scholarly journals Defining growth in small pulmonary nodules using volumetry: results from a “coffee-break” CT study and implications for current nodule management guidelines

2021 ◽  
Author(s):  
Emily C. Bartlett ◽  
Samuel V. Kemp ◽  
Bhavin Rawal ◽  
Anand Devaraj
Keyword(s):  
Pulmonary Nodule ◽  
Short Interval ◽  
Pulmonary Nodules ◽  
Mean Difference ◽  
Coffee Break ◽  
Limits Of Agreement ◽  
Management Guidelines ◽  
Upper Limits ◽  
Nodule Volume ◽  
Volume Difference

Abstract Objectives An increase in lung nodule volume on serial CT may represent true growth or measurement variation. In nodule guidelines, a 25% increase in nodule volume is frequently used to determine that growth has occurred; this is based on previous same-day, test–retest (coffee-break) studies examining metastatic nodules. Whether results from prior studies apply to small non-metastatic nodules is unknown. This study aimed to establish the interscan variability in the volumetric measurements of small-sized non-metastatic nodules. Methods Institutional review board approval was obtained for this study. Between March 2019 and January 2021, 45 adults (25 males; mean age 65 years, range 37–84 years) with previously identified pulmonary nodules (30–150 mm3) requiring surveillance, without a known primary tumour, underwent two same-day CT scans. Non-calcified solid nodules were measured using commercial volumetry software, and interscan variability of volume measurements was assessed using a Bland–Altman method and limits of agreement. Results One hundred nodules (range 28–170 mm3; mean 81.1 mm3) were analysed. The lower and upper limits of agreement for the absolute volume difference between the two scans were − 14.2 mm3 and 12.0 mm3 respectively (mean difference 1.09 mm3, range − 33–12 mm3). The lower and upper limits of agreement for relative volume difference were − 16.4% and 14.6% respectively (mean difference 0.90%, range − 24.1–32.8%). Conclusions The interscan volume variability in this cohort of small non-metastatic nodules was smaller than that in previous studies involving lung metastases of varying sizes. An increase of 15% in nodule volume on sequential CT may represent true growth, and closer surveillance of these nodules may be warranted. Key Points • In current pulmonary nodule management guidelines, a threshold of 25% increase in volume is required to determine that true growth of a pulmonary nodule has occurred. • This test–retest (coffee break) study has demonstrated that a smaller threshold of 15% increase in volume may represent true growth in small non-metastatic nodules. • Closer surveillance of some small nodules growing 15–25% over a short interval may be appropriate.

Effects of injectate volume on thermodilution measurements of cardiac output in patients with low ventricular ejection fraction

1999 ◽  
Vol 8 (2) ◽  
pp. 86-92 ◽  
Author(s):  
K McCloy ◽  
S Leung ◽  
J Belden ◽  
J Castenada ◽  
V Erickson ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Ejection Fraction ◽  
Mean Difference ◽  
Ventricular Ejection ◽  
Limits Of Agreement ◽  
Additional Measurement ◽  
Thermodilution Cardiac Output ◽  
Ventricular Ejection Fraction ◽  
Upper Limits ◽  
Cardiac Output Measurements

OBJECTIVE: To determine the effect of 5-mL injectate on cardiac output measurements in critically ill patients with low ventricular ejection fraction (< 35%). METHODS: Thermodilution cardiac output measurements obtained with three 5-mL and three 10-mL (randomly ordered) iced injectates in 50 patients with low ejection fraction were averaged if the measurements were within 10% of the median. If the 3 measurements were not within those limits, additional measurements were obtained. RESULTS: Cardiac output measured with the 5-mL injectate (mean, 4.63 L/min) and cardiac output measured with the 10-mL injectate (mean, 4.52 L/min) were not significantly different (P = .64). Lower and upper limits of agreement were -1.7 L/min to +1.6 L/min. The bias (mean difference between 10- and 5-mL measurements) of all measurements was -0.09, and the precision was 1.43 L/min, with a 95% confidence limit (mean difference +/- 2 SD) of -1.7 to +1.6 L/min. An additional measurement was necessary in 77% of patients in the 5-mL group but in only 48% of the 10-mL group (P = .006). CONCLUSIONS: Cardiac outputs measured with 5- and 10-mL injectates do not differ significantly. The greater variability of measurements obtained with a 5-mL injectate suggests that more measurements, and thus more time, are needed to measure cardiac output accurately. Clinicians must weigh the benefit of minimizing fluid volume used against the potential decreased reliability of cardiac output measurements.

scholarly journals Effect of a pulmonary nodule fact sheet on patient anxiety and knowledge: a quality improvement initiative

2018 ◽  
Vol 7 (3) ◽  
pp. e000437 ◽  
Author(s):  
Matthew T Koroscil ◽  
Mitchell H Bowman ◽  
Michael J Morris ◽  
Andrew J Skabelund ◽  
Andrew M Hersh
Keyword(s):  
Lung Cancer ◽  
Quality Improvement ◽  
Pulmonary Nodule ◽  
Early Stage ◽  
Pulmonary Nodules ◽  
Low Risk ◽  
Quality Improvement Initiative ◽  
Patient Anxiety ◽  
Patient Understanding ◽  
Fact Sheet

IntroductionThe utilisation of chest CT for the evaluation of pulmonary disorders, including low-dose CT for lung cancer screening, is increasing in the USA. As a result, the discovery of both screening-detected and incidental pulmonary nodules has become more frequent. Despite an overall low risk of malignancy, pulmonary nodules are a common cause of emotional distress among adult patients.MethodsWe conducted a multi-institutional quality improvement (QI) initiative involving 101 participants to determine the effect of a pulmonary nodule fact sheet on patient knowledge and anxiety. Males and females aged 35 years or older, who had a history of either screening-detected or incidental solid pulmonary nodule(s) sized 3–8 mm, were included. Prior to an internal medicine or pulmonary medicine clinic visit, participants were given a packet containing a pre-fact sheet survey, a pulmonary nodule fact sheet and a post-fact sheet survey.ResultsOf 101 patients, 61 (60.4%) worried about their pulmonary nodule at least once per month with 18 (17.8%) worrying daily. The majority 67/101 (66.3%) selected chemotherapy, chemotherapy and radiation, or radiation as the best method to cure early-stage lung cancer. Despite ongoing radiographic surveillance, 16/101 (15.8%) stated they would not be interested in an intervention if lung cancer was diagnosed. Following review of the pulmonary nodule fact sheet, 84/101 (83.2%) reported improved anxiety and 96/101 (95.0%) reported an improved understanding of their health situation. Patient understanding significantly improved from 4.2/10.0 to 8.1/10.0 (p<0.01).ConclusionThe incorporation of a standardised fact sheet for subcentimeter solid pulmonary nodules improves patient understanding and alleviates anxiety. We plan to implement pulmonary nodule fact sheets into the care of our patients with low-risk subcentimeter pulmonary nodules.

scholarly journals Malignant melanoma without primary, presenting as solitary pulmonary nodule: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
George Tsaknis ◽  
Muhammad Naeem ◽  
Advitya Singh ◽  
Siddharth Vijayakumar
Keyword(s):  
Lung Cancer ◽  
Malignant Melanoma ◽  
Pulmonary Nodule ◽  
Solitary Pulmonary Nodule ◽  
Past History ◽  
White Male ◽  
Pulmonary Nodules ◽  
Metastatic Malignant Melanoma ◽  
Unknown Primary ◽  
Solitary Pulmonary Nodules

Abstract Background Solitary pulmonary nodules are the most common incidental finding on chest imaging. Their management is very well defined by several guidelines, with risk calculators for lung cancer being the gold standard. Solitary intramuscular metastasis combined with a solitary pulmonary nodule from malignant melanoma without a primary site is rare. Case presentation A 57-year-old white male was referred to our lung cancer service with solitary pulmonary nodule. After positron-emission tomography, we performed an ultrasound-guided core needle biopsy of an intramuscular solitary lesion, not identified on computed tomography scan, and diagnosed metastatic malignant melanoma. The solitary pulmonary nodule was resected and also confirmed metastatic melanoma. There was no primary skin lesion. The patient received oral targeted therapy and is disease-free 5 years later. Conclusions Clinicians dealing with solitary pulmonary nodules must remain vigilant for other extrathoracic malignancies even in the absence of obvious past history. Lung metastasectomy may have a role in metastatic malignant melanoma with unknown primary.

scholarly journals 3D Spatial Pyramid Dilated Network for Pulmonary Nodule Classification

Symmetry ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 376 ◽  
Author(s):  
Guokai Zhang ◽  
Xiao Liu ◽  
Dandan Zhu ◽  
Pengcheng He ◽  
Lipeng Liang ◽  
...  
Keyword(s):  
Pulmonary Nodule ◽  
Early Stage ◽  
Receptive Fields ◽  
Small Diameter ◽  
Pulmonary Nodules ◽  
Lung Cancer Mortality ◽  
Classification Performance ◽  
Dilated Convolution ◽  
Detailed Characteristic ◽  
Spatial Pyramid

Lung cancer mortality is currently the highest among all kinds of fatal cancers. With the help of computer-aided detection systems, a timely detection of malignant pulmonary nodule at early stage could improve the patient survival rate efficiently. However, the sizes of the pulmonary nodules are usually various, and it is more difficult to detect small diameter nodules. The traditional convolution neural network uses pooling layers to reduce the resolution progressively, but it hampers the network’s ability to capture the tiny but vital features of the pulmonary nodules. To tackle this problem, we propose a novel 3D spatial pyramid dilated convolution network to classify the malignancy of the pulmonary nodules. Instead of using the pooling layers, we use 3D dilated convolution to learn the detailed characteristic information of the pulmonary nodules. Furthermore, we show that the fusion of multiple receptive fields from different dilated convolutions could further improve the classification performance of the model. Extensive experimental results demonstrate that our model achieves a better result with an accuracy of 88 . 6 % , which outperforms other state-of-the- art methods.

scholarly journals Update on Pulmonary Ossifications in the Differential Diagnosis of Solitary Pulmonary Nodules

2021 ◽  
Vol 10 (20) ◽  
pp. 4795
Author(s):  
Jan F. Gielis ◽  
Lawek Berzenji ◽  
Vasiliki Siozopoulou ◽  
Marloes Luijks ◽  
Paul E. Y. Van Schil
Keyword(s):  
Differential Diagnosis ◽  
Pulmonary Nodule ◽  
Solitary Pulmonary Nodule ◽  
Lower Lobe ◽  
Pulmonary Nodules ◽  
Solitary Pulmonary Nodules ◽  
Pulmonary Surgery ◽  
Pubmed Database ◽  
Post Mortem Findings ◽  
The Right

Pulmonary ossifications have often been regarded as rare, post-mortem findings without any clinical significance. We have investigated the occurrence of pulmonary ossifications in patients undergoing thoracic procedures, and how this may affect the differential diagnosis of solitary pulmonary nodules. In addition, we have performed a literature search on the occurrence and possible pathogenesis of these ossifications. From January 2008 until August 2019, we identified pulmonary ossifications in 34 patients who underwent elective pulmonary surgery. Pre-operative imaging was unable to differentiate these ossifications from solid tumors. A definitive diagnosis was made by an experienced pathologist (VS, ML). The PubMed database was researched in December 2019 with the search terms “pulmonary ossifications”; “heterotopic ossifications”; and “solitary pulmonary nodule”. In total, 27 patients were male, with a mean age of 63 ± 12 years (age 41 to 82 on diagnosis). All lesions were identified on thoracic CT and marked for resection by a multidisciplinary team. A total of 17 patients were diagnosed with malignancy concurrent with ossifications. There was a clear predilection for the right lower lobe (12 cases, 35.3%) and most ossifications had a nodular form (70.6%). We could not identify a clear association with any other pathology, either cancerous or non-cancerous in origin. Oncologic or pulmonary comorbidities did not influence patient survival. Pulmonary ossifications are not as seldom as thought and are not just a curiosity finding by pathologists. These formations may be mistaken for a malignant space-occupying lesion, both pre-and perioperatively, as they are indistinguishable in imaging. We propose these ossifications as an underestimated addition to the differential diagnosis of a solitary pulmonary nodule.

scholarly journals Agreement between arterial and capillary pH, pCO2 and lactate in patients in the emergency department

2020 ◽  
Author(s):  
V. Collot ◽  
S. Malinverni ◽  
E. Schweitzer ◽  
J. Haltout ◽  
P. Mols ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Sensitivity And Specificity ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Mean Difference ◽  
Blood Gas ◽  
Limits Of Agreement ◽  
Study Objective ◽  
Arterial Blood Gas ◽  
Arterial Blood

AbstractStudy objectiveThe primary objective of the study was a quantitative analysis to assess the mean difference and 95% confidence interval of the difference between capillary and arterial blood gas analyses for pH, pCO2 and lactate. Secondary objective was to measure the sensitivity and specificity of capillary samples to detect altered pH, hypercarbia and lactic acidosis.MethodsAdults admitted to the ED for whom the treating physician deemed necessary an arterial blood gas analysis (BGA) were screened for inclusion. Simultaneous arterial and capillary samples were drawn for BGA. Agreement between the two methods for pH, pCO2 and lactate were studied with Bland-Altman bias plot analysis. Sensitivity, specificity, positive and negative predictive value as well as AUC were calculated for the ability of capillary samples to detect pH values outside normal ranges, hypercarbia and hyperlactatemia.Results197 paired analyses were included in the study. Mean difference for pH, between arterial and capillary BGA was 0.0095, 95% limits of agreement were -0.048 to 0.067. For pCO2, mean difference was -0.3 mmHg, 95% limits of agreement were -8.5 to 7.9 mmHg. Lactate mean difference was -0.93 mmol/L, 95% limits of agreement were -2.7 to 0.8 mmol/L. At a threshold of 7.34 for capillary pH had 98% sensitivity and 97% specificity to detect acidemia; at 45.9 mmHg capillary pCO2 had 89% sensitivity and 96% specificity to detect hypercarbia. Finally at a threshold of 3.5 mmol/L capillary lactate had 66% sensitivity to detect lactic acidosis.ConclusionCapillary measures of pH, pCO2 and lactate can’t replace arterial measurements although there is high concordance between the two methods for pH and pCO2 and moderate concordance for lactate. Capillary blood gas analysis had good accuracy when used as a screening tool to detect altered pH and hypercarbia but insufficient sensitivity and specificity when screening for lactic acidosis.

Discrimination of Pulmonary Nodule Volume Change for Low- and High-contrast Tasks in a Phantom CT Study with Low-dose Protocols

2019 ◽  
Vol 26 (7) ◽  
pp. 937-948 ◽  
Author(s):  
Marios A. Gavrielides ◽  
Qin Li ◽  
Rongping Zeng ◽  
Benjamin Paul Berman ◽  
Berkman Sahiner ◽  
...  
Keyword(s):  
Volume Change ◽  
Pulmonary Nodule ◽  
Low Dose ◽  
High Contrast ◽  
Nodule Volume

scholarly journals Evaluation of Inter-System Variability in Liver Stiffness Measurements

2018 ◽  
Vol 40 (01) ◽  
pp. 64-75 ◽  
Author(s):  
Giovanna Ferraioli ◽  
Annalisa De Silvestri ◽  
Raffaella Lissandrin ◽  
Laura Maiocchi ◽  
Carmine Tinelli ◽  
...  
Keyword(s):  
Shear Wave ◽  
Liver Stiffness ◽  
Shear Wave Elastography ◽  
Mean Difference ◽  
Observer Agreement ◽  
Concordance Correlation ◽  
Limits Of Agreement ◽  
Inter Observer Variability ◽  
System Variability ◽  
The Mean

Abstract Aim The primary aim of this study was to determine the inter-system variability of liver stiffness measurements (LSMs) in patients with varying degrees of liver stiffness. The secondary aim was to determine the inter-observer variability of measurements. Materials and Methods 21 individuals affected by chronic hepatitis C and 5 healthy individuals were prospectively enrolled. The assessment of LSMs was performed using six ultrasound (US) systems, four of which with point shear wave elastography (p-SWE) and two with 2 D shear wave elastography (2D-SWE) systems. The Fibroscan (Echosens, France) was used as the reference standard. Four observers performed the measurements in pairs (A-B, C-D). The agreement between different observers or methods was calculated using Lin’s concordance correlation coefficient. The Bland-Altman limits of agreement (LOA) were calculated as well. Results There was agreement above 0.80 for all pairs of systems. The mean difference between the values of the systems with 2D-SWE technique was 1.54 kPa, whereas the maximum mean difference between the values of three out of four systems with the pSWE technique was 0.79 kPa. The intra-patient concordance for all systems was 0.89 (95 % CI: 0.83 – 0.94). Inter-observer agreement was 0.96 (95 % CI: 0.94 – 0.98) for the pair of observers A-B and 0.93 (95 % CI: 0.89 – 0.96) for the pair of observers C-D. Conclusion The results of this study show that the agreement between LSMs performed with different US systems is good to excellent and the overall inter-observer agreement in “ideal conditions” is above 0.90 in expert hands.

Biochemical Aspects and Clinical Perspectives of Continuous Urea Monitoring in Plasma Ultrafiltrate: Preliminary Results of a Multicenter Study

1995 ◽  
Vol 18 (9) ◽  
pp. 544-547 ◽  
Author(s):  
G. Colasanti ◽  
G. Arrigo ◽  
A. Santoro ◽  
S. Mandolfo ◽  
C. Tetta ◽  
...  
Keyword(s):  
Laboratory Method ◽  
Mean Difference ◽  
Limits Of Agreement ◽  
Laboratory Plasma ◽  
Plasma Urea ◽  
Urea Kinetics ◽  
On Line ◽  
The Mean ◽  
Plasma Urea Concentration

We tested a new biosensor for urea monitoring in the ultrafiltrate during PFD in a group of 5 hemodialyzed stable patients. The inspection of the UF-urea profile reflects the dynamical changes of the plasma urea concentration during diffusive dialysis and allows the fitting of the main mathematical models of urea kinetics. The biosensor efficiency was 98.4% on average (SD: 1.5%) at Uf fluxes varying from 45 to 55 ml/min (mean: 51 ml/min; SD: 3.2) and at Uf-urea concentrations varying from 23 to 165 mg/dl. The mean difference between Uf-urea determined by the laboratory method and Uf-urea assayed by the biosensor was -1.07 mg/dl and the 95% confidence interval ranged from -2.01 to 0.13 mg/dl. The mean difference between laboratory plasma urea and Uf-urea from the biosensor was on average -1.9 mg/dl and the estimated limits of agreement with a confidence of 95% were -3.16 and 0.64 mg/dl. Comparison between kinetic models and experimental profiles of plasma urea decrease, evaluations of recirculation and post-dialytic rebound, the role of Kt/V on-line during dialysis were the preliminary clinical applications of this biosensor.

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