ObjectiveTo compare the effectiveness and safety of electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules.MethodsThe literature published from the inception to January 2021 about the comparison between electromagnetic navigation-guided localization and CT-guided percutaneous localization for pulmonary nodules in the PubMed, The Cochrane Library, Web of Science, EMbase, Chinese Wanfang database and CNKI database was searched. RevMan (version 5.4) software was used for meta-analysis. Nonrandomized controlled trials were evaluated using methodological index for nonrandomized studies (MINORS).ResultsA total of six retrospective studies (567 patients) were included in this meta-analysis. MINORS scores of all studies were all 17 points and above. There were 317 patients in the CT-guided percutaneous localization group and 250 patients in the electromagnetic navigation-guided localization group. The complication rate of the CT-guided percutaneous localization group was significantly higher than that in the electromagnetic navigation-guided localization group (OR=11.08, 95%CI 3.35 to 36.65, P<0.001). There was no significant difference in the success rate of localization (OR=0.48, 95%CI 0.16 to 1.48, P=0.20), localization time (MD=0.30, 95%CI –6.16 to 6.77, P=0.93) or nodule diameter (MD=–0.07, 95%CI –0.19 to 0.06, P=0.29) between the two groups.ConclusionElectromagnetic navigation can be used as an effective preoperative positioning method for pulmonary nodules, which has the advantage of lower complication rate compared with the traditional CT positioning method.
Objective To investigate the value of a new double action MR contrast agent——Gd-BOPTA in the diagnosis of focal nodular hyperplasia (FNH) of the liver with correlation of pathology. Methods Dedicated MRI scans were performed for 5 patients suspected to have liver FNH on clinical and imaging basis (six lesions). The MR imaging protocol included axial T1W and T2W plain scan, coronal T2 weighted imaging, 3D MRCP, Gd-BOPTA enhanced LAVA dynamic tri-phasic acquisitions (scanning at 15 s, 55 s and 90 s respectively), enhanced 2D T1W scan, enhanced LAVA in delay phase (at 5 and 10 min) and in the hepatobiliary phase (at 40 and 80 min). The imaging features on each MR sequence were compared with surgical and pathological findings. Results Six lesions in 5 FNH patients were all correctly diagnosed (5 conformed by surgery and 1 by needle biopsy). ①The hemodynamic phase: The parenchyma of 5 lesions were markedly enhanced in the arterial phase, being isointense or slight hypointense in both the portal venous and delay phases, while 1 lesion was isointense in all phases except being slight hyperintense in the arterial phase; The central scar of 5 lesions were not enhanced in the dynamic phase, but showed delayed enhancement. ②The hepatobiliary (excretory) phase: The parenchyma of all 6 lesions were slight hyperintense or isointense, and tree-like bile ducts with hyperintensity were seen within one lesion. The scar showed no enhancement. ③Pathology: The parenchyma was consisted of disarranged normal hepatocytes but with cytoedema, lack of portal tracts and cholestatic change. The central scar showed rich fibrous tissue, a very thick-walled arteriole, proliferative bile ducts, infiltration of inflammatory cells and myxomatous changes. Conclusion As a dual-phase MR contrast agent capable of depicting both the hemodynamic attributes and hepatobiliary excretion, Gd-BOPTA enhanced MRI can reflect the pathological features of FNH and reach a high diagnostic accuracy.
Objective To analyze the imaging features of solitary pulmonary nodules ( SPNs) , and compare the two types of lung cancer prediction models in distinguishing malignancy of SPNs.Methods A retrospective study was performed on the patients admitted to Ruijin Hospital between 2002 and 2009 with newly discovered SPNs. The patients all received pathological diagnosis. The clinical and imaging characteristics were analyzed. Then the diagnostic accuracy of two lung cancer prediction models for distinguishing malignancy of SPNs was evaluated and compared.Results A total of 90 patients were enrolled, of which 32 cases were with benign SPNs, 58 cases were with malignant SPNs. The SPNs could be identified between benign and maligant by the SPN edge features of lobulation ( P lt;0. 05) . The area under ROC curve of VA model was 0. 712 ( 95% CI 0. 606 to 0. 821) . The area under ROC curve of Mayo Clinic model was 0. 753 ( 95% CI 0. 652 to 0. 843) , which was superior to VA model. Conclusions It is meaningful for the identification of benign and maligant SPNs by the obulation sign in CT scan. We can integrate the clinical features and the lung cancer predicting models to guide clinical work.
Objective To analyze the benign-malignant outcomes of pulmonary nodules in surgical patients and their influencing factors, and provide evidence and ideas for optimizing and improving the integrated management model of pulmonary nodules. Methods From October to December 2023, a convenience sampling method was used to select patients who underwent lung surgery at West China Hospital, Sichuan University between July 2022 and June 2023 for this study. The malignancy rate of postoperative pathological results of pulmonary nodules and its influencing factors were analyzed using univariate analysis and multiple logistic regression. Results A total of 4600 surgical patients with pulmonary nodules were included, with a malignancy rate of 88.65% (4078/4600) and a benign rate of 11.35% (522/4600). Univariate analysis showed significant differences in malignancy rates among different genders, ages, methods of pulmonary nodule detection, and smoking histories (P<0.05); however, no significant difference was found regarding place of birth or family history of lung cancer (P>0.05). Multiple logistic regression analysis indicated that females [odds ratio (OR)=1.533, 95% confidence interval (CI) (1.271, 1.850)], older age groups [61-75 vs. ≤30 years: OR=1.640, 95%CI (1.021, 2.634); >75 vs. ≤30 years: OR=2.690, 95%CI (1.062, 6.814)], and pulmonary nodules detected during physical examinations [OR=1.286, 95%CI (1.064, 1.554)] were high-risk factors for malignancy, with statistical significance (P<0.05). Conclusion In the integrated management of pulmonary nodules, it is crucial not to overlook females or older patients, as they may be more significant influencing factors than smoking; furthermore, lung examinations are effective means of early detection of malignant lung tumors and are worth promoting and popularizing.
Objective To summarize clinical features, imaging findings, diagnosis, treatment, and prognosis of patients with hepatic focal nodular hyperplasia. Method The clinical data of patients with hepatic focal nodular hyperplasia who underwent hepatectomy from July 2014 to July 2016 in the Xiangya Hospital of Central South University were analyzed retrospectively. Results There were 12 males and 19 females in the 31 patients with hepatic focal nodular hyperplasia, the male-to-female ratio was 1∶1.58. The age was from 15 to 67 years old with (39.7±11.5) years old. Physical examination found 21 cases, there were symptoms in 10 cases. Laboratory examination: only 2 patients with long-term drinking history had mild AST abnormality, HBsAgs of 6 cases were positive, CA19-9 level of one patient was slightly increased (40.54 kU/L). Thirteen patients with hepatic focal nodular hyperplasia were diagnosed by imaging examination, the diagnostic rate of MRI was significantly higher than that of color Doppler ultrasound (P<0.05) or CT (P<0.05). The diameter of the lesions ranged from 2 cm to 11 cm with (4.6±2.1) cm. All lesions were resected, including 13 cases by laparoscopic hepatectomy, and 18 cases by laparotomy. Compared with by the laparotomy, the intraoperative blood loss was less (P<0.05), the hospital stay and intestinal exhaust time were shorter (P<0.05) by the laparoscopic hepatectomy. Twenty-nine patients were followed up from 3 to 24 months, no patient died, the quality of life was better, no recurrence and metastasis happened. Conclusions Hepatic focal nodular hyperplasia is benign lesion, it has a good prognosis, generally without clinical symptoms, its laboratory feature has no abnormality. The combination of multiple imagings and pathological diagnosis could improve diagnosis rate. Surgical resection should be performed for suspected malignant tumor or other hepatic occupying lesions. Laparoscopic surgery has some advantages of quick recovery and less bleeding for it.
ObjectiveTo investigate the clinical efficacy of preoperative location of pulmonary nodules guided by electromagnetic navigation bronchoscopy (ENB). MethodsPatients who received preoperative ENB localization and then underwent surgery from March 2021 to November 2022 in the Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were collected. The clinical efficacy and safety of ENB localization and the related factors that may affect the success of ENB localization were analyzed. ResultsInitially 200 patients were included, among whom 17 undergoing preoperative localization and biopsy were excluded and a total of 183 patients and 230 nodules were finally included. There were 62 males and 121 females with a mean age of 49.16±12.50 years. The success rate of navigation was 88.7%, and the success rate of ENB localization was 67.4%. The rate of complications related to ENB localization were 2.7%, and the median localization time was 10 (7, 15) min. Multi-variable analysis showed that factors related to successful localization included distance from localization site (OR=0.27, 95%CI 0.13-0.59, P=0.001), staining material (OR=0.40, 95%CI 0.17-0.95, P=0.038), and staining dose (OR=60.39, 95%CI 2.31-1 578.47, P=0.014). Conclusion ENB-guided preoperative localization of pulmonary nodules is safe and effective, and the incidence of complications is low, which can be used to effectively assist the diagnosis and treatment of early lung cancer.