Resolving small pulmonary nodules: CT features

Diederich, Stefan; Hansen, J. Lundsgaard; Wormanns, Dag

doi:10.1007/s00330-005-2836-4

Cited by 34 publications

(27 citation statements)

References 27 publications

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“…Radiographic characteristics that have been proposed as useful to analyze pulmonary nodules include [1][2][3][4]12]:…”

Section: Discussionmentioning

confidence: 99%

“…However, compared to CT imaging, sensitivity and specificity for the detection of lung nodules are low. In addition, small lung nodules are a frequent finding specifically in a risk population for bronchial carcinoma, such as heavy smokers [1,2]. Hence, an improved accuracy to determine a lung nodule's likelihood for malignancy would be desirable, i.e., by a reliable detection of calcifications.…”

Section: Introductionmentioning

confidence: 99%

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CsI-detector-based dual-exposure dual energy in chest radiography for lung nodule detection: results of an international multicenter trial

et al. 2008

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To assess both sensitivity and specificity of digital chest radiography alone and in conjunction with dual-exposure dual-energy chest radiography for the detection and classification of pulmonary nodules. One hundred patients with a total of 149 lung nodules (3-45 mm; median, 11 mm) confirmed by CT were included in this study. Dual-exposure dual-energy chest radiographies of each patient were obtained using a CsI detector system. Experienced board-certified chest radiologists from four different medical centers in Europe reviewed standard chest radiographs alone and in conjunction with dual-energy images blinded and in random order. The reviewers rated the probability of presence, calcification and malignancy of all lung nodules on a five-point rating scale. Lesions detected were identified by applying a specific coordinate system to enable precise verification by the study leader. A receiver-operating characteristic (ROC) analysis was performed. In addition to the 149 true-positive CT proven lesions, 236 false-positive lung nodules were described in digital chest radiographies in conjunction with dual-energy chest radiographies. The cumulative sensitivity of chest radiography in conjunction with dual energy was 43%, specificity was 55%. For digital radiography alone, sensitivity was 35% and specifity was 83%. For the dual energy system, positive predictive value was 58%, and negative predictive value was 66% compared to the digital radiography with a positive predictive value of 59% and a negative predictive value of 65%. Areas under the curve in a ROC analysis resulted in 0.631 (95% confidence interval =0.61 to 0.65) for radiography with dual energy and 0.602 (95% confidence interval =0.58 to 0.63) for digital radiography alone. This difference was not statistically significant. For the detection of lesion calcification or the determination of malignancy, ROC analysis also failed to show significant differences. CsI-based flat-panel dual-exposure dual-energy imaging added to standard chest radiography did not show statistically significant improvement for the detection of pulmonary nodules, nor the identification of calcifications, nor the determination of malignancy.

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“…Radiographic characteristics that have been proposed as useful to analyze pulmonary nodules include [1][2][3][4]12]:…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

CsI-detector-based dual-exposure dual energy in chest radiography for lung nodule detection: results of an international multicenter trial

et al. 2008

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“…Such nodules are detected in 5 to 66% of individuals who smoke (as our trial participant did) (20)(21)(22)(23)(24)(25)(26). Resolution or reduction in size of these nodules is also well recognized, with nodules of less than or equal to 5 mm being the most likely to resolve (20,27). Possible diagnoses that have been proposed for resolving nodules include focal inflammatory lesions, mucoid impaction in small bronchi, or intermittent enlargement of benign intrapulmonary lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Safety and Immunogenicity of a New Tuberculosis Vaccine, MVA85A, in Mycobacterium tuberculosis–infected Individuals

Sander¹,

Pathan²,

Beveridge³

et al. 2009

Am J Respir Crit Care Med

111

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Rationale: An effective new tuberculosis (TB) vaccine regimen must be safe in individuals with latent TB infection (LTBI) and is a priority for global health care. Objectives: To evaluate the safety and immunogenicity of a leading new TB vaccine, recombinant Modified Vaccinia Ankara expressing Antigen 85A (MVA85A) in individuals with LTBI.Methods: An open-label, phase I trial of MVA85A was performed in 12 subjects with LTBI recruited from TB contact clinics in Oxford and London or by poster advertisements in Oxford hospitals. Patients were assessed clinically and had blood samples drawn for immunological analysis over a 52-week period after vaccination with MVA85A. Thoracic computed tomography scans were performed at baseline and at 10 weeks after vaccination. Safety of MVA85A was assessed by clinical, radiological, and inflammatory markers. The immunogenicity of MVA85A was assessed by IFNg and IL-2 ELISpot assays and FACS. Measurements and Main Results: MVA85A was safe in subjects with LTBI, with comparable adverse events to previous trials of MVA85A. There were no clinically significant changes in inflammatory markers or thoracic computed tomography scans after vaccination. MVA85A induced a strong antigen-specific IFN-g and IL-2 response that was durable for 52 weeks. The magnitude of IFN-g response was comparable to previous trials of MVA85A in bacillus CalmetteGuérin-vaccinated individuals. Antigen 85A-specific polyfunctional CD4 1 T cells were detectable prior to vaccination with statistically significant increases in cell numbers after vaccination. Conclusions: MVA85A is safe and highly immunogenic in individuals with LTBI. These results will facilitate further trials in TB-endemic areas. Clinical trial registered with www.clinicaltrials.gov (NCT00456183).

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“…Two other screening studies reported confl icting results about potential predictors of resolv ing (and therefore benign) nodules. 18,19 Other studies have used computer-assisted techniques or novel CT scan parameters to discriminate between malignant and benign nodules, but these have been limited by small size, imprecision, and lack of external validation. 20,21 Consequently, although CT scan morphology often helps to estimate the probability of malignancy, it is rarely conclusive.…”

Section: Suitability For Surgery or Othermentioning

confidence: 99%

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

Gould

Donington

Lynch

et al. 2013

Chest

1,163

1,089

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we suggest that no additional diagnostic evaluation need be performed (Grade 2C) .Remark : This recommendation applies only to solid nodules. For guidance about follow-up of subsolid nodules, see Recommendations 6.5.1 to 6.5.4 . 2.3.3.In the individual with an indeterminate nodule that is identifi ed by chest radiography, we recommend that CT of the chest should be performed (preferably with thin sections Objectives: The objective of this article is to update previous evidence-based recommendations for evaluation and management of individuals with solid pulmonary nodules and to generate new recommendations for those with nonsolid nodules. Methods: We updated prior literature reviews, synthesized evidence, and formulated recommendations by using the methods described in the "Methodology for Development of Guidelines for Lung Cancer" in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed. Results: We formulated recommendations for evaluating solid pulmonary nodules that measure . 8 mm in diameter, solid nodules that measure Յ 8 mm in diameter, and subsolid nodules. The recommendations stress the value of assessing the probability of malignancy, the utility of imaging tests, the need to weigh the benefi ts and harms of different management strategies (nonsurgical biopsy, surgical resection, and surveillance with chest CT imaging), and the importance of eliciting patient preferences. Conclusions: Individuals with pulmonary nodules should be evaluated and managed by estimating the probability of malignancy, performing imaging tests to better characterize the lesions, evaluating the risks associated with various management alternatives, and eliciting their preferences for management. CHEST 2013; 143(5)(Suppl):e93S-e120SAbbreviations: AAH 5 atypical adenomatous hyperplasia; ACCP 5 American College of Chest Physicians; AIS 5 adenocarcinoma in situ; EBUS 5 endobronchial ultrasound; ENB 5 electromagnetic navigation bronchoscopy; FDG 5 fl uorodeoxyglucose; HU 5 Hounsfi eld unit; LR 5 likelihood ratio; SPECT 5 single-photon emission CT; TBB 5 transbronchial biopsy; TTNB 5 transthoracic needle biopsy; VATS 5 video-assisted thoracic surgery; VBN 5 virtual bronchoscopy navigation; VDT 5 volume doubling time

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Resolving small pulmonary nodules: CT features

Cited by 34 publications

References 27 publications

CsI-detector-based dual-exposure dual energy in chest radiography for lung nodule detection: results of an international multicenter trial

CsI-detector-based dual-exposure dual energy in chest radiography for lung nodule detection: results of an international multicenter trial

Safety and Immunogenicity of a New Tuberculosis Vaccine, MVA85A, in Mycobacterium tuberculosis–infected Individuals

Evaluation of Individuals With Pulmonary Nodules: When Is It Lung Cancer?

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