CT Signs and Differential Diagnosis of Peripheral Lung Cancer and Inflammatory Pseudotumor: A Meta-Analysis

We aimed to systematically evaluate the imaging features of peripheral lung cancer and inflammatory pseudotumor. PubMed, Embase, Cochrane Library, Chinese Knowledge Infrastructure (CNKI), Wanfang database (Wanfang), and Chinese Biomedical Network (CBM) were searched to collect relevant studies on CT image comparison of peripheral lung cancer and inflammatory pseudotumor. The search time was from database establishment to July 15, 2021. The search language was limited to Chinese and English. Data from the literature were screened and extracted, and meta-analysis was performed using Stata 16.0 software. A total of 8 cohort studies were included in this meta-analysis, including 675 patients. Meta-analysis showed that the lesion size of inflammatory pseudotumor was greater than that of peripheral lung cancer, and the difference had statistical significance [SMD = 0.29, 95% CI (0.01, 0.58), P < 0.05 ]. The difference in HU value between inflammatory pseudotumor and peripheral lung cancer CT had no statistical significance [SMD = −0.09, 95% CI (−0.79, 0.60), P > 0.05 ]. The HU value of enhanced CT of inflammatory pseudotumor was higher than that of peripheral lung cancer, and the difference had statistical significance [SMD = 0.75, 95% CI (0.15, 1.34), P < 0.05 ]. The incidence of calcification of inflammatory pseudotumor was significantly higher than that of peripheral lung cancer, and the difference had statistical significance [RR = 2.85, 95% CI (1.33, 6.11), P < 0.05 ]. The incidence of long hair puncture sign of inflammatory pseudotumor was lower than that of peripheral lung cancer, and the difference had statistical significance [RR = 0.49, 95% CI (0.24, 0.97), P < 0.05 ]. There was no significant difference between inflammatory pseudotumor and peripheral lung cancer in terms of cavity incidence, vacuole sign, pleural indentation, and bronchial inflation sign ( P > 0.05 ). Based on the available literature evidence, it can be found that there are differences in the CT signs between peripheral lung cancer and inflammatory pseudotumor, and the lesion size, HU value on enhanced CT, incidence of calcification, and incidence of burr sign may be important indicators for differentiating peripheral lung cancer from inflammatory pseudotumor.

Diagnostic Value of Chest CT Images Based on Full Model Iterative Reconstruction Algorithm for Lung Cancer Patients

Objective. To evaluate the value of low-dose CT scanning and full model iteration recombinant technology peripheral lung cancer in the paper using whole model iterative reconstruction algorithm and compare iterative model-wide restructuring, reorganization part of an iterative algorithm, affecting filtered back projection image quality. Method. Fifty-two patients with peripheral lung cancer, all of whom were diagnosed by pathological biopsy, were selected for the study. All patients received three scans of low-dose chest CT, next-low-dose, and low-dose, after which the raw data of three different doses were reconstructed using filtered back-projection, iterative partial algorithm reconstitution, and reconstructed full-model iteration, respectively, and the effect of each algorithm on the processing of chest CT images of peripheral lung cancer at different doses and the diagnosis of the disease were compared after the reconstitution was completed. Results. The average effective radiation dose for the low-dose group was (0.3±0.02) mSv At each dose level, image noise objective recombinant whole iterative model < part of the reorganization of the iterative algorithm < filtered back projection, the difference was significant. In the case of lung lesions, the full-model iterative algorithm has similar evaluation power to the LD-partial iterative algorithm. When a patient’s body mass index (BMI) > 25 kg/m2, the whole model iteration reorganization image quality is reduced, but the lesions-to-noise ratio (SNR) is unaffected. Conclusion. The combination of a very low dose of recombinant iterative model as compared to full-dose low-dose chest CT dose can be reduced to 88% but does not reduce the overall image quality and can show good radiological signs of peripheral lung cancer and not affect BMI patients.

Bronchoscopic needle-based confocal laser endomicroscopy (nCLE) as a real-time detection tool for peripheral lung cancer

IntroductionDiagnosing peripheral lung cancer with the bronchoscope is challenging with near miss of the target lesion as major obstacle. Needle-based confocal laser endomicroscopy (nCLE) enables real-time microscopic tumour visualisation at the needle tip (smart needle).AimTo investigate feasibility and safety of bronchoscopic nCLE imaging of suspected peripheral lung cancer and to assess whether nCLE imaging allows real-time discrimination between malignancy and airway/lung parenchyma.MethodsPatients with suspected peripheral lung cancer based on (positron emission tomography-)CT scan underwent radial endobronchial ultrasound (rEBUS) and fluoroscopy-guided flexible bronchoscopy. After rEBUS lesion detection, an 18G needle loaded with the CLE probe was inserted in the selected airway under fluoroscopic guidance. The nCLE videos were obtained at the needle tip, followed by aspirates and biopsies. The nCLE videos were reviewed and compared with the cytopathology of the corresponding puncture and final diagnosis. Five blinded raters validated nCLE videos of lung tumours and airway/lung parenchyma twice.ResultsThe nCLE imaging was performed in 26 patients. No adverse events occurred. In 24 patients (92%) good to high quality videos were obtained (final diagnosis; lung cancer n=23 and organising pneumonia n=1). The nCLE imaging detected malignancy in 22 out of 23 patients with lung cancer. Blinded raters differentiated nCLE videos of malignancy from airway/lung parenchyma (280 ratings) with a 95% accuracy. The inter-observer agreement was substantial (κ=0.78, 95% CI 0.70 to 0.86) and intra-observer reliability excellent (mean±SD κ=0.81±0.05).ConclusionBronchoscopic nCLE imaging of peripheral lung lesions is feasible, safe and allows real-time lung cancer detection. Blinded raters accurately distinguished nCLE videos of lung cancer from airway/lung parenchyma, showing the potential of nCLE imaging as real-time guidance tool.

The Value of Additional Conventional Transbronchial Biopsy in the Negative Results of Rapid On-site Evaluation During Endobronchial Ultrasound With Guide Sheath to Diagnose Small Peripheral Lung Cancer

Objective: The accuracy of rapid on-site evaluation (ROSE) during endobronchial ultrasonography with guide sheath (EBUS-GS) was reported to be approximately 90% for diagnosing small peripheral pulmonary lesions (PPLs). When ROSE during EBUS-GS for diagnosing small peripheral lung cancer is carried out and does not include malignant cells in a position whereby the probe was located within or adjacent to the lesion, the best technique for overcoming the lower diagnostic yield remains unknown. This study aimed to evaluate factors affecting positive results of ROSE during EBUS-GS in such a probe position. Moreover, when the results of ROSE were consistently negative, we evaluated the effectiveness of conventional transbronchial biopsy (TBB) in addition to EBUS-GS alone. Methods: We performed a retrospective analysis of consecutive patients who underwent EBUS-GS combined with ROSE for diagnosing small peripheral lung cancer (≤30 mm). We classified the results of ROSE into two groups based on the presence of malignant cells: the ROSE positive group (included malignant cells) and the ROSE negative group (did not include malignant cells). The significant predictors of positive ROSE results during EBUS-GS were analyzed using multivariate logistic regression analyses. Results: We identified 67 lesions (43 lesions in the ROSE positive group and 24 lesions in the ROSE negative group, respectively). Multivariate logistic analysis revealed that the significant factor affecting positive ROSE results was lesion size (>15 mm) (OR = 9.901). The diagnostic yield of additional conventional TBB to EBUS-GS was significantly higher than that of EBUS-GS alone (75.0% vs 33.3%, P = .041). Conclusion: The positive results of ROSE during EBUS-GS were significantly influenced by lesion size (>15 mm). When the results of ROSE during EBUS-GS were consistently negative in a position whereby the probe was located within or adjacent to the lesion, additional conventional TBB was effective to improve the diagnostic yield compared with EBUS-GS alone.