT imaging between 2006 and 2016. We used a validated natural language processing algorithm to identify nodules and their characteristics by scanning the text of dictated radiology reports. We reported patient and nodule characteristics stratified by the presence or absence of a lung cancer diagnosis within 27 months of nodule identification and estimated the area under the receiver operating characteristic curve (AUC) to compare the accuracy of the Mayo Clinic and Brock models for identifying cancer. RESULTS: The sample included 23,780 individuals with a nodule measuring > 8 mm, including 2,356 patients (9.9%) with a lung cancer diagnosis within 27 months of nodule identification. Cancer was diagnosed in 5.4% of never smokers, 12.2% of former smokers, and 17.7% of current smokers. Cancer was diagnosed in 5.7% of patients with nodules measuring 9 to 15 mm, 12.1% of patients with nodules > 15 to 20 mm, and 18.4% of patients with nodules > 20 to 30 mm. In the full sample, the Mayo Clinic model (AUC, 0.747; 95% CI, 0.737-0.757) was more accurate than the Brock model (AUC, 0.713; 95% CI, 0.702-0.724; P < .0001). When restricted to ever smokers, the Mayo Clinic model was still more accurate. Both models overestimated the probability of cancer. INTERPRETATION: Almost 10% of patients with an incidental pulmonary nodule measuring > 8 mm in diameter will receive a lung cancer diagnosis. Existing prediction models have only fair accuracy and overestimate the probability of cancer.
Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Nódulo Pulmonar Solitario , Tomografía Computarizada por Rayos X , Anciano , Femenino , Humanos , Hallazgos Incidentales , Masculino , Persona de Mediana Edad , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Valor Predictivo de las Pruebas , Probabilidad , Estudios Retrospectivos , Factores de Riesgo , Fumar/efectos adversos , Nódulo Pulmonar Solitario/diagnóstico por imagenRESUMEN
CASE PRESENTATION: A 57-year-old man with history of stage IIIB right-sided malignant pleural mesothelioma was admitted from his oncologist's office for progressive dyspnea of two weeks duration. He had associated dyspnea at rest and a new dry cough. He denied sputum production, hemoptysis, or fevers, but he did endorse chills, fatigue, and weight loss. The patient was a veteran of the Navy and had extensive international travel in his 20s. He had never been incarcerated and denied any sick contacts or recent travels. He had received a diagnosis of mesothelioma 11 months earlier after presenting to his physician's office with complaints of shortness of breath on exertion. Initial imaging revealed a large right-sided pleural effusion with irregular pleural thickening. He underwent right-sided thoracoscopy, and the pleural biopsy result was consistent with epithelioid mesothelioma. Because of invasion of his seventh rib, he was not a candidate for surgery and underwent palliative radiation and chemotherapy with cisplatin, pemetrexed, and bevacizumab. He was undergoing his eighth cycle of chemotherapy at the time of presentation.
Asunto(s)
Quimioradioterapia/métodos , Pulmón , Mesotelioma Maligno , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Metástasis de la Neoplasia/diagnóstico por imagen , Neoplasias Pleurales , Biopsia/métodos , Broncoscopía/métodos , Diagnóstico Diferencial , Progresión de la Enfermedad , Disnea/diagnóstico , Disnea/etiología , Resultado Fatal , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Mesotelioma Maligno/patología , Mesotelioma Maligno/fisiopatología , Mesotelioma Maligno/terapia , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Pleurales/patología , Neoplasias Pleurales/fisiopatología , Neoplasias Pleurales/terapia , Radiografía Torácica/métodos , Tomografía Computarizada por Rayos X/métodosRESUMEN
El cáncer de pulmón es la causa de muertes por cáncer por año más importante en Argentina. Según el Instituto Nacional de Cáncer fue responsable en 2019 de 10.662 muertes, lo que significa el 16% de las muertes por esa enfermedad en ambos sexos y el 19,2% del total de varones1-3. En el año 2018, 234.000 personas en Estados Unidos fueron diagnosticadas de cáncer de pulmón y ese mismo año 154.000 murieron a causa de dicho cáncer. La gran mayoría, 85% de los cánceres eran cáncer de pulmón no a células pequeñas, 10 a 15% eran a células pequeñas y menos del 5% eran tumores carcinoides de pulmón
Asunto(s)
Neoplasias Pulmonares , Nódulos Pulmonares Múltiples , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/diagnóstico por imagenRESUMEN
Resumen Introducción: Inspirado en el sistema BI-RADS (Breast Imaging Reporting), el American College of Radiology (ACR) desarrolló el sistema Lung-RADS, con la intención de realizar informes estandarizados sobre los nódulos pulmonares detectados en el En Argentina y en muchos lugares del mundo, no se realiza el Lung Cancer Screening (LCS) debido a los altos costos; sin embargo, en las TC de tórax los hallazgos incidentales de nódulos pulmonares, es frecuente. Para evaluarlos, existen diversos sistemas basados en caracte rísticas que permiten establecer un seguimiento. Entre ellos, Guía Fleischner, British Thoracic Society Guidelines y Lung-RADS, siendo este último el único que posee una categorización numérica. En este artículo se estudia la utilidad del Lung-RADS, como método de diagnóstico y seguimiento en la clasificación de los nódulos pulmonares. Objetivo: Evaluación del nódulo pulmonar diagnosticado en la TC de Tórax, mediante el uso del Lung-RADS para determinar su valor clínico, comparando la correlación entre esta clasificación y la malignidad o benignidad en el examen histopatológico. Material y Método: Estudio descriptivo, estadístico, observacional, retrospectivo y prospectivo.Se estudiaron un total de 100 pacientes adultos, de ambos sexos, con diagnóstico de nódulo pulmonar, comprendidos entre Enero del año 2017 hasta Diciembre del 2019, de los cuales se excluyeron aquellos que no tuvieron un seguimiento. Estudio tomográfico realizado en tomógrafo de 128 hileras de detectores. Las variables estudiadas incluyeron: sexo y edad de los pacientes, tamaño y densidad del nódulo, malignidad de la lesión en el estudio anatomopatológico, categoría del Lung-RADS y terapéutica realizada y sugerida. Para el análisis descriptivo, se utilizaron frecuencias relativas (porcentajes) y absolutas (número de casos) para las variables cualitativas; y para las variables cuantitativas se utilizó media y desvío estándar, y rango de valores mínimomáximo. Para las pruebas de hipótesis, se realizaron pruebas de Chi cuadrado para las variables cualitativas. Para las variables cuantitativas se realizaron, en primer lugar, pruebas de Shapiro Wilks y de Kolmogorov. Resultados: En 100 pacientes en los que se aplicó el Lung-RADS para determinar seguimiento y tratamiento, se identificaron diferentes tipos de escenarios tanto en el comportamiento como en el seguimiento de los mismos, algunos con necesidad de recategorización y cambios en conducta diagnóstica y tratamiento. En cuanto al análisis estadístico se analizó la asociación entre la Clasificación Lung- RADS obtenida y la presencia o ausencia de malignidad en el examen anatomopatológico obteniendo resultados estadísticamente significativos (p-valor <0,0001) para esta asociación. Discusión: Actualmente se utiliza en sistema Lung-RADS y las guías de recomendaciones de los nódulos pulmonares de la Sociedad Fleischner. Ambas tienen criterios similares y se basan en la sospecha morfológica de malignidad, que incluye la densidad del nódulo (sólido, parcialmente sólido o en vidrio esmerilado), tamaño y, cuando está disponible, el crecimiento o evolución, que se aplican en distintos grupos de pacientes. La determinación del puntaje Lung-RADS ha demostrado su utilidad en este estudio, dada la correlación patológica del nódulo, con resultado estadísticamente aceptable y buena correlación con la decisión de seguimiento y tratamiento. Conclusión: La aplicación del sistema Lung-RADS en serie ha demostrado un buen manejo de seguimiento de los mismos posibilitando, en algunos casos, la realización de resecciones quirúrgicas y, en otros, una conducta expectante con cierta seguridad evitando, en muchas oportunidades, la adopción de tratamientos agresivos innecesarios.
Asunto(s)
Nódulos Pulmonares Múltiples , Nódulos Pulmonares Múltiples/epidemiología , Nódulos Pulmonares Múltiples/diagnóstico por imagenRESUMEN
Abstract Introduction: Inspired by the BI-RADS system (Breast Imaging Reporting and Data System), the American College of Radiology (ACR) developed the Lung-RADS system, for the purpose of making standardized reports on lung nodules detected in lung cancer screening (LCS). In Argentina and in many other parts of the world the LCS is not performed due to high costs; however, in chest CT scans pulmonary nodules frequently appear as incidental findings. There are multiple systems to evaluate them based on a series of features that allow subsequent follow-up. Some of them are the Fleischner Guidelines, the British Thoracic Society Guidelines and the Lung-RADS system, the latter being the only one with numerical categorization. In this article we study the usefulness of the Lung- RADS, as a diagnostic, follow-up method for the classification of pulmonary nodules. Objective: Evaluation of the pulmonary nodule diagnosed on chest CT scan, using the Lung-RADS system to determine its clinical importance, comparing the correlation between this classification and the malignancy or benignancy in the histopathological examination. Material and Method: Descriptive, statistical, observational, retrospective and prospective study. A total of 100 adult patients, both men and women, with a diagnosis of pulmonary nodule were studied between January 2017 and December 2019. Patients without follow-up were excluded. Studies were performed with a 128-slice scanner. The variables under evaluation were: patients' sex and age, size and density of the nodule, malignancy of the lesion found in the anatomopathological study, Lung-RADS category and treatment performed and suggested. For the descriptive analysis we used relative frequencies (percentages) and absolute frequencies (number of cases) for qualitative variables; and mean and standard deviation as well as range of minimum-maximum values for the quantitative variables. For hypothesis tests, Chi-Square tests were performed for qualitative variables. For quantitative variables, Shapiro Wilks and Kolmogorov tests were performed. Results: In 100 patients in whom Lung-RADS was applied to determine follow-up and treatment, different types of scenarios could be identified regarding the approach and follow-up: some needed recategorization and changes in the diagnostic approach and treatment. As for the statistical analysis, we analyzed the association between the Lung-RADS classification obtained and the presence or absence of malignancy in the anatomopathological examination, and obtained statistically significant results (p-value <0.0001) for this association. Discussion: The Lung-RADS system and the Fleischner Society Guidelines on pulmonary nodules are used at present. Both have similar criteria and are based on the morphological suspicion of malignancy that includes the density of the nodule (solid, partially solid or ground-glass), the size and, when available, growth or evolution, which can be applied in different groups of patients. Determining the Lung-RADS score has proven its usefulness in this study, based on the pathological correlation of the nodule, with a statistically acceptable result and a good correlation with the treatment and follow-up decision. Conclusion: The application of the Lung-RADS system to this series of patients has shown a good management of patients' follow-up, with surgical resections in some cases and an expectant approach in others, providing certain security and mostly avoiding the use of unnecessary aggressive treatments.
Asunto(s)
Nódulos Pulmonares Múltiples , Nódulos Pulmonares Múltiples/epidemiología , Nódulos Pulmonares Múltiples/diagnóstico por imagenRESUMEN
INTRODUCCIÓN: Para facilitar la localización intraoperatoria de los nódulos pulmonares existe la alternativa de marcarlos previamente con lipiodol. OBJETIVO: Describir los resultados quirúrgicos de los pacientes sometidos a resección por videotoracoscopía de nódulos pulmonares marcados previamente con lipiodol. MATERIAL Y MÉTODOS: Estudio descriptivo. Se incluyeron los pacientes que fueron sometidos a resección por videotoracoscopía de nódulos pulmonares marcados con lipiodol, en Clínica Las Condes e Instituto Nacional del Tórax, entre junio de 2012 y junio de 2019. Se consideraron variables demográficas, radiológicas, quirúrgicas e histológicas. RESULTADOS: Se estudió un total de 93 pacientes. La edad promedio fue 63,5 (± 11,9) años. El tamaño promedio de los nódulos fue de 10,7 (± 5,8) mm. Se identificó y extrajo el 100% de los nódulos marcados. Los días de hospitalización promedio fueron 4,7 (± 6,9). Solo se registró un fallecimiento de causa no quirúrgica. CONCLUSIONES: La resección videotoracoscópica de nódulos pulmonares marcados previamente con lipiodol, es una técnica segura y eficaz.
BACKGROUND: To facilitate the intraoperative location of lung nodules there is the alternative of pre-marking them with lipiodol. OBJECTIVE: To describe the surgical results of patients undergoing videotoracoscopy resection of pulmonary nodules previously marked with lipiodol. MATERIAL AND METHODS: Descriptive study. Patients who underwent videotorcoscopy resection of pulmonary nodules marked with lipiodol were included at Clínica Las Condes and Instituto Nacional del Tórax between June 2012 and June 2019. Demographic, radiological, surgical and histological variables were considered. RESULTS: A total of 93 patients were studied. The average age was 63,5 (± 11.9) years. The average size of the nodules was 10.7 (± 5.8) mm. 100% of the marked nodules were identified and extracted. The average hospitalization days were 4.7 (± 6.9). Only one death of non-surgical cause was recorded. CONCLUSIONS: Videotoracoscopic resection of pulmonary nodules previously marked with lipiodol is a safe and effective technique.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Aceite Etiodizado , Cirugía Torácica Asistida por Video , Nódulos Pulmonares Múltiples/cirugía , Toracoscopía , Estudios Retrospectivos , Resultado del Tratamiento , Medios de Contraste , Nódulos Pulmonares Múltiples/patología , Nódulos Pulmonares Múltiples/diagnóstico por imagenRESUMEN
INTRODUCCIÓN: en la actualidad no existe un consenso respecto al manejo de los nódulos pulmonares subsólidos (NPSS). OBJETIVO: describir los resultados del manejo quirúrgico de los NPSS, basados en un algoritmo local. MATERIAL Y MÉTODOS: estudio descriptivo de corte transversal. Se revisaron las fichas clínicas electrónicas de los pacientes operados por NPSS, sugerentes de ser malignos, a juicio de un equipo multidisciplinario, entre enero de 2014 y enero de 2018, en el Departamento de Cirugía de Adultos de Clínica Las Condes. RESULTADOS: se estudió un total de 35 pacientes. La edad promedio fue de 65,8 años. El tamaño promedio de los nódulos fue de 15 mm. Todos los pacientes fueron abordados por cirugía videotoracoscópica asistida. El 88,6% de las biopsias demostró la presencia de una neoplasia maligna. CONCLUSIONES: la adopción de un algoritmo local, instituido por un equipo multidisciplinario, es una alternativa para el manejo adecuado de los portadores de NPSS.
BACKGROUND: Nowadays, there is no consensus in the management of pulmonary subsolid nodules (SSNs). AIM: describe the results of surgical management of SSNs, based on institutional algorithm. MATERIAL AND METHODS: cross-sectional, descriptive study, with revision of clinical electronic records, that included all patients intervened for SSNs, suggestive of malignancy, by the judgment of a multi-disciplinary team, from January 2014 to January 2018 at the Department of Adult Surgery, Clinica Las Condes. RESULTS: 35 patients were studied. The average age was 65.8 years. The average size of the nodules was 15 mm. All patients were approached by video-assisted thoracoscopic surgery. 88.6% of biopsies turned out to be malignant neoplasm. CONCLUSIONS: the acquisition of a local algorithm established by a multidisciplinary team is an appropriate alternative for the management of the patients with SSNs.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Nódulos Pulmonares Múltiples/cirugía , Algoritmos , Análisis de Supervivencia , Estudios Transversales , Estudios de Seguimiento , Cirugía Torácica Asistida por Video , Nódulos Pulmonares Múltiples/mortalidad , Nódulos Pulmonares Múltiples/diagnóstico por imagenRESUMEN
CASE PRESENTATION: A 44-year-old woman was referred for evaluation of dyspnea on exertion and multiple nodular opacities on a chest CT scan. She had a medical history of autoimmune encephalitis, diabetes mellitus, hypertension, migraines, and allergic rhinitis. Ten years earlier, the patient was admitted to an outside institution with symptoms of shortness of breath. She was found to have multiple pulmonary nodules and was diagnosed empirically with and treated for sarcoidosis. She was told that her pulmonary nodules had improved on follow up. However, she continued to have symptoms of dyspnea. Due to progressive symptoms of shortness of breath, she was referred to pulmonology. She reported a weight gain of 80 pounds over the last year. She denied fever, chills, hemoptysis, night sweats, joint swelling, or skin rash. She is a former cigarette smoker with a 15 pack-year smoking history, quit smoking in 2005. She denied alcohol or drug use. She resided in Arkansas and Texas over the past decade. She previously worked as a teacher and is currently unemployed. She had no other relevant exposures. She denied a family history of autoimmune diseases or malignancies.
Asunto(s)
Disnea/etiología , Predicción , Neoplasias Pulmonares/complicaciones , Pulmón/diagnóstico por imagen , Linfoma de Células B de la Zona Marginal/complicaciones , Nódulos Pulmonares Múltiples/etiología , Adulto , Biopsia , Diagnóstico Diferencial , Progresión de la Enfermedad , Disnea/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/diagnóstico , Linfoma de Células B de la Zona Marginal/diagnóstico , Nódulos Pulmonares Múltiples/diagnósticoRESUMEN
OBJECTIVE: to report the preoperative localization of pulmonary nodules with the placement of a guidewire oriented by Computed Tomography. METHODS: the nodules were marked using a needle in the shape of a hook or another in the shape of a Q, guided by tomography. The choice of the location for the marking was the shortest distance from the chest wall to the nodule. The marking procedure was performed under local anesthesia and a tomographic control was obtained immediately at the end. Patients were referred to the operating room. Surgical resection occurred less than two hours after the needle placement. RESULTS: between February 2017 and October 2019, 22 patients aged 43 to 82 years (mean 62.1) were included. The nodules had diameters that varied from 4 to 30 mm and the distance between the nodules and the pleural surface varied from 2 to 43 mm. The location and resection of the nodules were successfully performed in all cases. The guidewire was displaced in five cases. Five patients presented pneumothorax, with the space between the visceral and parietal pleura varying from 2 to 19 mm. In nine patients, an intraparenchymal hematoma of 6 to 35 mm in length was observed without signs, symptoms, or hemodynamic and ventilatory repercussions. The histopathological study was conclusive in all patients. CONCLUSIONS: the localization of pulmonary nodules through guidewires proved to be safe, reliable, and feasible in this series of cases. There was no need for surgical intervention to treat complications.