Mass screening for lung cancer with mobile spiral computed tomography scanner

Sone, Shusuke; Takashima, S; Li, Feng; Yang, Zhi‐gang; Honda, Takayuki; Maruyama, Yoshihiro; Hasegawa, Masatoshi; Yamanda, Takeshi; Kubo, Keishi; Hanamura, K.; Asakura, Keiko

doi:10.1016/s0140-6736(97)08229-9

Cited by 824 publications

(462 citation statements)

References 9 publications

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“…Last, practicing pathologists confronted with the possible significance of AAH must communicate with clinicians to ascertain prognosis and management of this lesion and with radiologists, who continue to enhance the resolution power of computed tomography and allied technologies that allow them to detect ever higher numbers of increasingly smaller pulmonary nodules (113). In regards to management, a conservative approach has been suggested by Colby et al (114) and Ritter (115).…”

Section: Resultsmentioning

confidence: 99%

Atypical Adenomatous Hyperplasia of the Lung: A Probable Forerunner in the Development of Adenocarcinoma of the Lung

et al. 2001

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An increasingly large body of work suggests that atypical adenomatous hyperplasia (AAH) of the lung may be a forerunner of pulmonary adenocarcinoma. Recognizing this fact, the World Health Organization now acknowledges the existence of AAH while noting difficulties that may be encountered in distinguishing AAH from the nonmucinous variant of bronchioloalveolar carcinoma. Regrettably, a universally acceptable definition of morphologic criteria for the diagnosis of AAH has not been achieved. This review of the literature examines the epidemiology, gross appearance, light microscopic findings, morphometry, immunohistochemistry, and molecular features of AAH and suggests a set of histopathologic features that may help the practicing pathologist identify this intriguing lesion. These features include the following: irregularly bordered focal proliferations of atypical cells spreading along the preexisting alveolar framework; prominent cuboidal to low columnar alveolar epithelial cells with variable degree of atypia but less than that seen in adenocarcinoma; increased cell size and nuclearcytoplasmic ratio with hyperchromasia and prominent nucleoli, generally intact intercellular attachment of atypical cells with occasional empty-looking spaces between them without high cellularity and without tufting or papillary structures; and slight thickening of the alveolar walls on which the AAH cells have spread, with some fibrosis but without scar formation or significant chronic inflammation of the surrounding lung tissue. Several lines of evidence indicate that AAH is a lesion closely associated with adenocarcinoma of the lung, suggesting AAH may be involved in the early stage of a complex multistep carcinogenesis of pulmonary adenocarcinoma.

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Section: Resultsmentioning

confidence: 99%

Atypical Adenomatous Hyperplasia of the Lung: A Probable Forerunner in the Development of Adenocarcinoma of the Lung

et al. 2001

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“…Some evidence suggests that early detection of lung cancer may allow for timely therapeutic intervention, which in turn results in a more favorable prognosis for the patients. Therefore, screening programs for early detection of lung cancer have been attempted in the U.S. and Japan by use of computed tomography (CT) [2,3]. In a screening program with CT, radiologists must read a large number of images, and they are likely to overlook some lung cancers.…”

Section: Introductionmentioning

confidence: 99%

Computerized Detection of Lung Nodules in Thin-Section CT Images by Use of Selective Enhancement Filters and an Automated Rule-Based Classifier

Li¹,

Li²,

Doi³

2008

Academic Radiology

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132

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We have been developing a computer-aided diagnostic (CAD) scheme for lung nodule detection in order to assist radiologists in the detection of lung cancer in thin-section computed tomography (CT) images. Our database consisted of 117 thin-section CT scans with 153 nodules, obtained from a lung cancer screening program at a Japanese university (85 scans, 91 nodules) and from clinical work at an American university (32 scans, 62 nodules). The database included nodules of different sizes (4-28 mm, mean 10.2 mm), shapes, and patterns (solid and ground-glass opacity (GGO)). Our CAD scheme consisted of modules for lung segmentation, selective nodule enhancement, initial nodule detection, feature extraction, and classification. The selective nodule enhancement filter was a key technique for significant enhancement of nodules and suppression of normal anatomic structures such as blood vessels, which are the main sources of false positives. Use of an automated rule-based classifier for reduction of false positives was another key technique; it resulted in a minimized overtraining effect and an improved classification performance. We employed a case-based four-fold cross-validation testing method for evaluation of the performance levels of our computerized detection scheme. Our CAD scheme achieved an overall sensitivity of 86% (small: 76%, medium-sized: 94%, large: 95%; solid: 86%, mixed GGO: 89%, pure GGO: 81%) with 6.6 false positives per scan; an overall sensitivity of 81% (small: 69%, medium-sized: 91%, large: 91%; solid: 79%, mixed GGO: 88%, pure GGO: 81%) with 3.3 false positives per scan; and an overall sensitivity of 75% (small: 60%, medium-sized: 88%, large: 87%; solid: 70%, mixed GGO: 87%, pure GGO: 81%) with 1.6 false positives per scan. The experimental results indicate that our CAD scheme with its two key techniques can achieve a relatively high performance for nodules presenting large variations in size, shape, and pattern.

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“…3 Owing to recent technological improvements in high-resolution computed tomography and the introduction of computed tomography screening, the incidence of small-sized pathological-T1 (pT1) cases is on the rise among surgically resected adenocarcinoma cases. 4,5 Although bronchioloalveolar carcinoma is reported as the only subtype without any invasive features and shows an excellent prognosis, some of the other pT1 adenocarcinoma cases may develop distant metastasis in a short period after complete surgical resection. [6][7][8] Thus, although the tumornode-metastasis (TNM) stage and the pathological stage, including the presence or absence of lymph node metastasis, have been the most reliable prognostic factors in patients with lung carcinoma, 9,10 it is crucial to identify additional prognostic factors within each given stage to select most appropriate therapy and individualize the follow-up frequency.…”

mentioning

confidence: 99%

Micropapillary pattern and grade of stromal invasion in pT1 adenocarcinoma of the lung: usefulness as prognostic factors

et al. 2007

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Recently, the stromal invasion grading system was proposed for small adenocarcinomas of r2.0 cm. The system is based on the presence or absence of a fibrotic focus, and the extent of invasion into the fibrotic focus. Although stromal invasion grading system closely correlated with the prognosis, stromal invasion grade 3, representing stromal invasion into the center of a fibrotic focus, was the largest group of tumors and showed variable prognosis. In this study, we investigated whether stromal invasion grading system could be applied to and validated in pT1 adenocarcinomas as the TNM classification is the most universally used system. Furthermore, we investigated whether stromal invasion grade 3 cases could be subclassified according to the presence and absence of micropapillary pattern. The study included 120 cases of pT1 lung adenocarcinomas, of which 81 (68%) cases were stromal invasion grade 3. Micropapillary pattern was positive in 80% of grade 3 cases. For stromal invasion grade 3 cases, the 5-year survival rate of patients with micropapillary patternpositive carcinomas was 63%, which was significantly worse than 94% of those with micropapillary patternnegative carcinomas (P ¼ 0.0196). The latter was very close to that for patients with stromal invasion grade 0-2 (95%). Moreover, small cluster invasion was observed at sites of stromal invasion significantly more often in micropapillary pattern-positive cases than negative cases. Thus, the stromal invasion grading system is reproducible and correlates with prognosis even in pT1 lung adenocarcinomas. Moreover, among patients with stromal invasion grade 3 carcinomas, favorable prognosis is noted in micropapillary pattern-negative cases. The micropapillary pattern subclassification provides an advantage to the stromal invasion grading system and reconfirms the importance of micropapillary pattern as a prognostic marker. Our study is the first to point to the possible association of micropapillary pattern-positive carcinomas and small cluster invasion.

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Mass screening for lung cancer with mobile spiral computed tomography scanner

Cited by 824 publications

References 9 publications

Atypical Adenomatous Hyperplasia of the Lung: A Probable Forerunner in the Development of Adenocarcinoma of the Lung

Atypical Adenomatous Hyperplasia of the Lung: A Probable Forerunner in the Development of Adenocarcinoma of the Lung

Computerized Detection of Lung Nodules in Thin-Section CT Images by Use of Selective Enhancement Filters and an Automated Rule-Based Classifier

Micropapillary pattern and grade of stromal invasion in pT1 adenocarcinoma of the lung: usefulness as prognostic factors

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