Shades of Gray

Azour, Lea; Ko, Jane P.; Naidich, David P.; Moore, William

doi:10.1016/j.chest.2020.09.252

Cited by 13 publications

(4 citation statements)

References 80 publications

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“…Nodule growth is defined as a change in size of ≥2 mm in the BTS guidelines ( 75 ) and ≥1.5 mm in Lung-RADS 2022 ( 79 ) and NCCN guidelines ( 80 ). Nodule progression may manifest as a new or increasing solid component, or a uniform increase in attenuation ( 81 ). All guidelines recommend active surveillance and intervention for SSNs with interval progression.…”

Section: Clinical Guidelines For the Surveillance Of Incidentally Det...mentioning

confidence: 99%

A narrative review of the clinical approach to subsolid pulmonary nodules

Kim¹,

Um²

2023

Ann Transl Med

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Background and Objective The widespread use of chest computed tomography (CT) for lung cancer screening has led to increased detection of subsolid pulmonary nodules. The management of subsolid nodules (SSNs) is challenging since they are likely to grow slowly and a long-term follow-up is needed. In this review, we discuss the characteristics, natural history, genetic features, surveillance, and management of SSNs. Methods PubMed and Google Scholar were searched to identify relevant articles published in English between January 1998 and December 2022 using the following keywords: “subsolid nodule”, “ground-glass nodule (GGN)”, and “part-solid nodule (PSN)”. Key Content and Findings The differential diagnosis of SSNs includes transient inflammatory lesions, focal fibrosis, and premalignant or malignant lesions. Long-term CT surveillance follow-up is needed to manage SSNs that persist for >3 months. Although most SSNs have an indolent clinical course, PSNs may have a more aggressive clinical course than pure GGNs. The proportion of growth and the time to grow is higher and shorter in PSN than pure GGN. In lung adenocarcinoma manifesting as SSNs, EGFR mutations were the major driver mutations. Guidelines are available for the management of incidentally detected and screening-detected SSNs. The size, solidity, location, and number of SSNs are important factors in determining the need for surveillance and surgical resection, as well as the interval of follow-up. Positron emission tomography/CT and brain magnetic resonance imaging (MRI) are not recommended for the diagnosis of SSNs, especially for pure GGNs. Periodic CT surveillance and lung-sparing surgery are the main strategies for the management of persistent SSNs. Nonsurgical treatment options for persistent SSNs include stereotactic body radiotherapy (SBRT) and radiofrequency ablation (RFA). For multifocal SSNs, the timing of repeated CT scans and the need for surgical treatment are decided based on the most dominant SSN(s). Conclusions The SSN is a heterogeneous disease and a personalized medicine approach is required in the future. Future studies of SSNs should focus on their natural history, optimal follow-up duration, genetic features, and surgical and nonsurgical treatments to improve the corresponding clinical management. All these efforts will lead to the personalized medicine approach for the SSNs.

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Section: Clinical Guidelines For the Surveillance Of Incidentally Det...mentioning

confidence: 99%

A narrative review of the clinical approach to subsolid pulmonary nodules

Kim¹,

Um²

2023

Ann Transl Med

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“…For example, hydatid cyst rupture can disseminate contents and lead to severe allergic reaction or eosinophilic pleurisy 24 . In the setting of new lesions, a short-term follow-up may be beneficial, as many transient lesions may mimic malignancy 25 …”

Section: Lesion Factorsmentioning

confidence: 99%

“…24 In the setting of new lesions, a short-term follow-up may be beneficial, as many transient lesions may mimic malignancy. 25…”

Section: Lesion Factorsmentioning

confidence: 99%

Percutaneous Transthoracic Lung Biopsy: Optimizing Yield and Mitigating Risk

Azour

Liu

Washer

et al. 2021

J Comput Assist Tomogr

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Percutaneous computed tomography-guided transthoracic lung biopsy is an effective and minimally invasive procedure to achieve tissue diagnosis. Radiologists are key in appropriate referral for further workup, with percutaneous computed tomography-guided transthoracic lung biopsy performed by both thoracic and general interventionalists. Percutaneous computed tomography-guided transthoracic lung biopsy is increasingly performed for both diagnostic and research purposes, including molecular analysis. Multiple patient, lesion, and technique-related variables influence diagnostic accuracy and complication rates. A comprehensive understanding of these factors aids in procedure planning and may serve to maximize diagnostic yield while minimizing complications, even in the most challenging scenarios.

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“…Persistent GGNs on computed tomography (CT) are usually the earliest stage in the development of lung adenocarcinomas (2). For newly detected GGNs, the Fleischner Society, American College of Radiology, and NELSON study gave corresponding management recommendations according to the size and volume of nodules, respectively (4)(5)(6)(7)(8). Physicians usually review CT scans after a specific interval (3 months, 6 months, or even one year) to observe the change in GGNs and then decide whether to intervene or continue to follow up according to the growth rate.…”

Section: Introductionmentioning

confidence: 99%

Baseline whole-lung CT features deriving from deep learning and radiomics: prediction of benign and malignant pulmonary ground-glass nodules

Huang,

Deng,

et al. 2023

Front. Oncol.

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ObjectiveTo develop and validate the model for predicting benign and malignant ground-glass nodules (GGNs) based on the whole-lung baseline CT features deriving from deep learning and radiomics.MethodsThis retrospective study included 385 GGNs from 3 hospitals, confirmed by pathology. We used 239 GGNs from Hospital 1 as the training and internal validation set; 115 and 31 GGNs from Hospital 2 and Hospital 3 as the external test sets 1 and 2, respectively. An additional 32 stable GGNs from Hospital 3 with more than five years of follow-up were used as the external test set 3. We evaluated clinical and morphological features of GGNs at baseline chest CT and extracted the whole-lung radiomics features simultaneously. Besides, baseline whole-lung CT image features are further assisted and extracted using the convolutional neural network. We used the back-propagation neural network to construct five prediction models based on different collocations of the features used for training. The area under the receiver operator characteristic curve (AUC) was used to compare the prediction performance among the five models. The Delong test was used to compare the differences in AUC between models pairwise.ResultsThe model integrated clinical-morphological features, whole-lung radiomic features, and whole-lung image features (CMRI) performed best among the five models, and achieved the highest AUC in the internal validation set, external test set 1, and external test set 2, which were 0.886 (95% CI: 0.841-0.921), 0.830 (95%CI: 0.749-0.893) and 0.879 (95%CI: 0.712-0.968), respectively. In the above three sets, the differences in AUC between the CMRI model and other models were significant (all P < 0.05). Moreover, the accuracy of the CMRI model in the external test set 3 was 96.88%.ConclusionThe baseline whole-lung CT features were feasible to predict the benign and malignant of GGNs, which is helpful for more refined management of GGNs.

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Shades of Gray

Cited by 13 publications

References 80 publications

A narrative review of the clinical approach to subsolid pulmonary nodules

A narrative review of the clinical approach to subsolid pulmonary nodules

Percutaneous Transthoracic Lung Biopsy: Optimizing Yield and Mitigating Risk

Baseline whole-lung CT features deriving from deep learning and radiomics: prediction of benign and malignant pulmonary ground-glass nodules

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