Follow-Up of Small (4 mm or Less) Incidentally Detected Nodules by Computed Tomography in Oncology Patients: A Retrospective Review

Munden, Reginald F.; Erasmus, Jeremy J.; Wahba, Hisham; Fineberg, Naomi S.

doi:10.1097/jto.0b013e3181f2636e

Cited by 27 publications

(23 citation statements)

References 13 publications

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“…It is important to note, that the median lesion size of these malignant lesions was smaller compared to all lesions (median lesion size: 6 mm vs. 8 mm). This is in accordance with the literature where many small pulmonary nodules are reported to be benign even in oncologic patients (35). …”

Section: Discussionsupporting

confidence: 93%

Diagnosing Lung Nodules on Oncologic MR/PET Imaging: Comparison of Fast T1-Weighted Sequences and Influence of Image Acquisition in Inspiration and Expiration Breath-Hold

et al. 2016

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ObjectiveFirst, to investigate the diagnostic performance of fast T1-weighted sequences for lung nodule evaluation in oncologic magnetic resonance (MR)/positron emission tomography (PET). Second, to evaluate the influence of image acquisition in inspiration and expiration breath-hold on diagnostic performance.Materials and MethodsThe study was approved by the local Institutional Review Board. PET/CT and MR/PET of 44 cancer patients were evaluated by 2 readers. PET/CT included lung computed tomography (CT) scans in inspiration and expiration (CTin, CTex). MR/PET included Dixon sequence for attenuation correction and fast T1-weighted volumetric interpolated breath-hold examination (VIBE) sequences (volume interpolated breath-hold examination acquired in inspiration [VIBEin], volume interpolated breath-hold examination acquired in expiration [VIBEex]). Diagnostic performance was analyzed for lesion-, lobe-, and size-dependence. Diagnostic confidence was evaluated (4-point Likert-scale; 1 = high). Jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis was performed.ResultsSeventy-six pulmonary lesions were evaluated. Lesion-based detection rates were: CTex, 77.6%; VIBEin, 53.3%; VIBEex, 51.3%; and Dixon, 22.4%. Lobe-based detection rates were: CTex, 89.6%; VIBEin, 58.3%; VIBEex, 60.4%; and Dixon, 31.3%. In contrast to CT, inspiration versus expiration did not alter diagnostic performance in VIBE sequences. Diagnostic confidence was best for VIBEin and CTex and decreased in VIBEex and Dixon (1.2 ± 0.6; 1.2 ± 0.7; 1.5 ± 0.9; 1.7 ± 1.1, respectively). The JAFROC figure-of-merit of Dixon was significantly lower. All patients with malignant lesions were identified by CTex, VIBEin, and VIBEex, while 3 patients were false-negative in Dixon.ConclusionFast T1-weighted VIBE sequences allow for identification of patients with malignant pulmonary lesions. The Dixon sequence is not recommended for lung nodule evaluation in oncologic MR/PET patients. In contrast to CT, inspiration versus expiratory breath-hold in VIBE sequences was less crucial for lung nodule evaluation but was important for diagnostic confidence.

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Section: Discussionsupporting

confidence: 93%

Diagnosing Lung Nodules on Oncologic MR/PET Imaging: Comparison of Fast T1-Weighted Sequences and Influence of Image Acquisition in Inspiration and Expiration Breath-Hold

et al. 2016

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“…MacMahon et al reported that the malignancy risk is highly related to its size: 0.2% for nodule < 3 mm, 0.9% for nodules 4–7 mm, and 18% for 8–20 mm [ 25 ]. However, Munden et al found that 28% of small pulmonary nodules detected at baseline CT scan will increase in size, indicating metastatic disease [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

CNN models discriminating between pulmonary micro-nodules and non-nodules from CT images

Monkam

et al. 2018

BioMed Eng OnLine

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BackgroundEarly and automatic detection of pulmonary nodules from CT lung screening is the prerequisite for precise management of lung cancer. However, a large number of false positives appear in order to increase the sensitivity, especially for detecting micro-nodules (diameter < 3 mm), which increases the radiologists’ workload and causes unnecessary anxiety for the patients. To decrease the false positive rate, we propose to use CNN models to discriminate between pulmonary micro-nodules and non-nodules from CT image patches.MethodsA total of 13,179 micro-nodules and 21,315 non-nodules marked by radiologists are extracted with three different patch sizes (16 × 16, 32 × 32 and 64 × 64) from LIDC/IDRI database and used in the experiments. Three CNN models with different depths (1, 2 or 4 convolutional layers) are designed; their performances are evaluated by the fivefold cross-validation in term of the accuracy, area under the curve (AUC), F-score and sensitivity. The network parameters are also optimized.ResultsIt is found that the performance of the CNN models is greatly dependent on the patches size and the number of convolutional layers. The CNN model with two convolutional layers presented the best performance in case of 32 × 32 patches size, achieving an accuracy of 88.28%, an AUC of 0.87, a F-score of 83.45% and a sensitivity of 83.82%.ConclusionsThe CNN models with appropriate depth and size of image patches can effectively discriminate between pulmonary micro-nodules and non-nodules, and reduce the false positives and help manage lung cancer precisely.

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“…Metastatic pulmonary diseases are sometimes detected incidentally during the workup for other diseases . In such cases, almost of them are found by plain radiograph or CT scan .…”

Section: Discussionmentioning

confidence: 99%

Pulmonary metastasis from uterine leiomyosarcoma in a patient with limited cutaneous systemic scleroderma

Okauchi

Watanabe

Tamura

et al. 2017

J of Gen and Family Med

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A 51‐year‐old woman, who was diagnosed as having limited cutaneous systemic scleroderma, presented with pulmonary nodules incidentally detected in a chest radiograph. The patient had surgical biopsy of the nodules. In microscopic examination of the specimens, proliferation, mitotic activity, and cellular anaplasia of spindle cells were present. Fluorodeoxyglucose‐positron emission tomography showed tumors in lungs as well as uterus. The diagnosis of the tumor was pulmonary metastases from uterine leiomyosarcoma. We should be on alert the possibility of developing malignant disease in patient with this autoimmune disease. If it is certain that there is metastasis, we believe that therapy for the primary lesion will be preceded by biopsy and surgery for the metastatic lesions.

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Follow-Up of Small (4 mm or Less) Incidentally Detected Nodules by Computed Tomography in Oncology Patients: A Retrospective Review

Cited by 27 publications

References 13 publications

Diagnosing Lung Nodules on Oncologic MR/PET Imaging: Comparison of Fast T1-Weighted Sequences and Influence of Image Acquisition in Inspiration and Expiration Breath-Hold

Diagnosing Lung Nodules on Oncologic MR/PET Imaging: Comparison of Fast T1-Weighted Sequences and Influence of Image Acquisition in Inspiration and Expiration Breath-Hold

CNN models discriminating between pulmonary micro-nodules and non-nodules from CT images

Pulmonary metastasis from uterine leiomyosarcoma in a patient with limited cutaneous systemic scleroderma

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