BackgroundEstimation of the risk of malignancy in pulmonary nodules detected by CT is central in clinical management. The use of artificial intelligence (AI) offers an opportunity to improve risk prediction. Here we compare the performance of an AI algorithm, the lung cancer prediction convolutional neural network (LCP-CNN), with that of the Brock University model, recommended in UK guidelines.MethodsA dataset of incidentally detected pulmonary nodules measuring 5–15 mm was collected retrospectively from three UK hospitals for use in a validation study. Ground truth diagnosis for each nodule was based on histology (required for any cancer), resolution, stability or (for pulmonary lymph nodes only) expert opinion. There were 1397 nodules in 1187 patients, of which 234 nodules in 229 (19.3%) patients were cancer. Model discrimination and performance statistics at predefined score thresholds were compared between the Brock model and the LCP-CNN.ResultsThe area under the curve for LCP-CNN was 89.6% (95% CI 87.6 to 91.5), compared with 86.8% (95% CI 84.3 to 89.1) for the Brock model (p≤0.005). Using the LCP-CNN, we found that 24.5% of nodules scored below the lowest cancer nodule score, compared with 10.9% using the Brock score. Using the predefined thresholds, we found that the LCP-CNN gave one false negative (0.4% of cancers), whereas the Brock model gave six (2.5%), while specificity statistics were similar between the two models.ConclusionThe LCP-CNN score has better discrimination and allows a larger proportion of benign nodules to be identified without missing cancers than the Brock model. This has the potential to substantially reduce the proportion of surveillance CT scans required and thus save significant resources.
Orthotopic liver transplantation has been performed in Birmingham since 1982. Two types of biliary reconstruction have been used, the choledocho-choledochostomy and the choledocho-cholecysto-choledochostomy (gallbladder (GB) conduit). A retrospective study was undertaken to compare the biliary tract complications encountered at cholangiography in these two groups to assess which reconstruction is safest. In the gallbladder (GB) conduit reconstruction, the incidence of biliary leakage (20.4%) and stricture formation (14.4%), the two most serious complications, was higher than in end-to-end duct anastomosis (11% and 10%, respectively), though these differences did not reach statistical significance. This supports evidence from other centres that the choledocho-choledochostomy is the procedure of choice to minimize biliary complications. Biliary debris (14.2%) presented additional problems and was strongly associated with biliary strictures. T-tube related problems were least troublesome. The close relationship between hepatic artery occlusion and biliary complications, particularly leakage, noted in other studies is also emphasized.
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