Diagnostic Value of Bronchoscopy for Peripheral Metastatic Lung Tumors

Although lungs are one of the most frequent sites of metastasis for malignant tumors, little has been reported about the value of bronchoscopy for lung metastases presenting with peripheral pulmonary lesions (PPLs). This retrospective cohort study investigated the diagnostic value of bronchoscopy for peripheral metastatic lung tumors. Consecutive patients who underwent diagnostic bronchoscopy with radial endobronchial ultrasound for PPLs and were finally diagnosed with metastatic lung tumors from April 2012 to March 2019 were included. We analyzed 235 PPLs, with a median size of 18.8 mm. The overall diagnostic yield was 76.6%. In a multivariable analysis, large lesion size (>20.0 mm vs. <20.0 mm: 87.6% vs. 67.7%, p = 0.043, OR = 2.26), inner location (inner 2/3 vs. outer 1/3: 84.8% vs. 69.1%, p = 0.004, OR = 2.79), and visibility on radiography (visible vs. invisible: 83.2% vs. 56.1%, p = 0.015, OR = 3.29) significantly affected the diagnostic yield. Although a positive bronchus sign tended to have a higher yield, no significant difference was observed (81.8% vs. 70.6%, p = 0.063). Only one case of lung abscess was observed, with no serious complications. In conclusion, bronchoscopy is a valuable technique for peripheral metastatic lung tumors, with good diagnostic accuracy and safety.

Adaptive MR-Guided Stereotactic Radiotherapy is Beneficial for Ablative Treatment of Lung Tumors in High-Risk Locations

PurposeTo explore the benefit of adaptive magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) for treatment of lung tumors in different locations with a focus on ultracentral lung tumors (ULT).Patients &amp; MethodsA prospective cohort of 21 patients with 23 primary and secondary lung tumors was analyzed. Tumors were located peripherally (N = 10), centrally (N = 2) and ultracentrally (N = 11, planning target volume (PTV) overlap with proximal bronchi, esophagus and/or pulmonary artery). All patients received MRgSBRT with gated dose delivery and risk-adapted fractionation. Before each fraction, the baseline plan was recalculated on the anatomy of the day (predicted plan). Plan adaptation was performed in 154/165 fractions (93.3%). Comparison of dose characteristics between predicted and adapted plans employed descriptive statistics and Bayesian linear multilevel models. The posterior distributions resulting from the Bayesian models are presented by the mean together with the corresponding 95% compatibility interval (CI).ResultsPlan adaptation decreased the proportion of fractions with violated planning objectives from 94% (predicted plans) to 17% (adapted plans). In most cases, inadequate PTV coverage was remedied (predicted: 86%, adapted: 13%), corresponding to a moderate increase of PTV coverage (mean +6.3%, 95% CI: [5.3–7.4%]) and biologically effective PTV doses (BED10) (BEDmin: +9.0 Gy [6.7–11.3 Gy], BEDmean: +1.4 Gy [0.8–2.1 Gy]). This benefit was smaller in larger tumors (−0.1%/10 cm³ PTV [−0.2 to −0.02%/10 cm³ PTV]) and ULT (−2.0% [−3.1 to −0.9%]). Occurrence of exceeded maximum doses inside the PTV (predicted: 21%, adapted: 4%) and violations of OAR constraints (predicted: 12%, adapted: 1%, OR: 0.14 [0.04–0.44]) was effectively reduced. OAR constraint violations almost exclusively occurred if the PTV had touched the corresponding OAR in the baseline plan (18/19, 95%).ConclusionAdaptive MRgSBRT is highly recommendable for ablative treatment of lung tumors whose PTV initially contacts a sensitive OAR, such as ULT. Here, plan adaptation protects the OAR while maintaining best-possible PTV coverage.

Study on Motion Management of Lung Cancer Treated by CyberKnife: Based on Tumor Position

Purpose: We investigated the movement characteristics of lung cancers and the clinical accuracy of tracking lung tumors with Synchrony Respiratory Tracking System (SRTs) during the CyberKnife treatment. We also explored the influencing factors of accuracy. These data provided the appropriate expansion margins of patients with different respiratory characteristics, which was helpful to realize the personalized design of treatment plans of CyberKnife. Methods and Materials: 73 patients with lung cancer treated with CyberKnife SRTs were selected retrospectively for this study. The patient's age, gender, respiratory characteristics and tumor datas (tumor size, anatomical position and geometric position) were recorded. During treatment, the deviation was checked every 45 s and compensated by the synchronous respiratory tracking system.Results: The total mean motion amplitudes and standard deviations of lung tumors in superior-inferior (SI), left-right (LR), and anterior-posterior (AP) directions were 4.15 ± 3.47 mm, 3.98 ± 3.21 mm and 3.79 ± 2.73 mm, respectively. The overall mean correlation errors and standard deviations were 0.86 ± 0.45 mm, 1.04 ± 0.76 mm and 0.70 ± 0.47 mm, respectively. The overall mean prediction errors and standard deviations were 0.18 ± 0.17 mm, 0.35 ± 0.39 mm and 0.35 ± 0.42 mm, respectively. The correlation errors of LR direction were less correlated with the geometric position of the tumor (r = 0.38), and not correlated with the anatomical position of the tumor (r < 0.3). The prediction errors were moderately correlated with the respiratory amplitude (r = 0.588), and less correlated with the baseline drift and the motion amplitude of the tumor (r = 0.407 and 0.365, respectively).Conclusions: The patient’s respiratory amplitude, the tumor motion amplitude, the tumor baseline drift and geometric position were the main factors affecting the tracking accuracy. Tumors at different geometric positions should be treated differently to ensure sufficient dose coverage of the lung tumor target.

Boosted Weighted Optimized Convolutional Neural Network Ensemble Classification for Lung Cancer Prediction

One of the major causes of cancer-related mortality worldwide is lung tumors. An earlier prediction of lung tumors is crucial since it may severely increase the death rates. For this reason, genomic profiles have been considered in many advanced microarray technology schemes. Amongst, an Improved Dragonfly optimization Algorithm (IDA) with Boosted Weighted Optimized Neural Network Ensemble Classification (BWONNEC) has been developed which extracts most suitable features and fine-tunes the weights related to the ensemble neural network classifiers. But, its major limitations are the number of learning factors in neural network and computational difficulty. Therefore in this article, a Boosted Weighted Optimized Convolutional Neural Network Ensemble Classification (BWOCNNEC) algorithm is proposed to lessen the number of learning factors and computation cost of neural network. In this algorithm, the boosting weights are combined into the CNN depending on the least square fitness value. Then, the novel weight values are assigned to the features extracted by the IDA. Moreover, these weight values and the chosen features are processed in different CNN structures within the boosted classifier. Further, the best CNN structure in each iteration i.e., CNNs having the least weighted loss is selected and ensemble to predict and diagnose the lung tumors effectively. Finally, the investigational outcomes exhibit that the IDA-BWOCNNEC achieves better prediction efficiency than the existing algorithms.

New Drug Sotorasib Reduces Tumor Size and Promises to Improve and Increase Survival in Patients with Lung Tumors Caused by Specific DNA Mutations

According to the results of a global phase 2 clinical trial, the new drug stores reduce tumor size and promises to improve and increase survival in patients with lung tumors caused by specific DNA mutations. It is designed to counteract the effects of mutations that are seen in about 13% of patients with non-small cell lung adenocarcinoma (a common type of lung cancer). The Food and Drug Administration (FDA) on May 28 approved the drug as a targeted treatment for patients with small cell lung cancer whose tumors express a specific mutation called G12C in the KRAS gene. Small cell lung cancer accounts for more than 80% of lung cancers. More than 200,000 new cases of non-small cell lung cancer are diagnosed in the United States each year. Keywords: Cancer; Cells; Tissues; Tumors; Prevention; Prognosis; Diagnosis; Imaging; Screening, Treatment; Management

Đánh giá hiệu quả sinh thiết u phổi xuyên thành ngực bằng kim dưới hướng dẫn CT-scan

TÓM TẮT Mục tiêu: Xác định độ chính xác và tỉ lệ tai biến của phương pháp sinh thiết u phổi xuyên thành ngực bằng kim dưới hướng dẫn CTscan. Phương pháp và đối tượng: Hồi cứu, mô tả các bệnh nhân được sinh thiết u phổi xuyên thành ngực bằng kim dưới hướng dẫn CTscan tại bệnh viện Bình Dân từ 3/2019 đến hết 12/2019. Kết quả: Tổng số mẫu là 57 bệnh nhân, nam gần gấp đôi nữ, tuổi trung bình 60,7. Phần lớn bệnh nhân tình cờ phát hiện u phổi (78,9%). U phổi bên phải nhiều hơn bên trái. Kết quả sinh thiết: Ung thư 57,9%; viêm 35,1% và lao 7%. Các trường hợp kết quả sinh thiết là lao: phù hợp với bệnh cảnh lâm sàng, hình ảnh học và được chẩn đoán xác định bởi bác sĩ chuyên khoa lao - Bệnh viện Phạm Ngọc Thạch. Các trường hợp kết quả sinh thiết là viêm: kết quả phẫu thuật là lao 50%, ung thư 20%, viêm 20%. Các trường hợp kết quả sinh thiết là ung thư: so sánh với kết quả phẫu thuật chúng tôi nhận thấy độ nhạy trong phát hiện ung thư phổi của sinh thiết là 85,7%; độ đặc hiệu 100%; giá trị tiên đoán dương 100% và giá trị tiên đoán âm 80%. Tỉ lệ tai biến 21,1% gồm tràn khí màng phổi 12,3%, ho ra máu 7% và tụ máu nhu mô phổi 1,8%. Tỉ lệ tràn khí màng phổi cần dẫn lưu màng phổi cấp cứu là thấp (3,5%). Kết luận: Phương pháp sinh thiết u phổi xuyên thành ngực bằng kim dưới hướng dẫn CTscan khả thi, hiệu quả cao và tương đối an toàn, vì vậy có vai trò quan trọng trong chẩn đoán u phổi. ABSTRACT EVALUATE THE EFFECTIVENESS OF COMPUTED TOMOGRAPHY - GUIDED TRANSTHORACIC CORE NEEDLE BIOPSY OF PULMONARY TUMORS Objectives: The present study aims to determine the diagnostic accuracy of computed tomography (CT) - guided transthoracic core needle biopsy of pulmonary tumorsand the complications of the procedure. Methods: A retrospective descriptive studywas carried out in a series of patients with pulmonary tumors diagnosed by CT - guided transthoracic core needle biopsy at Binh Dan Hospital between 3/2019 and 12/2019. Results: The total sample was 57 patients with an average age was 60.7, male/female = 1.85. Most of the patients were detected lung tumors incidentally (78.9%), and right-side tumors were more than the left - side tumors. Biopsy results included cancer, inflammation, and tuberculosis, with incidence rates were 57.9%, 35.1%, and 7%, respectively. The cases, which were confirmed tuberculosis on biopsy results, were determined tuberculosis by a specialist who worked in Pham Ngoc Thach Hospital. The patients had inflammatory results and were operated on, which had surgical outcomes were tuberculosis (50%), cancer (20%), and inflammation (20%). The cases, which were confirmed cancer on biopsy results after comparing with surgical outcome, found that the biopsy of detecting lung cancer had 85.7% sensitivity, 100% specificity, 100% positive predictive value, and 80% negative predictive value. The rate of complications was 21.1%, including pneumothorax (12.3%), hemoptysis (7%), and pulmonary parenchymal hematoma (1.8%). The rate of pneumothorax requiring emergency pleural drainage was low (3.5%). Conclusions: CT - guided transthoracic core needle biopsy is feasible, highly effective, and relatively safe; therefore, it plays an important role in diagnosing lung tumors. Keywords: Lung tumor, tuberculosis (TB), lung cancer, core biopsy

Percutaneous Image-Guided Ablation of Lung Tumors

Tumors of the lung, including primary cancer and metastases, are notoriously common and difficult to treat. Although surgical resection of lung lesions is often indicated, many conditions disqualify patients from being surgical candidates. Percutaneous image-guided lung ablation is a relatively new set of techniques that offers a promising treatment option for a variety of lung tumors. Although there have been no clinical trials to definitively compare its efficacy to those of traditional treatments, lung ablation is widely practiced and generally accepted to be safe and effective. Especially encouraging results have recently emerged for cryoablation, one of the newer ablative techniques. This article reviews the indications, techniques, contraindications, and complications of percutaneous image-guided ablation of lung tumors with special attention to cryoablation and its recent developments in protocol optimization.