Incidence and mortality attributed to lung cancer has risen steadily since the 1930s. Efforts to improve outcomes have not only led to a greater understanding of the etiology of lung cancer, but also the histologic and molecular characteristics of individual lung tumors. This article describes this evolution by discussing the extent of the current lung cancer epidemic including contemporary incidence and mortality trends, the risk factors for development of lung cancer, and details of promising molecular targets for treatment.

Overall intra- and interobserver variability rates were similar; in clinical practice, serial CT measurements can be safely performed by different radiologists. Smooth margins, larger lesion size, and greater reader experience resulted in a higher consistency of measurements. Depending on lesion size, increases of 4%-6% or greater in long axis and 5%-7% or greater in short axis and decreases of -6% to -10% or greater in long axis and -6% to -12% or greater in short axis at CT can be considered true changes rather than measurement variation, with 95% confidence.

Dr(hc) Michelle S. Ginsberg, MD Purpose:To assess variability of computed tomographic (CT) measurements of lesions of various sizes and margin sharpness in several organs taken by readers with different levels of experience, as would be found in routine clinical practice. Materials and Methods:In this institutional review board-approved, HIPAA-compliant retrospective study, 17 radiologists with varying levels of experience independently obtained bidimensional orthogonal axial measurements of 80 lymph nodes, 120 pulmonary lesions, and 120 hepatic lesions, categorized by size and margin sharpness. Repeat measurements were performed 2 or more weeks later. Intraclass correlation coefficients and Bland-Altman plots were used to assess intra-and interobserver variability. Results:For long-and short-axis measurements, respectively, overall intraobserver agreement rates were 0.957 (95% confidence interval [CI]: 0.947, 0.966) and 0.945 (95% CI: 0.933, 0.955); interobserver agreement rates were 0.954 (95% CI: 0.943, 0.963) and 0.941 (95% CI: 0.929, 0.951).Both intra-and interobserver agreement differed by lesion size, margin sharpness, location, and reader experience. Agreement ranged from 0.847 to 0.886 for lesions 20 mm or larger versus 0.745-0.785 for lesions smaller than 10 mm, 0.961 to 0.975 for smooth margins versus 0.924-0.942 for irregular margins, 0.955 to 0.97 for lung lesions versus 0.884-0.94 for lymph nodes, and 0.95 to 0.97 for attending radiologists versus 0.928-0.945 for fellows. Measurement variability decreased with increasing lesion size; 95% limits of agreement for short-axis measurements were 211.6% to 6.7% for lesions smaller than 10 mm versus 26.2% to 4.7% for lesions 20 mm or larger. Conclusion:Overall intra-and interobserver variability rates were similar; in clinical practice, serial CT measurements can be safely performed by different radiologists. Smooth margins, larger lesion size, and greater reader experience resulted in a higher consistency of measurements. Depending on lesion size, increases of 4%-6% or greater in long axis and 5%-7% or greater in short axis and decreases of 26% to 210% or greater in long axis and 26% to 212% or greater in short axis at CT can be considered true changes rather than measurement variation, with 95% confidence.q RSNA, 2013

Introduction The increasing use of computed tomography (CT) has led to more-frequent identification of asymptomatic lesions in the anterior mediastinum. The purpose of this study is to identify CT features that distinguish benign thymic lesions from early stage malignant thymic neoplasms. Methods We retrospectively reviewed preoperative CT imaging for 66 patients who had undergone thymectomy for benign thymic lesions or early stage malignant thymic neoplasms. All variables with a p-value <0.2 on univariate logistic regression analysis were evaluated by multivariate analysis. Stepwise selection was performed, and variables with a p-value <0.05 were retained in the final model. Results Thirty-eight malignant (58%) and 28 benign thymic lesions (42%) were included. Patients with benign thymic tumors were significantly younger (median age, 49.5 years) than patients with malignant tumors (60.0 years; p=0.007). Malignant tumors were larger in short-axis dimension (p=0.028) and more frequently in a non-midline location in the anterior mediastinum (p=0.029). Intralesional fat was seen exclusively in benign masses (p=0.002). Seven benign tumors (25%) and 1 malignant tumor (2.6%) had a triangular thymic shape (p=0.023). In multivariate analysis, lower age, smaller short-axis dimension, and lack of infiltration of the mediastinal fat were significant independent predictors of benign pathologic results. Conclusion Intralesional fat, midline location, and triangular thymic shape are more frequently found in benign thymic lesions. Lack of infiltration of the mediastinal fat, younger patient age, and smaller size are independent predictors of benign thymic lesions. These features may help characterize thymic masses as benign and avert potentially unnecessary invasive diagnostic procedures.

The Gunther Tulip retrievable filter can be used as a permanent or a retrievable filter. It is safe and efficacious. GT filters can be safely retrieved at a mean time interval of 33.6 days. The newly developed Celect filter may extend the retrieval interval.