•In this single-institution study, the lung cancer screening incidence was 9.4%.•The overall survival did not differ between females and males among screened group.•Females unscreened had a lower ...risk of mortality and better survival than males.
Low dose computed tomography (LDCT) became the standard method for lung cancer (LC) screening in 2013. However, it is unclear whether there are differences in survival rates based on sex and whether the differences depend on screening status. We aimed to evaluate the LC survival rates between females and males based on screening.
This retrospective cohort study examined data from the Boston LC Study (BLCS) between 2013 and 2021. LC screening depends on patients’ demographics (age and smoking history) to determine whether a person is a high-risk individual and, therefore, undergo LDCT. Descriptive statistics were calculated for race, age, histology, smoking history, stage, and treatment. These variables' distributions were compared between sex and screening status using t-test and chi-square, respectively. Cox proportional hazards model and Kaplan-Meier curves were used to compare survival between sex and screening. Propensity score matching was applied to account for selection bias in screening when evaluating the association between screening and stage.
A total of 1,216 LC patients were identified with a screening incidence of 9.4 %, among whom 56 % were female. Unscreened males had 1.59 times higher risk of mortality than unscreened females (P=.0002) and had a worse 5-year survival (male 50 %; 95 %CI, 0.38,0.6 vs female 70 %; 95 %CI,0.62,0.76). In contrast, there were no significant differences in survival between sexes among screened. In a balanced cohort of screened and unscreened, the odds of being diagnosed at late stages for females and smokers were 1.33 and 2.51 times that of males and nonsmokers; however, there were no statistical significance.
Unscreened females had a lower risk of mortality and better survival than unscreened males, while among the screened population, there was no difference in the overall survival. These observations demonstrate the influence of sex on survival prognosis in LC when screening is not performed.
This study aimed to assess if computed tomography (CT) radiomics can predict the severity and outcome of patients with coronavirus disease 2019 (COVID-19) pneumonia.
This institutional ethical ...board-approved study included 92 patients (mean age, 59 ± 17 years; 57 men, 35 women) with positive reverse transcription polymerase chain reaction assay for COVID-19 infection who underwent noncontrast chest CT. Two radiologists evaluated all chest CT examinations and recorded opacity type, distribution, and extent of lobar involvement. Information on symptom duration before hospital admission, the period of hospital admission, presence of comorbid conditions, laboratory data, and outcomes (recovery or death) was obtained from the medical records. The entire lung volume was segmented on thin-section Digital Imaging and Communication in Medicine images to derive whole-lung radiomics. Data were analyzed using multiple logistic regression with receiver operator characteristic area under the curve (AUC) as the output.
Computed tomography radiomics (AUC, 0.99) outperformed clinical variables (AUC, 0.89) for prediction of the extent of pulmonary opacities related to COVID-19 pneumonia. Type of pulmonary opacities could be predicted with CT radiomics (AUC, 0.77) but not with clinical or laboratory data (AUC, <0.56; P > 0.05). Prediction of patient outcome with radiomics (AUC, 0.85) improved to an AUC of 0.90 with the addition of clinical variables (patient age and duration of presenting symptoms before admission). Among clinical variables, the combination of peripheral capillary oxygen saturation on hospital admission, duration of symptoms, platelet counts, and patient age provided an AUC of 0.81 for predicting patient outcomes.
Radiomics from noncontrast CT reliably predict disease severity (AUC, 0.99) and outcome (AUC, 0.85) in patients with COVID-19 pneumonia.
To assess radiation dose reduction and image quality for weight-based chest computed tomographic (CT) examination results reconstructed using adaptive statistical iterative reconstruction (ASIR) ...technique.
With local ethical committee approval, weight-adjusted chest CT examinations were performed using ASIR in 98 patients and filtered backprojection (FBP) in 54 weight-matched patients on a 64-slice multidetector CT. Patients were categorized into 3 groups: 60 kg or less (n = 32), 61 to 90 kg (n = 77), and 91 kg or more (n = 43) for weight-based adjustment of noise indices for automatic exposure control (Auto mA; GE Healthcare, Waukesha, Wis). Remaining scan parameters were held constant at 0.984:1 pitch, 120 kilovolts (peak), 40-mm table feed per rotation, and 2.5-mm section thickness. Patients' weight, scanning parameters, and CT dose index volume were recorded. Effective doses (EDs) were estimated. Image noise was measured in the descending thoracic aorta at the level of the carina. Data were analyzed using analysis of variance.
Compared with FBP, ASIR was associated with an overall mean (SD) decrease of 27.6% in ED (ASIR, 8.8 2.3 mSv; FBP, 12.2 2.1 mSv; P < 0.0001). With the use of ASIR, the ED values were 6.5 (1.8) mSv (28.8% decrease), 7.3 (1.6) mSv (27.3% decrease), and 12.8 (2.3) mSv (26.8% decrease) for the weight groups of 60 kg or less, 61 to 90 kg, and 91 kg or more, respectively, compared with 9.2 (2.3) mSv, 10.0 (2.0) mSv, and 17.4 (2.1) mSv with FBP (P < 0.0001). Despite dose reduction, there was less noise with ASIR (12.6 2.9 mSv) than with FBP (16.6 6.2 mSv; P < 0.0001).
Adaptive statistical iterative reconstruction helps reduce chest CT radiation dose and improve image quality compared with the conventionally used FBP image reconstruction.
The aims of this study were to investigate the association between 8-week tumor volume decrease and survival in an independent cohort of epidermal growth factor receptor (EGFR)-mutant advanced ...non-small cell lung cancer (NSCLC) patients treated with first-line erlotinib or gefitinib, and to assess the rate of their volumetric tumor growth after the volume nadir.
In patients with advanced NSCLC harboring sensitizing EGFR mutations treated with first-line erlotinib or gefitinib, computed tomography (CT) tumor volumes of dominant lung lesions were analyzed for (1) the association with survival, and (2) the volumetric tumor growth rate after the volume nadir.
In 44 patients with the 8-week follow-up CT, the 8-week tumor volume decrease (%) was significantly associated with longer overall survival when fitted as a continuous variable in a Cox model (P = 0.01). The growth rate of the logarithm of tumor volume (logeV), obtained using a linear mixed-effects model adjusting for time since baseline, was 0.096/month (SE: 0.013/month; 95% confidence interval CI: 0.071-0.12/month), which was similar to the rate of 0.12/month (SE: 0.015/month; 95%CI: 0.090-0.15/month) observed in the previous report.
The 8-week tumor volume decrease was validated as a marker for longer survival in the independent cohort of EGFR-mutant NSCLC patients treated with first-line erlotinib or gefitinib. The volumetric tumor growth rate after the nadir in this cohort was similar to that of the previous cohort, indicating the reproducibility of the observation among different patient cohorts.
We hypothesized that clinical process improvement strategies can reduce frequency of motion artifacts and expiratory phase scanning in chest CT. We reviewed 826 chest CT to establish the baseline ...frequency. Per clinical process improvement guidelines, we brainstormed corrective measures and priority-pay-off matrix. The first intervention involved education of CT technologists, following which 795 chest CT were reviewed. For the second intervention, instructional videos on optimal breath-hold were shown to 245 adult patients just before their chest CT. Presence of motion artifacts and expiratory phase scanning was assessed. We also reviewed 311 chest CT scans belonging to a control group of patients who did not see the instructional videos. Pareto and percentage run charts were created for baseline and post-intervention data. Baseline incidence of motion artifacts and expiratory phase scanning in chest CT was 35% (292/826). There was no change in the corresponding incidence following the first intervention (36%; 283/795). Respiratory motion and expiratory phase chest CT with the second intervention decreased (8%, 20/245 patients). Instructional videos for patients (and not education and training of CT technologists) reduce the frequency of motion artifacts and expiratory phase scanning in chest CT.
Guidelines recommend obtaining a computed tomography scan of the chest for the staging of pleural mesothelioma and for assessing response to treatment. Consensus is lacking regarding the necessity of ...serial imaging of distant extrathoracic sites. In this study, we determined the prevalence of extrathoracic metastases in patients with pleural mesothelioma.
We conducted a retrospective review of patients with pleural mesothelioma treated at Massachusetts General Hospital between 1999 and 2022 who were referred for extrathoracic imaging during their disease course. Imaging reports were reviewed to determine sites of metastasis and calculate the time to development of extrathoracic metastasis. Overall survival and prevalence of extrathoracic metastasis were compared for patients with epithelioid versus nonepithelioid mesothelioma.
The study included 148 patients, 69 (47%) of whom had undergone cytoreductive surgery. Histologic types included epithelioid (n = 82, 55%), biphasic (n = 49, 33%), and sarcomatoid (n = 10, 7%) mesothelioma. The median overall survival for the cohort was 24.0 months, specifically 34.7 months and 16.7 months for patients with epithelioid and nonepithelioid tumors, respectively (p < 0.001). There were 65 (44%) patients who developed extrathoracic metastases, with a median time to extrathoracic metastasis of 11.5 months. The most common sites of involvement were extrathoracic nodes (22%), peritoneum (20%), bone (11%), and liver (11%). Of the 76 patients referred for brain imaging, seven (9%) had brain metastases. The frequency of extrathoracic metastasis was identical for epithelioid and nonepithelioid mesothelioma (44%). Overall survival was shorter for patients who developed extrathoracic metastases (hazard ratio 5.9, p < 0.001).
Patients with pleural mesothelioma often develop extrathoracic metastases, providing a rationale for routinely obtaining imaging that encompasses sites outside of the thoracic cavity.
Rearranged during transfection proto-oncogene (
) fusions represent a potentially targetable oncogenic driver in non-small cell lung cancer (NSCLC). Imaging features and metastatic patterns of ...advanced
fusion-positive (
+) NSCLC are not well established. Our goal was to compare the imaging features and patterns of metastases in
+,
+ and
+ NSCLC. Patients with
+,
+, or
+ NSCLC seen at our institution between January 2014 and December 2018 with available pre-treatment imaging were identified. The clinicopathologic features, imaging characteristics, and the distribution of metastases were reviewed and compared. We identified 215 patients with NSCLC harboring
,
, or
gene fusion (
= 32;
= 116;
= 67). Patients with
+ NSCLC were older at presentation compared to
+ and
+ patients (median age:
= 64 years;
= 51 years,
< 0.001; ROS = 54 years,
= 0.042) and had a higher frequency of neuroendocrine histology (
= 12%;
= 2%,
= 0.025;
= 0%,
= 0.010). Primary tumors in
+ patients were more likely to be peripheral (
= 69%;
= 47%,
= 0.029;
= 36%,
= 0.003), whereas lobar location, size, and density were comparable across the three groups.
+ NSCLC was associated with a higher frequency of brain metastases at diagnosis compared to
+ NSCLC (
= 32%,
= 10%;
= 0.039. Metastatic patterns were otherwise similar across the three molecular subgroups, with high incidences of lymphangitic carcinomatosis, pleural metastases, and sclerotic bone metastases.
+ NSCLC shares several distinct radiologic features and metastatic spread with
+ and
NSCLC. These features may suggest the presence of
fusions and help identify patients who may benefit from further molecular genotyping.
Summary Organizing pneumonia (OP) is a histopathologic pattern of response to lung injury. Fibrin is a marker of acute microvascular injury, and variable amounts of intraalveolar fibrin are seen in ...OP; however, its relevance to clinical outcomes is unclear. We examined lung wedge biopsies of 26 patients with cryptogenic organizing pneumonia (COP), assessed the amount of fibrin associated with airspace organization, and correlated fibrin levels with other histologic, clinical, and radiographic findings. Seven patients with COP had disease relapse. Patients with multifocal fibrin deposits or acute fibrinous and organizing pneumonia (collectively, “high fibrin”) showed a higher rate of OP relapse compared to those with no or focal fibrin (60% versus 6%, P < .05). Patients with radiographic evidence of disease involving all three lung zones (upper, middle, and lower) also showed higher rates of relapse compared to those in whom disease was limited to one or two zones (41% versus 0%, P = .055). In patients with both pathologic evidence of high fibrin and radiographic evidence of three-zone disease, OP relapse could be predicted with a sensitivity of 86% and specificity of 84% (positive predictive value of 67% and negative predictive value of 94%). The presence of high levels of intraalveolar fibrin in lung biopsies and radiographic evidence of disease involving all three lung zones is associated with increased risk of relapse in patients with COP, and these features may help identify patients who may benefit from more intensive steroid therapy.
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