Modern medicine is supported by increasingly sophisticated algorithms. In diagnostics or screening, statistical models are commonly used to assess the risk of disease development, the severity of its ...course, and expected treatment outcome. The growing availability of very detailed data and increased interest in personalized medicine are leading to the development of effective but complex machine learning models. For these models to be trusted, their predictions must be understandable to both the physician and the patient, hence the growing interest in the area of Explainable Artificial Intelligence (XAI). In this paper, we present selected methods from the XAI field in the example of models applied to assess lung cancer risk in lung cancer screening through low-dose computed tomography. The use of these techniques provides a better understanding of the similarities and differences between three commonly used models in lung cancer screening, i.e., BACH, PLCOm2012, and LCART. For the presentation of the results, we used data from the Domestic Lung Cancer Database. The XAI techniques help to better understand (1) which variables are most important in which model, (2) how they are transformed into model predictions, and facilitate (3) the explanation of model predictions for a particular screenee.
Introduction The history of the treatment of neoplastic metastases and its evolution over more than one hundred years has raised many doubts as to the purposefulness of such management. The main ...problem that made it difficult to draw certain statistically confirmed conclusions was the inability to conduct prospective studies. Over the years, based on the experience gained and the multicenter analyses carried out, it was determined which elements of the surgical treatment affect the prognosis. Some doubts are raised by the issue of the progression of secondary proliferative disease, which results in a greater number of metastasectomies. Aim To investigate the factors influencing progression-free survival (PFS) after surgical treatment of secondary proliferative disease with lung involvement. This parameter is directly related to the overall survival time. Material and methods Five hundred and seventy-seven patients treated surgically due to secondary neoplastic disease with lung involvement were included. One-, three- and five-year PFS was examined. PFS was defined as the time from the first to the next metastasectomy or death from any other cause. One-factor and multi-factor statistical analysis was used. Results Longer PFS was found in patients over 60 years of age, after unilateral and radical metastasectomies, with a longer time from primary tumor resection to secondary lesions (disease-free interval, DFI). The longest PFS was found for colorectal cancer, the shortest for sarcoma. The presence of nodal metastases and gender did not differentiate PFS. Conclusions The greatest probability of longer relapse-free survival, and thus longer overall survival, occurs in patients after radical unilateral metastasectomy. Another parameter that positively influences PFS is longer DFI. Histological type differentiates PFS.
Surgical treatment of neoplastic lung metastases is a big therapeutic problem, at the stage of qualifying for the procedure, in the surgical technique itself, and in the tactics of managing ...subsequent disease relapses. The most doubtful aspect is determining which factors influence the prolongation of survival in patients with such a diagnosis.
To determine which factors influence the effectiveness of surgical treatment of neoplastic metastases to the lungs.
A group of 577 patients was subjected to the study. An analysis of all performed operations (1009) was also carried out according to the set goals. Statistical analysis was performed using the estimates of the χ
test, Kaplan-Meier estimator, and log-rank test.
It was established what statistically significant factors may improve the treatment effectiveness. It was found that the lack of radicalism was influenced by: the number of lung metastases, the presence of changes in the lymph nodes, age, histology of the primary tumor and its location, and the number of treatments. Nodal metastases are more common in non-radical procedures, depend on the patient's age, are more often found in unilateral procedures, and depend on the location and histology of the primary tumor.
It was found that the radical nature of the procedure did not affect the progression of the disease, but it did have an impact on survival. Relapses are more common in bilateral procedures, reducing survival. Lymph node metastases worsen the prognosis.
Abstract
OBJECTIVES
We aimed to investigate the clinical significance of left lower paratracheal nodes (#4L) and their impact on survival in patients with left-sided lung cancer.
METHODS
This was a ...retrospective analysis of prospective data. The study included 5369 patients who underwent surgery between 2005 and 2015. Six hundred fifty-nine patients underwent #4L dissection (4LND+), and 4710 did not (4LND−). Propensity score matching was used to minimize analytic error (659 vs 659).
RESULTS
The percentage of #4L metastasis increased with tumour size. Between pT2a and pT2b, it nearly doubled from 8% to 14%. The mean percentage of #4L metastasis in the pN2 group was 46, which was higher in left upper lobectomy compared to left lower lobectomy (63% vs 43%, respectively, P < 0.001). In univariable analysis, no differences in 5-year survival were observed between 4LND+ and 4LND− (48% vs 50%, respectively, P = 0.65). However, we detected a significant difference among non-metastatic 4LND+, 4LND− and metastatic 4LND+ (P < 0.0001). After propensity score matching, there were no significant differences in survival among the pN2 subgroups (pN2a1, pN2a2, pN2b1, pN2b2). Multivariable analysis after propensity score matching for each pN2 subgroup did not confirm the effect of #4L metastasis as an independent prognostic factor.
CONCLUSIONS
Despite #4L nodes not being an independent prognostic factor in lung cancer, the percentage of nodal metastases notably increases above pT2a grade and is comparable to the percentage of #5 and #7 metastasis. Therefore, lymphadenectomy in advanced stages of cancer could benefit from resections of the #4L nodes.
Objective:
Mediastinoscopy as diagnostic procedure for evaluation of mediastinum in patients with non-small-cell lung cancer has long been considered the reference standard. However, less invasive ...method has occurred. Endobronchial ultrasound–guided transbronchial needle aspiration came into widespread use and has resulted in controversy as to whether it is a good replacement for mediastinoscopy. We chose to demonstrate the usefulness of endobronchial ultrasound–guided transbronchial needle aspiration in evaluating the mediastinum in patients with non-small-cell lung cancer.
Material and methods:
Over a 48-month period, 1841 patients underwent endobronchial ultrasound–guided transbronchial needle aspiration at our healthcare centre. In all patients, 2964 biopsies from the lymph node group N2 and 783 from group N1 were taken. The mean short axis of the lymph nodes biopsied was 2.0 (range: 0.6–2.6). The mean number of lymph node stations biopsied per patient was 2.6. Patients with a negative result of endobronchial ultrasound–guided transbronchial needle aspiration underwent mediastinoscopy. All patients with a negative result in endobronchial ultrasound–guided transbronchial needle aspiration and mediastinoscopy underwent surgical resection with lymph node sampling.
Results:
The metastases to lymph nodes N2/N3 and N1 were found in 1111 (60.3%) and 199 (9.3%), respectively. Mediastinoscopy was performed in 730 patients with a positive result in 83 (11.4%) patients. In the group of operated patients, metastatic N1 disease was found in 264 (14.1%). In the group of the operated patients, mediastinal involvement of disease (N2) was found in 30 patients (4.5%). The sensitivity, negative predictive value and diagnostic accuracy for hilar lymph node staging for endobronchial ultrasound–guided transbronchial needle aspiration were 57%, 96% and 96%, respectively. The sensitivity, negative predictive value and diagnostic accuracy per patient for mediastinal lymph node staging for endobronchial ultrasound–guided transbronchial needle aspiration and mediastinoscopy were 91%, 85%, 93% and 73%, 95.5%, 97%, respectively. The specificity and positive predictive value of both tests were 100%.
Conclusion:
The clinical usefulness of endobronchial ultrasound–guided transbronchial needle aspiration is undeniable according to diagnostic performance data. Endobronchial ultrasound–guided transbronchial needle aspiration should be considered complementary to mediastinoscopy in the evaluation of patients with radiographically abnormal mediastinum.
The problem of treating secondary cancer is very controversial. Huge progress in its treatment began in the 1970s with the introduction of chemotherapy. In the surgical aspect Pastorino's work ...published in 1997 was a milestone. To this day, most authors cite its research results.
The task is to answer the question what tactics to follow in the surgical treatment of patients with secondary cancer affecting the respiratory system.
Retrospective studies were conducted on a group of 577 patients. Men prevailed slightly. The average age was 56 years. Surgical access used in the vast majority of cases was anterolateral thoracotomy. Wedge resection was the most common scope of surgery. Lymph nodes were not removed as standard. Single and multifactorial statistical surveys were conducted (Kaplan-Meier estimator and multifactorial Cox regression analysis).
A total of 1,058 operations were performed during which 1889 metastases were removed. Negative tissue margins were obtained in 90.4%. The median survival was 47 months. Complications occurred in 76 patients, which constituted 7.1% of performed procedures. There were 3 perioperative deaths.
It was found that the factors negatively affecting survival were lack of radicalism, size of the metastasis > 3 cm, and number of metastases > 1. The factors positively influencing survival were a longer time than primary surgery and a greater number of operations. Histological diagnosis differentiated patient survival.
Background and Aims
Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is an accurate and minimally invasive technique that has been shown to have excellent diagnostic yield ...in the diagnosis of mediastinal and hilar lymphadenopathy. However, endoscopic bronchial biopsy (EBB) and transbronchial lung biopsy (TBLB) are still the standard method for making a pathologic diagnosis of sarcoidosis. The aim of this study was to compare the diagnostic yield of EBUS‐TBNA and TBLB through a flexible bronchoscope in patients with stage I and II sarcoidosis.
Methods
A total of 653 patients with suspected stage I and II sarcoidosis were included in this retrospective study. After radiological assessment, patients were qualified to bronchoscopy. Patients underwent sequential EBUS‐TBNA followed by TBLB and/or EBB. In all patients, 1056 biopsies from mediastinal lymph nodes group were taken.
Results
In all of the biopsied lymph nodes, positive results were obtained in 549 patients (84%). In 180 patients with stage II TBLB, a biopsy was taken from affected part of the lung. Positive results were found in 79 patients (43.9%). EBB was performed in 340 patients, with a positive result in 101 (29.7%). Mediastinoscopy was performed in 60 patients (9.2%) with a negative result in EBUS‐TBNA, TBLB and/or EBB. Non‐caseating granulomas were found in 48 patients. The sensitivity of TBLB technique alone was significantly lower at 43.9% (79/180) (P < 0.001). The sensitivity of EBB was significantly lower than EBUS‐TBNA and TBLB and reached 29.7% (101/340) (P < 0.0001, P < 0.003). The overall diagnostic accuracy for EBUS‐TBNA was 84%, and the combination of EBUS‐TBNA with standard bronchoscopic techniques had a diagnostic accuracy of 89%.
Conclusion
The diagnostic yield of the EBUS‐TBNA for stage I and II sarcoidosis is clearly higher than for TBLB and EBB. The combination of EBUS‐TBNA with standard bronchoscopic techniques is safe and feasible, and optimizes the diagnostic yield in patients with pulmonary sarcoidosis and enlarged intrathoracic lymph nodes. EBUS‐TBNA in combination with standard bronchoscopy may be considered to be the first‐line investigation in patients with suspected sarcoidosis and enlarged intrathoracic lymphadenopathy.
Micro-Abstract The aim of the study was to evaluate risk factors for local and distant recurrence after surgical treatment of non–small-cell lung cancer. A total of 14,578 patients met the inclusion ...criteria and had complete follow-up information. Analysis indicated independent effects of the following risk factors on the risk of recurrence: age 64–90 years, histologic type of adenocarcinoma, blood vessel invasion, lymphatic vessel invasion, visceral pleural invasion, N1 or N2 disease, tumor size of 20–30 mm, 30–50 mm, 50–70 mm, and 70–100 mm, pneumonectomy, and sublobar resection.
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