Development and Validation of a Radiomics Nomogram for Differentiating Pulmonary Cryptococcosis and Lung Adenocarcinoma in Solitary Pulmonary Solid Nodule

ObjectiveTo establish a CT-based radiomics nomogram model for classifying pulmonary cryptococcosis (PC) and lung adenocarcinoma (LAC) in patients with a solitary pulmonary solid nodule (SPSN) and assess its differentiation ability.Materials and MethodsA total of 213 patients with PC and 213 cases of LAC (matched based on age and gender) were recruited into this retrospective research with their clinical characteristics and radiological features. High-dimensional radiomics features were acquired from each mask delineated by radiologists manually. We adopted the max-relevance and min-redundancy (mRMR) approach to filter the redundant features and retained the relevant features at first. Then, we used the least absolute shrinkage and operator (LASSO) algorithms as an analysis tool to calculate the coefficients of features and remove the low-weight features. After multivariable logistic regression analysis, a radiomics nomogram model was constructed with clinical characteristics, radiological signs, and radiomics score. We calculated the performance assessment parameters, such as sensitivity, specificity, accuracy, negative predictive value (NPV), and positive predictive value (PPV), in various models. The receiver operating characteristic (ROC) curve analysis and the decision curve analysis (DCA) were drawn to visualize the diagnostic ability and the clinical benefit.ResultsWe extracted 1,130 radiomics features from each CT image. The 24 most significant radiomics features in distinguishing PC and LAC were retained, and the radiomics signature was constructed through a three-step feature selection process. Three factors—maximum diameter, lobulation, and pleural retraction—were still statistically significant in multivariate analysis and incorporated into a combined model with radiomics signature to develop the predictive nomogram, which showed excellent classification ability. The area under curve (AUC) yielded 0.91 (sensitivity, 80%; specificity, 83%; accuracy, 82%; NPV, 80%; PPV, 83%) and 0.89 (sensitivity, 81%; specificity, 83%; accuracy, 82%; NPV, 81%; PPV, 82%) in training and test cohorts, respectively. The net reclassification indexes (NRIs) were greater than zero (p < 0.05). The Delong test showed a significant difference (p < 0.0001) between the AUCs from the clinical model and the nomogram.ConclusionsThe radiomics technology can preoperatively differentiate PC and lung adenocarcinoma. The nomogram-integrated CT findings and radiomics feature can provide more clinical benefits in solitary pulmonary solid nodule diagnosis.

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Khorana Score: Νew Predictor of Early Mortality in Patients With Lung Adenocarcinoma

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029618777153 ◽

2018 ◽

Vol 24 (8) ◽

pp. 1347-1351 ◽

Cited By ~ 5

Author(s):

Ioannis Vathiotis ◽

Evangelos P. Dimakakos ◽

Paraskevi Boura ◽

Angeliki Ntineri ◽

Andiani Charpidou ◽

...

Keyword(s):

Venous Thromboembolism ◽

Adjuvant Chemotherapy ◽

Lung Adenocarcinoma ◽

Treatment Period ◽

Predictive Value ◽

First Line ◽

Thromboembolic Risk ◽

Patients With Cancer ◽

Risk Of Death ◽

Significant Difference

Venous thromboembolism (VTE) is a typical complication in patients with lung cancer. Khorana score is an established tool for thromboembolic risk stratification of ambulatory patients with cancer undergoing outpatient chemotherapy. The aim of this study was to evaluate the predictive value of the Khorana score for VTE and death in patients with lung adenocarcinoma during first-line or adjuvant chemotherapy. Medical records of 130 patients with lung adenocarcinoma receiving first-line or adjuvant chemotherapy were retrospectively studied during the time period June 2013 to May 2015. Venous thromboembolism occurred in 13 (10.0%) patients. Thromboembolic events were significantly correlated with reduced survival during treatment period (hazard ratio [HR]: 3.24; 95% confidence interval [CI]: 1.11-9.49; P = .032). The VTE rates did not present statistically significant difference between different Khorana score groups ( P = .96). In univariate analysis, the risk of death during treatment period (median: 16 weeks) was 3.75 times higher in high-risk versus intermediate-risk patients (HR: 3.75, 95% CI: 1.36-10.36; P = .001) and had 2.25 times higher per point increase in the Khorana score (HR: 2.25, 95% CI: 1.36-3.73; P = .002); the above results were also reproduced in multivariate analysis. Khorana score represents a valuable tool for identifying patients with cancer in low thromboembolic risk but does not preserve its predictive value for higher risk individuals. Khorana score is an independent risk factor for death in patients with lung adenocarcinoma receiving first-line or adjuvant chemotherapy.

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Combine preoperative estimation of serum thyroglobulin and ACR-thyroid imaging reporting and data system scoring could accurately define malignant thyroid nodules

International Surgery Journal ◽

10.18203/2349-2902.isj20205866 ◽

2020 ◽

Vol 8 (1) ◽

pp. 32

Author(s):

Waseem A. Shoda

Keyword(s):

Roc Curve ◽

Predictive Value ◽

Thyroid Nodules ◽

Curve Analysis ◽

Data System ◽

Operating Characteristics ◽

Roc Curve Analysis ◽

Serum Thyroglobulin ◽

Thyroid Imaging ◽

Significant Difference

Background: Evaluation of diagnostic ability of preoperative estimation of serum thyroglobulin (TG) to detect malignant thyroid nodules (TN) in comparison to the American College of Radiology, Thyroid imaging reporting and data system (ACR-TIRADS), fine needle aspiration cytology (FNAC) and intraoperative frozen section (IO-FS).Methods: 34 patients with ACR-TIRADS 2-4 TN were evaluated preoperatively for identification of malignancy and all underwent total thyroidectomy with bilateral neck block dissection if indicated. Results of preoperative investigations were statistically analyzed using the Receiver operating characteristics (ROC) curve analysis as predictors for malignancy in comparison to postoperative paraffin sections.Results: Preoperative serum TG levels had 100% sensitivity and negative predictive value, while ACR-TIRADS scoring had 100% specificity and positive predictive value with accuracy rates of 95.35% and 97.67% for TG and TIRADS, respectively. ROC curve analysis defined preoperative ACR-TIRADS class and serum TG as highly diagnostic than FNAC for defining malignancy with non-significant difference between areas under curve for TIRADS and TG. For cases had intermediate risk of malignancy on TIRADS, IO-FS had missed 3, FNAC missed 4, while serum TG levels were very high in the 13 cases and were defined by ROC curve as the only significant predictor for malignancy.Conclusions: Preoperative estimation of serum TG showed higher diagnostic validity than FNAC, high predictability of cancer and ability to verify the intermediate findings on TIRADS. Combined preoperative TIRADS and TG estimation could accurately discriminate malignant TN with high accuracy and spare the need for preoperative FNAC or IO-FS.

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Different subtypes of EGFR exon19 mutation can affect prognosis of patients with non-small cell lung adenocarcinoma

10.1101/374710 ◽

2018 ◽

Author(s):

Yingying Tian ◽

Jiuzhou Zhao ◽

Pengfei Ren ◽

Bo Wang ◽

Chengzhi Zhao ◽

...

Keyword(s):

Amino Acids ◽

Amino Acid ◽

Lung Adenocarcinoma ◽

Therapeutic Effect ◽

Clinical Characteristics ◽

Kinase Inhibitors ◽

Small Cell ◽

Small Cell Lung ◽

Codon Substitution ◽

Significant Difference

AbstractAimsIn this study, we determined whether different subtypes of epidermal growth factor receptor (EGFR) exon19 mutation are associated with the therapeutic effect of EGFR-tyrosine kinase inhibitors (TKIs) on advanced non-small cell lung adenocarcinoma.MethodsA total of 122 patients with stage III or IV non-small cell lung adenocarcinoma were retrospectively reviewed. Clinical characteristics of these patients, including progression-free survival (PFS) outcome for EGFR-TKI treatment, were analyzed.ResultsAccording to the mutation pattern, we classified the in-frame deletions detected on EGFR Exon19 into three different types: codon deletion (CD), with a deletion of one or more original codons; codon substitution and skipping (CSS), with a deletion of one or two nucleotides but the residues could be translated into a new amino acid without changing following amino acid sequence; CD or CSS plus single nucleotide variant (SNV) (CD/CSS+SNV), exclude CD or CSS, there’s another SNV nearby the deletion region. The clinical characteristics of three groups were analyzed and as a result, no significant difference was found. By comparing the average number of missing bases and amino acids of the three mutation subtypes, it could be discovered that the number of missing bases and amino acids of the three mutation subtypes is diverse, and group CSS> group CD> group CD/CSS+SNV. Finally, survival analysis was performed between three groups of patients. The median PFS of group CD, group CSS and group CD/CSS+SNV was 11 months, 9 months and 14 months respectively. There was a distinct difference in the PFS between group CSS and group CD/CSS+SNV (P=0.035<0.05), and the PFS of group CD/CSS+SNV was longer.ConclusionsDifferent mutation subtypes of EGFR exon19 can predict the therapeutic effect of EGFR-TKIs on advanced non-small cell lung adenocarcinoma.

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MiR-22-3p Expression is down-regulated in lung adenocarcinoma

Acta Biochimica Polonica ◽

10.18388/abp.2020_5540 ◽

2021 ◽

Author(s):

Dong-Jie Ma ◽

Xiao-Yun Zhou ◽

Ying-Zhi Qin ◽

Zhen-Huan Tian ◽

Hong-Sheng Liu ◽

...

Keyword(s):

Matrix Metalloproteinase ◽

Lung Adenocarcinoma ◽

Time Correlation ◽

Clinicopathological Characteristics ◽

Immunohistochemical Method ◽

Maximum Diameter ◽

Normal Lung ◽

Control Group ◽

Matrix Metalloproteinase 3 ◽

Significant Difference

Background: Our current study was performed with an attempt to detect the expression of microRNA-22-3p (miR-22-3p) in lung adenocarcinoma, as well as to analyze its role in clinical practice. In addition, its relationship with vascular endothelial growth factor (VEGF) and metastasis related indexes was focused. Material and Method: The trials in which 62 cases of lung adenocarcinoma were received to collect tumor tissue (study group) and normal lung tissue (control group) were eligible for this study. The expression of miR-22-3p in the two groups was detected through RT-PCR. Immunohistochemical method was used to detect the expression of VEGF and leukocyte differentiation antigen 31 (CD31) marked microvessel density (MVD) in lung adenocarcinoma. The expressions of matrix metalloproteinase-3 (MMP-3) and matrix metalloproteinase-7 (MMP-7) in lung adenocarcinoma were also detected through the use of Western Blot. Results: The present study revealed significant difference in the expression of miR-22-3p between the two groups. No significant difference in the expression of gender, age, neural invasion and the number of lesions were observed between groups. There was significant difference in the expression of miR-22-3p in the maximum diameter of tumor, pleural recidivism, vascular recidivism, lymph node metastasis and different TNM stages. Based on survival analysis, miR-22-3p was linked to survival time. Correlation analysis indicated that there was negative correlation between miR-22-3p and VEGF, miR-22-3p and MVD, miR-22-3p and MMP-3, and miR-22-3p and MMP-7 in lung adenocarcinoma. Conclusion: Our findings provide evidence that miR-22-3p is low expressed in lung adenocarcinoma tissues and the low expression of miR-22-3p is closely associated with clinicopathological characteristics and the prognosis. MiR-22-3p may be involved in the tumor progression of lung adenocarcinoma and may serve as a biomarker for the diagnosis and prognosis of lung adenocarcinoma.

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Abstract 12875: Serum Neutrophil Gelatinase-associated Lipocalin Has a Predictive Value for the Neurological Outcome of Post Cardiac Arrest Victims

Circulation ◽

10.1161/circ.132.suppl_3.12875 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Tadashi Kaneko ◽

Motoki Fujita ◽

Yasuaki Ogino ◽

Hiroki Irie ◽

Shinsuke Iwashita ◽

...

Keyword(s):

Cardiac Arrest ◽

Roc Curve ◽

Predictive Value ◽

Neurological Outcome ◽

Neuron Specific Enolase ◽

Area Under The Curve ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Significant Difference ◽

Neutrophil Gelatinase

Introduction: Neutrophil gelatinase-associated lopocalin (NGAL) is well known as the biomarker of acute kidney injury. Currently, serum NGAL is reported as the biomarker which is associated with mortality and multiple organ dysfunction syndrome in septic patients. In this study, we measured serum NGAL in post cardiac arrest syndrome (PCAS) patients to investigate the predictive value of neurological outcome. Hypothesis: Serum NGAL is associated with favorable neurological outcome of PCAS patients. Methods: 43 cases of PCAS patients were measured serum NGAL on day 1 and 2, and serum neuron specific enolase (NSE) was also measured on day 2. Patients were divided into two group (group G: CPC 1-2 and group P: CPC 3-5, CPC: cerebral performance categories). Serum NGAL and NSE were compared between group G and P. Receiver operation characteristic (ROC) curve analysis were performed of both NGAL and NSE. Results: Group G (n = 20) and P (n = 23) were analyzed. Serum NGAL showed significant difference in day 2 (G: 282±116 ng/mL v.s. P: 299±87 ng/mL in day1: P = 0.609, G: 185±124 ng/mL v.s. P: 353±110 ng/mL in day 2: P<0.001). The ROC curve analysis showed area under the curve of NGAL in day 2 was 0.871, and the area of NSE in day2 showed 0.918. Conclusions: Serum NGAL in PCAS patients had the predictive value for neurological outcome which is comparable to serum NSE. (This study was supported by grants from Japanese Ministry of Health, Labour and Welfare: No. 25462824)

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Clinical characteristics of pulmonary cryptococcosis coexisting with lung adenocarcinoma: Three case reports

World Journal of Clinical Cases ◽

10.12998/wjcc.v8.i24.6444 ◽

2020 ◽

Vol 8 (24) ◽

pp. 6444-6449

Author(s):

Gui-Xian Zheng ◽

Hai-Juan Tang ◽

Zhi-Ping Huang ◽

Hui-Ling Pan ◽

Han-Yi Wei ◽

...

Keyword(s):

Lung Adenocarcinoma ◽

Clinical Characteristics ◽

Case Reports ◽

Pulmonary Cryptococcosis

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The Value of Colorectal Filling Contrast Ultrasonography in Diagnosing Paediatric Juvenile Polyps

10.21203/rs.3.rs-744642/v1 ◽

2021 ◽

Author(s):

Min Zhang ◽

Hai Lin ◽

Tang Na Wu ◽

Jie Hu ◽

Sheng Xin Fu ◽

...

Keyword(s):

Predictive Value ◽

Detection Rate ◽

Clinical Symptoms ◽

False Negative ◽

Clinical Signs ◽

Colorectal Polyps ◽

Maximum Diameter ◽

Juvenile Polyps ◽

Significant Difference ◽

Contrast Ultrasonography

Abstract Objectives: To describe a facilitated procedure of colorectal filling contrast ultrasonography (CFCUS) and investigate its potential role in the assessment of paediatric juvenile polyps. Methods: The general information, clinical symptoms, ultrasound image characteristics, and colonoscopy findings of 101 children with clinical signs of colorectal polyps admitted to our hospital between May 2018 and May 2021 were retrospectively reviewed. All children underwent conventional transabdominal ultrasonography (CTUS), and CFCUS before colonoscopy, and the latter served as the gold standard. Chi-squared tests and Mann-Whitney U tests were used for the statistical analysis. Results: Forty-five children with fifty-two colorectal polyps were diagnosed by colonoscopy. Ten polyps had false-negative results on CTUS, six of which were detected by CFCUS. The sensitivity, specificity, positive predictive value, and negative predictive value of CFCUS vs CTUS was 92.3% vs 80.7%, 100% vs 100%, 100% vs 100%, 93.3% vs 84.8%, respectively. The maximum diameter of polyps (mean ± standard deviation) missed by CTUS was significantly smaller than that detected by CTUS (7.50±2.12 mm [range 4–12 mm] vs. 19.62±7.89 mm [range 6–41 mm], P<0.0001). A significant difference was observed between CTUS and CFCUS. The difference between CTUS and CFCUS regarding the detection rate of polyps with a diameter < 1 cm (P=0.031). A statistical difference was observed in the detection rate of polyps (P=0.031), and pedicles (P<0.001) between CTUS and CFCUS. The Kappa values for the assessment of Yamada’s classification between CTUS and colonoscopy and CFCUS and colonoscopy were 0.51 and 0.84, respectively. Six colonic polyps were accompanied by a punctate hyperechoic area on the surface, which may be suggestive of a correlation with erosion and bleeding findings.Conclusion: CFCUS can increase the detection rate of polyps and pedicles, especially polyps with diameters <1 cm, and accurately evaluate Yamada’s classification, providing useful preoperative information for colonoscopy.

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Introduction of intraoperative neuromonitoring does not necessarily improve overall long-term outcome in elective aneurysm clipping

Journal of Neurosurgery ◽

10.3171/2018.12.jns182177 ◽

2020 ◽

Vol 132 (4) ◽

pp. 1188-1196 ◽

Cited By ~ 2

Author(s):

Tobias Greve ◽

Veit M. Stoecklein ◽

Franziska Dorn ◽

Sophia Laskowski ◽

Niklas Thon ◽

...

Keyword(s):

Evoked Potentials ◽

Predictive Value ◽

Neurological Outcome ◽

Positive Impact ◽

Case Series ◽

Intraoperative Neuromonitoring ◽

Neurosurgical Procedures ◽

Long Term Outcome ◽

Unruptured Intracranial Aneurysms ◽

Significant Difference

OBJECTIVEIntraoperative neuromonitoring (IOM), particularly of somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs), evolved as standard of care in a variety of neurosurgical procedures. Case series report a positive impact of IOM for elective microsurgical clipping of unruptured intracranial aneurysms (ECUIA), whereas systematic evaluation of its predictive value is lacking. Therefore, the authors analyzed the neurological outcome of patients undergoing ECUIA before and after IOM introduction to this procedure.METHODSThe dates of inclusion in the study were 2007–2014. In this period, ECUIA procedures before (n = 136, NIOM-group; 2007–2010) and after introduction of IOM (n = 138, IOM-group; 2011–2014) were included. The cutoff value for SSEP/MEP abnormality was chosen as an amplitude reduction ≥ 50%. SSEP/MEP changes were correlated with neurological outcome. IOM-undetectable deficits (bulbar, vision, ataxia) were not included in risk stratification.RESULTSThere was no significant difference in sex distribution, follow-up period, subarachnoid hemorrhage risk factors, aneurysm diameter, complexity, and location. Age was higher in the IOM-group (57 vs 54 years, p = 0.012). In the IOM group, there were 18 new postoperative deficits (13.0%, 5.8% permanent), 9 hemisyndromes, 2 comas, 4 bulbar symptoms, and 3 visual deficits. In the NIOM group there were 18 new deficits (13.2%; 7.3% permanent, including 7 hemisyndromes). The groups did not significantly differ in the number or nature of postoperative deficits, nor in their recovery rate. In the IOM group, SSEPs and MEPs were available in 99% of cases. Significant changes were noted in 18 cases, 4 of which exhibited postoperative hemisyndrome, and 1 suffered from prolonged comatose state (5 true-positive cases). Twelve patients showed no new detectable deficits (false positives), however 2 of these cases showed asymptomatic infarction. Five patients with new hemisyndrome and 1 comatose patient did not show significant SSEP/MEP alterations (false negatives). Overall sensitivity of SSEP/MEP monitoring was 45.5%, specificity 89.8%, positive predictive value 27.8%, and negative predictive value 95.0%.CONCLUSIONSThe assumed positive impact of introducing SSEP/MEP monitoring on overall neurological outcome in ECUIA did not reach significance. This study suggests that from a medicolegal point of view, IOM is not stringently required in all neurovascular procedures. However, future studies should carefully address high-risk patients with complex procedures who might benefit more clearly from IOM than others.

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Diagnostic Value of Real-Time Shear Wave Elastography in Diagnosing Thyroid Cancer

Revista de Chimie ◽

10.37358/rc.17.12.5985 ◽

2018 ◽

Vol 68 (12) ◽

pp. 2818-2822

Author(s):

Maria Cristina Oprea ◽

Mihaela Vlad ◽

Ioana Golu ◽

Ioan Sporea ◽

Lazar Fulger

Keyword(s):

Shear Wave ◽

Predictive Value ◽

Thyroid Nodules ◽

Imaging Techniques ◽

Area Under The Curve ◽

Thyroid Volume ◽

Shear Wave Elastography ◽

Maximum Diameter ◽

Diagnostic Tools ◽

Tissue Elasticity

Thyroid nodules are a common pathology found in 50 to 60% of otherwise healthy people. Diagnostic imaging techniques are help discriminating between benign and malignant nodules, while fine needle aspiration is still a gold standard. Shear wave elastography, a recent imaging technique, holds the promise to become reliable diagnostic tools and is currently used in combination with ultrasound. We here report data obtained in a series of 52 thyroid nodules analysed by means of elastography, as well as conventional and Doppler ultrasound. We found no differences in age, nodule and thyroid volume, length, width, thickness and maximum diameter between benign and malignant lesions. Several sonographic patterns are considered to be predictive of malignancy, out of which we only found the intranodular blood flow to be statistically significant. By the means of shear wave elastography we have first assessed tissue elasticities, which are shown in a range of colours, depending on tissue elasticity/stiffness. Then, we have measured and recorded four parameters automatically displayed by the system, namely SWE-mean, SWE-max, SWE-SD and SWE-ratio. Data analysis showed all these quantitative parameters had good sensitivity, specificity, positive predictive value, negative predictive value and area under the curve, as calculated by the ROC curve. As with these parameters, the cut-off points were lower than in literature, still able to indicate reliable diagnoses, which were confirmed by histopathological exam. Our conclusion is that shear wave elastography has great potential for reliably and accurately diagnosing thyroid malignancies.

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Clinical Characteristics and Prognostic Factors of Early-Onset Pancreatic Neuroendocrine Tumors

Cancer Control ◽

10.1177/1073274820986827 ◽

2021 ◽

Vol 28 ◽

pp. 107327482098682

Author(s):

Min Shi ◽

Biao Zhou

Keyword(s):

Prognostic Factors ◽

Neuroendocrine Tumors ◽

Early Onset ◽

Older Patients ◽

Clinical Characteristics ◽

Clinicopathological Characteristics ◽

Pancreatic Neuroendocrine Tumors ◽

Chi Square ◽

Younger Patients ◽

Significant Difference

Background: The incidence of pancreatic neuroendocrine tumors (PNETs) has increased significantly. The purpose of this study was to analyze the clinical characteristics and prognosis of patients under 50 years old. Methods: Patients with PNETs recorded in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 were analyzed. The clinical characteristics were analyzed by Chi-square test. The Kaplan-Meier method was used to estimate overall survival (OS). Multivariate Cox proportional risk regression analysis was used to determine independent prognostic factors. Results: 2,303 patients included, of which 547 (23.8%) patients were younger than 50 years old. The number of younger patients has increased steadily, while the proportion in total PNETs decreased recently. Compared with older group, the proportion of the Black, grade I/II, and surgery were higher in early-onset PNETs. Liver was the most frequent metastatic site. There was no significant difference in the incidence of different metastatic sites between younger and older PNETs patients, while younger patients had better OS (P < 0.05). Grade, N stage, M stage, and surgery were independent prognostic factors for OS in early-onset PNETs. Conclusions: Younger patients have unique clinicopathological characteristics compared with older patients in PNETs. Better OS was observed in younger patients which might due to the higher proportion of well-differentiated tumor and surgery than older patients.

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