Abstract Lung cancer is the leading cause of cancer-related deaths worldwide, with invasive non-mucinous adenocarcinoma (INMA) being the most common type and carrying a poor prognosis. In 2020, the International Association for the Study of Lung Cancer (IASLC) pathology committee proposed a new histological grading system, which offers more precise prognostic assessments by combining the proportions of major and high-grade histological patterns. Accurate identification of lung INMA grading is crucial for clinical diagnosis, treatment planning, and prognosis evaluation. Currently, non-invasive imaging methods (such as CT, PET/CT, and MRI) are increasingly being studied to predict the new grading of lung INMA, showing promising application prospects. This review outlines the establishment and prognostic efficiency of the new IASLC grading system, highlights the application and latest progress of non-invasive imaging techniques in predicting lung INMA grading, and discusses their role in personalized treatment of lung INMA and future research directions. Critical relevance statement The new IASLC grading system has important prognostic implications for patients with lung invasive non-mucinous adenocarcinoma (INMA), and non-invasive imaging methods can be used to predict it, thereby improving patient prognoses. Key Points The new IASLC grading system more accurately prognosticates for patients with lung INMA. Preoperative prediction of the new grading is challenging because of the complexity of INMA subtypes. It is feasible to apply non-invasive imaging methods to predict the new IASLC grading system. Graphical Abstract
This work aims to train, validate, and test a dual-stream three-dimensional convolutional neural network (3D-CNN) based on fluorine 18 (18F)-fluorodeoxyglucose (FDG) PET/CT to distinguish benign lesions and invasive adenocarcinoma (IAC) in ground-glass nodules (GGNs).We retrospectively analyzed patients with suspicious GGNs who underwent 18F-FDG PET/CT in our hospital from November 2011 to November 2020. The patients with benign lesions or IAC were selected for this study. According to the ratio of 7:3, the data were randomly divided into training data and testing data. Partial image feature extraction software was used to segment PET and CT images, and the training data after using the data augmentation were used for the training and validation (fivefold cross-validation) of the three CNNs (PET, CT, and PET/CT networks).A total of 23 benign nodules and 92 IAC nodules from 106 patients were included in this study. In the training set, the performance of PET network (accuracy, sensitivity, and specificity of 0.92 ± 0.02, 0.97 ± 0.03, and 0.76 ± 0.15) was better than the CT network (accuracy, sensitivity, and specificity of 0.84 ± 0.03, 0.90 ± 0.07, and 0.62 ± 0.16) (especially accuracy was significant, P-value was 0.001); in the testing set, the performance of both networks declined. However, the accuracy and sensitivity of PET network were still higher than that of CT network (0.76 vs. 0.67; 0.85 vs. 0.70). For dual-stream PET/CT network, its performance was almost the same as PET network in the training set (P-value was 0.372-1.000), while in the testing set, although its performance decreased, the accuracy and sensitivity (0.85 and 0.96) were still higher than both CT and PET networks. Moreover, the accuracy of PET/CT network was higher than two nuclear medicine physicians [physician 1 (3-year experience): 0.70 and physician 2 (10-year experience): 0.73].The 3D-CNN based on 18F-FDG PET/CT can be used to distinguish benign lesions and IAC in GGNs, and the performance is better when both CT and PET images are used together.
1329 Purpose: The value of 18F-FDG positron emission tomography/computed tomography (PET/CT) in preoperative judgement of ground-glass opacity nodules (GGNs) invasiveness remains elusive. The purpose of our study was to evaluate high-resolution computed tomography (HRCT) combined with PET/CT in the identification of invasive adenocarcinoma (IAC), minimally invasive adenocarcinoma (MIA), and pre-invasive lesions in patients with lung adenocarcinoma manifesting as GGNs ≤ 3 cm.
Materials and Methods: We retrospectively analyzed the data of lung adenocarcinoma patients with GGNs ≤ 3 cm who underwent HRCT and PET/CT between November 2011 and November 2018 in our hospital. The characteristics and measurement results of the GGNs were analyzed and compared between IAC and pre-invasive-MIA. Qualitative and quantitative parameters were analyzed using univariate and multivariate logistic regression models. The diagnostic performance of HRCT and PET/CT parameters were analyzed by receiver operating characteristic curves and compared using McNemar test.
Results: This study enrolled 89 lung adenocarcinoma patients with an average age of 60.1 ± 8.1 years (range, 36-78 years; male: female = 24: 65). The proportion of mixed GGN (mGGNs), polygonal/irregular shape, lobulated/spiculated edge, and dilated/distorted/cut-off bronchial sign were higher in IAC than in pre-invasive-MIA GGNs, as well as the attenuation value of the ground-glass opacity (GGO) component (CTGGO), the difference of CTGGO and normal lung parenchyma adjacent to GGO (ΔCTGGO-LP), maximum standard uptake value (SUVmax), and SUV index (tumor SUVmax/liver SUVmean) (P range: 0.001-0.022) (Figure 1 and Figure 2). Univariate and multivariate logistic regression analyses showed that CTGGO and SUV index were independent predictors for the invasiveness of GGNs. The accuracy of CTGGO in combination with SUV index was 81.4% for predicting the invasiveness of each GGN, and 85.4% for each patient. Combined modality had higher sensitivity and accuracy than morphological features, HRCT measurement parameters and PET measurement parameters alone (P < 0.001) (Figure 3).
Conclusions: The combined HRCT and PET/CT assessment modality is an effective method to preoperatively identify the invasiveness of lung adenocarcinoma manifesting as GGNs ≤ 3 cm.
To pick up serum high risk lithogenic factors predisposing one to gallstone formation and protective factors against gallstone formation in gallbladder. We compared serum lipid and apolipoprotein level of patients with gallbladder stone (stone group) with that of patients without gallbladder stone (control group). The correlation between serum lipid, apolipoprotein level and bile lipid level, cholesterol saturated index (CSI), characteristics of lipidemia in different kinds of gallbladder stones were studied. The results showed that the increase of serum Apo A1, C2 and E level in the stone group was more significant than in the control group. But there was no statistical significance in TC, TG, LDL-C, HDL-C, Apo A2, B, C3 level between the stone and control groups. These results suggested that serum apolipoproteins perhaps are more sensitive parameters than serum lipids in distinguishing patients with stones from those without stones. There were different profiles of serum lipid and apolipoproteins in different chemical types of gallbladder stones. Increased level in serum LDL-C, Apo B and ratio of LDL-C/HDL-C were characterized by an index for cholesterol stone, otherwise that in serum TG and Apo C2 an index for pigment stones. There was a positive correlation between serum total cholesterol (TC) or Apo B, C2, C3 and cholesterol amount or CSI in gallbladder bile. Therefore, TC, Apo B, C2, C3 could be considered as high risk lithogenic factors. A positive correlation existed between serum HDL-C and lecithin in gallbladder or common bile duct (CBD) bile as well as between HDL-C and bile acids in CBD bile. Thus, HDL-C might be a protective factor against gallstone formation in gallbladder.
OBJECTIVE. The purpose of this study was to explore the value of FDG PET combined with high-resolution CT (HRCT) in predicting the pathologic subtypes and growth patterns of early lung adenocarcinoma. MATERIALS AND METHODS. A retrospective analysis was conducted on the PET/CT data on ground-glass nodules (GGNs) resected from patients with stage IA lung adenocarcinoma. The efficacy of PET maximum standardized uptake value (SUVmax) combined with HRCT signs in prediction of histopathologic subtype and growth pattern of lung adeno-carcinoma was evaluated. RESULTS. SUVmax was significantly higher in GGNs with invasive HRCT signs. The diameter of GGN (odds ratio, 1.660; p = 0.000) and the difference in attenuation value (odds ratio, 1.012; p = 0.011) between ground-glass components and adjacent lung tissues were independent predictors of FDG uptake by GGNs. SUVmax was higher in invasive adenocarcinoma than in adenocarcinoma in situ (AIS)-minimally invasive adenocarcinoma (MIA) (median SUVmax, 2.0 vs 1.1; p = 0.008). An SUVmax of 2.0 was the optimal cutoff value for differentiating invasive adenocarcinoma from AIS-MIA. Acinar-papillary adenocarcinoma had a higher SUVmax than lepidic adenocarcinoma (median SUVmax, 2.1 vs 1.3; p = 0.037). An SUVmax of 1.4 was the optimal cutoff value for differentiating the growth pattern of adenocarcinoma. Use of PET/CT with HRCT significantly improved efficacy for differentiating invasive adeno-carcinoma from AIS-MIA. However, use of HRCT cannot significantly improve the diagnostic efficacy of FDG PET in the evaluation of tumors with different growth patterns. CONCLUSION. FDG PET can be used to predict the histopathologic subtypes and growth patterns of early lung adenocarcinoma. Combined with HRCT, it has value for predicting invasive histopathologic subtypes but no significance for predicting invasive growth patterns.
To investigate whether the maximum standardized uptake value (SUVmax) of 18F-deoxyglucose (FDG) PET imaging can increase the diagnostic efficiency of CT radiomics-based prediction model in differentiating benign and malignant pulmonary ground-glass nodules (GGNs). We retrospectively collected 190 GGNs from 165 patients who underwent 18F-FDG PET/CT examination from January 2012 to March 2020. Propensity score matching (PSM) was performed to select GGNs with similar baseline characteristics. LIFEx software was used to extract 49 CT radiomic features, and the least absolute shrinkage and selection operator (LASSO) algorithm was used to select parameters and establish the Rad-score. Logistic regression analysis was performed combined with semantic features to construct a CT radiomics model, which was combined with SUVmax to establish the PET + CT radiomics model. Receiver operating characteristic (ROC) was used to compare the diagnostic efficacy of different models. After PSM at 1:4, 190 GGNs were divided into benign group (n = 23) and adenocarcinoma group (n = 92). After texture analysis, the Rad-score with three CT texture features was constructed for each nodule. Compared with the Rad-score and CT radiomics model (AUC: 0.704 (95%CI: 0.562-0.845) and 0.908 (95%CI: 0.842-0.975), respectively), PET + CT radiomics model had the best diagnostic efficiency (AUC: 0.940, 95%CI: 0.889-0.990), and there was significant difference between each two of them (P = 0.001-0.030). SUVmax can effectively improve CT radiomics model performance in the differential diagnosis of benign and malignant GGNs. PET + CT radiomics might become a noninvasive and reliable method for differentiating of GGNs.
To establish reference intervals (RIs) for maternal blood and umbilical cord blood procalcitonin (PCT) in healthy Chinese women in late pregnancy.One hundred and twenty-seven healthy Chinese women in late pregnancy, including 70 vaginal deliveries and 57 cesarean section deliveries, were retrospectively analyzed. These pregnant women gave birth to 58 male infants and 69 female infants. Another 127 age-matched healthy women who were not pregnant were enrolled as the control group. PCT levels in maternal blood, umbilical cord blood and control blood were determined using electrochemiluminescence immunoassay. The RIs of PCT were defined using an intermediate 95% interval.The RIs for maternal blood and umbilical cord blood PCT were 0.020-0.075 ng/mL and 0.020-0.159 ng/mL, respectively. The cord blood PCT level was not significantly different between different delivery methods (P > 0.05). In contrast, the umbilical cord blood PCT in female newborns was higher than that in male newborns (0.088 ± 0.046 ng/mL vs 0.072 ± 0.030 ng/mL, P < 0.05).Maternal blood and umbilical cord blood PCT of Chinese women in late pregnancy have different RIs, and umbilical cord blood PCT level is affected by the gender of newborns.
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