Digital Tomosynthesis for Evaluating Metastatic Lung Nodules: Nodule Visibility, Learning Curves, and Reading Times

Abstract Background The purpose of this study was to analyze if the use of texture analysis on spectral detector CT (SDCT)-derived iodine maps (IM) in addition to conventional images (CI) improves lung nodule differentiation, when being applied to a k-nearest neighbor (KNN) classifier. Methods 183 cancer patients who underwent contrast-enhanced, venous phase SDCT of the chest were included: 85 patients with 146 benign lung nodules (BLN) confirmed by either prior/follow-up CT or histopathology and 98 patients with 425 lung metastases (LM) verified by histopathology, 18F-FDG-PET-CT or unequivocal change during treatment. Semi-automatic 3D segmentation of BLN/LM was performed, and volumetric HU attenuation and iodine concentration were acquired. For conventional images and iodine maps, average, standard deviation, entropy, kurtosis, mean of the positive pixels (MPP), skewness, uniformity and uniformity of the positive pixels (UPP) within the volumes of interests were calculated. All acquired parameters were transferred to a KNN classifier. Results Differentiation between BLN and LM was most accurate, when using all CI-derived features combined with the most significant IM-derived feature, entropy (Accuracy:0.87; F1/Dice:0.92). However, differentiation accuracy based on the 4 most powerful CI-derived features performed only slightly inferior (Accuracy:0.84; F1/Dice:0.89, p=0.125). Mono-parametric lung nodule differentiation based on either feature alone (i.e. attenuation or iodine concentration) was poor (AUC=0.65, 0.58, respectively). Conclusions First-order texture feature analysis of contrast-enhanced staging SDCT scans of the chest yield accurate differentiation between benign and metastatic lung nodules. In our study cohort, the most powerful iodine map-derived feature slightly, yet insignificantly increased classification accuracy compared to classification based on conventional image features only.

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Outcomes and Patterns of Failure With Stereotactic Body Radiation Therapy in the Treatment of Primary and Metastatic Lung Nodules in Elderly Patients

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2014.05.1835 ◽

2014 ◽

Vol 90 (1) ◽

pp. S615

Author(s):

N.N. Paryani ◽

S.J. Ko ◽

M.G. Heckman ◽

C. Serago ◽

A. Smith ◽

...

Keyword(s):

Radiation Therapy ◽

Elderly Patients ◽

Stereotactic Body Radiation Therapy ◽

Lung Nodules ◽

Patterns Of Failure ◽

Stereotactic Body Radiation ◽

Metastatic Lung

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Detection of lung nodules in chest digital tomosynthesis (CDT): effects of the different angular dose distribution

10.1117/12.2081767 ◽

2015 ◽

Author(s):

Byungdu Jo ◽

Youngjin Lee ◽

Dohyeon Kim ◽

Dong-Hoon Lee ◽

Seong-Soo Jin ◽

...

Keyword(s):

Dose Distribution ◽

Lung Nodules ◽

Digital Tomosynthesis

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Lung Nodules in Melanoma Patients: Morphologic Criteria to Differentiate Non-Metastatic and Metastatic Lesions

Diagnostics ◽

10.3390/diagnostics11050837 ◽

2021 ◽

Vol 11 (5) ◽

pp. 837

Author(s):

Simone Alexandra Stadelmann ◽

Christian Blüthgen ◽

Gianluca Milanese ◽

Thi Dan Linh Nguyen-Kim ◽

Julia-Tatjana Maul ◽

...

Keyword(s):

Lung Metastases ◽

Stage Iii ◽

Lung Nodules ◽

Metastatic Lesions ◽

Ajcc Stage ◽

Metastatic Lung ◽

Melanoma Patients ◽

Size And Morphology ◽

Benign Nodules

Lung nodules are frequent findings in chest computed tomography (CT) in patients with metastatic melanoma. In this study, we assessed the frequency and compared morphologic differences of metastases and benign nodules. We retrospectively evaluated 85 patients with melanoma (AJCC stage III or IV). Inclusion criteria were ≤20 lung nodules and follow-up using CT ≥183 days after baseline. Lung nodules were evaluated for size and morphology. Nodules with significant growth, nodule regression in line with RECIST assessment or histologic confirmation were judged to be metastases. A total of 438 lung nodules were evaluated, of which 68% were metastases. At least one metastasis was found in 78% of patients. A 10 mm diameter cut-off (used for RECIST) showed a specificity of 95% and a sensitivity of 20% for diagnosing metastases. Central location (n = 122) was more common in metastatic nodules (p = 0.009). Subsolid morphology (n = 53) was more frequent (p < 0.001), and calcifications (n = 13) were solely found in non-metastatic lung nodules (p < 0.001). Our data show that lung nodules are prevalent in about two-thirds of melanoma patients (AJCC stage III/IV) and the majority are metastases. Even though we found a few morphologic indicators for metastatic or non-metastatic lung nodules, morphology has limited value to predict the presence of lung metastases.

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Curved multiplanar reconstruction of CT scans for demonstration of multifocal metastatic lung nodules in children in a single image

Clinical Radiology ◽

10.1016/j.crad.2017.11.002 ◽

2018 ◽

Vol 73 (4) ◽

pp. 411.e1-411.e6

Author(s):

S. Andronikou ◽

S. Arthur ◽

H. Rees

Keyword(s):

Ct Scans ◽

Multiplanar Reconstruction ◽

Lung Nodules ◽

Single Image ◽

Metastatic Lung

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EP.TH.164Staging CXR preoperatively in invasive breast cancer, is it time it should be abandoned? A single-centre cohort review of its utility

British Journal of Surgery ◽

10.1093/bjs/znab309.023 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Claire Fung ◽

Matthew Rowland

Keyword(s):

Breast Cancer ◽

Invasive Breast Cancer ◽

Lung Nodules ◽

Lung Pathology ◽

X Rays ◽

Single Centre ◽

Improve Patient Satisfaction ◽

Metastatic Lung ◽

Improve Patient

Abstract Aim The use of preoperative chest x-rays (pCXR) for staging in invasive breast cancer has uncertain benefit. This review aimed to ascertain its utility in this cohort in a single centre. Methods Retrospective cohort review of consecutive patients with invasive breast cancer planned for surgery for 2018 was carried out. An 18-month follow-up allowed the identification of any subsequent lung pathology that may have potentially been seen on pCXR. Patients who had staging CT instead were excluded. Formal reports of pCXR and any subsequent imaging were reviewed. Results 244 patients with invasive breast cancer that was planned for surgery for 2018 were identified, 214 of whom had pCXR. 194 had no abnormalities reported. 16 had lung pathology; eight were indeterminate and were advised to have follow-up imaging. Of the six who had follow-up CTs, three had lung nodules; they were all subsequently discharged from follow-up as they were determined as benign. At 18 months, nine patients had new thoracic pathology: two had metastatic lung disease; six had lung nodules requiring follow-up. All nine patients’ pCXRs were reported as normal. Conclusions pCXR for invasive breast cancer has limited, if any, utility; it does not identify any management-altering pathology. Those that developed malignancy were not predicted by pCXR, but identified by post-operative symptoms, or on staging CT directed by post-operative nodal status. pCXR in this cohort, in the absence of respiratory symptoms, should therefore be discontinued. This would reduce cost, radiation exposure, hospital footfall, radiology reporting time, and likely improve patient satisfaction.

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