ObjectiveTo explore the application value of CT-guided microcoil localization in pulmonary nodule (diameter≤15 mm) surgery.MethodsThe clinical data of 175 patients with pulmonary nodules who underwent single utility port video-assisted thoracoscopic surgery at Nanjing Drum Tower Hospital from August 2018 to December 2019 were retrospectively analyzed. According to whether CT-guided coil localization was performed before operation, they were divided into a locating group and a non-locating group. There were 84 patients (34 males, 50 females, aged 57.8±8.8 years) in the locating group and 91 patients (46 males, 45 females, aged 57.6±10.8 years) in the non-locating group. The localization success rate, localization time, incidence of complications, surgical and postoperative conditions were analyzed between the two groups.ResultsAll 84 patients in the locating group were successfully located, and localization time was 19.0±3.6 minutes. Among them, 19 (22.6%) patients had a small pneumothorax, 4 (4.8%) pulmonary hemorrhage and 2 (2.4%) coil shift; 6 (7.1%) patients had mild pain, 3 (3.6%) moderate pain and 1 (1.2%) severe pain. Sex (P=0.181), age (P=0.673), nodule location (P=0.167), nature of lesion (P=0.244), rate of conversion to thoracotomy (P=0.414), rate of disposable resection of nodules (P=0.251) and postoperative hospital stay (P=0.207) were similar between the two groups. There were significant differences in nodule size (P<0.001), nature of nodule (P<0.001), the shortest distance from nodule to pleura (P<0.001), operation time (P<0.001), lung volume by wedge resection (P=0.031), number of staplers (P<0.001) and total hospitalization costs (P<0.001) between the two groups.ConclusionCT-guided microcoil localization has the characteristics of high success rate, and is simple, practicable, effective, safe and minimally invasive. Preoperative CT-guided microcoil localization has important clinical application value for small pulmonary nodules, especially those with small size, deep location and less solid components. It can effectively shorten the operation time, reduce surgical trauma and lower hospitalization costs, which is a preoperative localization technique worthy of popularization.
ObjectiveTo explore the clinical application of the comprehensive guidance technologies, such as cone beam computed tomography (CBCT), virtual bronchoscopic navigation (VBN), and superimposed high-frequency jet ventilator for respiratory control in the biopsy of peripheral pulmonary nodules (PPNs). MethodsThe clinical information of 3 patients with PPNs diagnosed by CBCT combined with VBN and superimposed high frequency superposition jet ventilator in Shanghai Changhai Hospital were retrospectively analyzed. Results Clinical data of 3 patients were collected. The average diameter of PPNs was (25.3±0.3) mm with various locations in left and right lung. The first nodule was located in the apex of the left upper lung, and the biopsy was benign without malignant cells. The lesion was not enlarged during the 5-year follow-up. The second one was located in the left lingual lung, and the postoperative pathology was confirmed as mucosa-associated lymphoma. The third one was located in the anterior segment of the right upper lung. After the failure of endobronchial procedure, percutaneous PPNs biopsy under CBCT combined with VBN was performed, and the pathological diagnosis was confirmed as primary lung adenocarcinoma. Postoperative pneumothorax complication occurred in the third patient with right lung compression rate approximately 20%. ConclusionsThe application of CBCT, combined with VBN and the superimposed high frequency jet ventilator for respiratory control can potentially improve the accuracy and safety in the diagnosis of PPNs. Multi-center clinical trials are needed to verify its further clinical application.
ObjectiveTo investigate the research progress of residual nodules after thermal ablation for benign thyroid nodules.MethodsThe domestic and foreign guidelines and consensus on the treatment of benign thyroid nodules were collected, and the indications for thermal ablation were summarized. The causes of residual nodules after ablation were analyzed, the characteristics of residual nodules were evaluated through multiple approaches, and the follow-up treatment measures were summarized.ResultsThe indications of thermal ablation of benign thyroid nodules were different at home and abroad. The causes of residual nodules included slow absorption after ablation and incomplete ablation. Among the evaluation methods of residual nodules, the nodules volume reduction rate was the evaluation standard of short-term efficacy, contrast-enhanced ultrasound was the best method, color Doppler blood color distributionwas the most commonly used method, elastic imaging was a valuable method, and puncture pathology biopsy was an important standard. Reablation and surgical resection were the follow-up treatments for residual nodules.ConclusionsAs a new technique, thermal ablation of benign thyroid nodules has some advantages, but it is flooding at present. In the future, it is necessary to standardize indications, improve the efficiency of first ablation, attach importance to pathological complete ablation, and reasonably evaluate the treatment of residual nodules, so that thermal ablation of benign thyroid nodules could reflect rationality, safety, and efficiency, and give full play to its advantages, so as to serve patients better and have better application prospects.
Objective To analyze the differences in distribution of traditional Chinese medicine (TCM) syndrome elements and salivary microbiota between the individuals with pulmonary nodules and those without, and to explore the potential correlation between the distribution of TCM syndrome elements and salivary microbiota in patients with pulmonary nodules. Methods We retrospectively recruited 173 patients with pulmonary nodules (PN) and 40 healthy controls (HC). The four diagnostic information was collected from all participants, and syndrome differentiation method was used to analyze the distribution of TCM syndrome elements in both groups. Saliva samples were obtained from the subjects for 16S rRNA high-throughput sequencing to obtain differential microbiota and to explore the correlation between TCM syndrome elements and salivary microbiota in the evolution of the pulmonary nodule disease. Results The study found that in the PN group, the primary TCM syndrome elements related to disease location were the lung and liver, and the primary TCM syndrome elements related to disease nature were yin deficiency and phlegm. In the HC group, the primary TCM syndrome elements related to disease location were the lung and spleen, and the primary TCM syndrome elements related to disease nature were dampness and qi deficiency. There were differences between the two groups in the distribution of TCM syndrome elements related to disease location (lung, liver, kidney, exterior, heart) and disease nature (yin deficiency, phlegm, qi stagnation, qi deficiency, dampness, blood deficiency, heat, blood stasis) (P<0.05). The species abundance of the salivary microbiota was higher in the PN group than that in the HC group (P<0.05), and there was significant difference in community composition between the two groups (P<0.05). Correlation analysis using multiple methods, including Mantel test network heatmap analysis and Spearman correlation analysis and so on, the results showed that in the PN group, Prevotella and Porphyromonas were positively correlated with disease location in the lung, and Porphyromonas and Granulicatella were positively correlated with disease nature in yin deficiency (P<0.05). ConclusionThe study concludes that there are notable differences in the distribution of TCM syndrome elements and the species abundance and composition of salivary microbiota between the patients with pulmonary nodules and the healthy individuals. The distinct external syndrome manifestations in patients with pulmonary nodules, compared to healthy individuals, may be a cascade event triggered by changes in the salivary microbiota. The dual correlation of Porphyromonas with both disease location and nature suggests that changes in its abundance may serve as an objective indicator for the improvement of symptoms in patients with yin deficiency-type pulmonary nodules.
The widespread application of low-dose computed tomography (LDCT) has significantly increased the detection of pulmonary small nodules, while accurate prediction of their growth patterns is crucial to avoid overdiagnosis or underdiagnosis. This article reviews recent research advances in predicting pulmonary nodule growth based on CT imaging, with a focus on summarizing key factors influencing nodule growth, such as baseline morphological parameters, dynamic indicators, and clinical characteristics, traditional prediction models (exponential and Gompertzian models), and the applications and limitations of radiomics-based and deep learning models. Although existing studies have achieved certain progress in predicting nodule growth, challenges such as small sample sizes and lack of external validation persist. Future research should prioritize the development of personalized and visualized prediction models integrated with larger-scale datasets to enhance predictive accuracy and clinical applicability.
Objective To evaluate the value of incremental dynamic enhanced computer tomography (CT) in diagnosis of solitary pulmonary nodules (SPN). Methods The data of 42 cases with SPN who had undergone pulmonary lobectomy were collected retrospectively to find the relationship between character of preoperative dynamic enhanced CT image and postoperative pathologic result. Results All bronchogenic carcinoma showed significant enhancement after intravenous 100 ml iodinated contrast material. The average degree of enhancement of bronchogenic carcinoma during the time 85s and 135s after infusion was significantly different from that of tuberculoma and other benign lesions(Plt;0.05). Conclusion Dynamic enhanced CT is valuable in identifying the malignant nodules from benign nodules. Emphasis should be paid to the lymph nodes in the relative field with dynamic enhanced CT, which is beneficial to the diagnosis of SPN and it is an important predictor of the result of surgical treatment.
Objective To compare differences of characteristics of ultrasonic elasticity imaging for benign and malignant small thyroid nodules with or without Hashimoto thyroiditis (HT). Methods The thyroid nodules with ≤1 cm size and the category 4A, 4B, 4C, and 5 of Thyroid Imaging Reporting and Data System (TI-RADS) were included into this study, and a further examination of real-time elastography was performed. The final diagnosis was relied on the pathological diagnosis. The elasticity score and strain ratio (SR) were recorded and compared between these two groups, respectively. Results Of the 424 nodules, 103 nodules were accompanied with HT (thyroid nodule with HT group), 321 nodules were not accompanied with HT (thyroid nodule without HT group). In the thyroid nodule with HT group, the area under the receiver operator characteristic (ROC) curve (AUCs) of the elasticity score and the SR was 0.685 and 0.676, respectively; the optimal cut offs of the elasticity score and the SR was 3 points and 2.45 respectively, their corresponding sensitivity, specificity, and accuracy was 75.7%, 57.6%, 68.0% and 75.7%, 60.6%, 67.6%, respectively. In the thyroid nodule without HT group, the AUCs of the elasticity score and the SR was 0.692 and 0.692, respectively; the optimal cut offs of the elasticity score and the SR was 4 points and 2.84, respectively; their corresponding sensitivity, specificity, and accuracy was 57.5%, 74.2%, 69.2% and 76.1%, 59.7%, 67.7%, respectively. Conclusions Elastography is helpful in differential diagnosis of benign and malignant small thyroid nodules. While, standards of elasticity score and SR value in differential diagnosis are different between benign and malignant small thyroid nodules with HT and without HT, elasticity score and SR ratio decrease in benign and malignant small thyroid nodules with HT.
ObjectiveTo evaluate the clinical feasibility and safety of CT-guided percutaneous microwave ablation for peripheral solitary pulmonary nodules.MethodsThe imaging and clinical data of 33 patients with pulmonary nodule less than 3 cm in diameter treated by CT-guided microwave ablation treatment (PMAT) in our hospital from July 2018 to December 2019 were retrospectively analyzed. There were 21 males and 12 females aged 38-90 (67.6±13.4) years. Among them, 26 patients were confirmed with lung cancer by biopsy and 7 patients were clinically considered as partial malignant lesions. The average diameter of 33 nodules was 0.6-3.0 (1.8±0.6) cm. The 3- and 6-month follow-up CT was performed to evaluate the therapy method by comparing the diameter and enhancement degree of lesions with 1-month CT manifestation. Short-term treatment analysis including complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) was calculated according to the WHO modified response evaluation criteria in solid tumor (mRECIST) for short-term efficacy evaluation. Eventually the result of response rate (RR) was calculated. Progression-free survival was obtained by Kaplan–Meier analysis.ResultsCT-guided percutaneous microwave ablation was successfully conducted in all patients. Three patients suffered slight pneumothorax. There were 18 (54.5%) patients who achieved CR, 9 (27.3%) patients PR, 4 (12.1%) patients SD and 2 (6.1%) patients PD. The short-term follow-up effective rate was 81.8%. Logistic analysis demonstrated that primary and metastatic pulmonary nodules had no difference in progression-free time (log-rank P=0.624).ConclusionPMAT is of high success rate for the treatment of solitary pulmonary nodules without severe complications, which can be used as an effective alternative treatment for nonsurgical candidates.
ObjectiveTo analyze the effect of indocyanine green (ICG) fluorescence dual-visualization technique on evaluating tumor margins during the thoracoscopic segmentectomy. MethodsA total of 36 patients who underwent thoracoscopic anatomical segmentectomy using ICG fluorescence dual-visualization technique in our hospital from December 2020 to June 2021 were retrospectively included. There were 15 males and 21 females aged from 20 to 69 years. The clinical data of the patients were retrospectively analyzed. ResultsThe ICG fluorescence dual-visualization technique clearly showed the position of lung nodules and the plane boundary line between segments during the operation. There was no ICG-related complication. The average operation time was 98.6±21.3 min, and the average intraoperative bleeding amount was 47.1±35.3 mL, the average postoperative drainage tube placement time was 3.3±2.8 d, the average postoperative hospital stay was 5.4±1.8 d, and the average tumor resection distance was 2.6±0.7 cm. There was no perioperative period death, and one patient suffered a persistent postoperative air leak. ConclusionThe ICG fluorescence dual-visualization technique is safe and feasible for evaluating the tumor margins during thoracoscopic segmentectomy. It simplifies the surgical procedure, shortens the operation time, ensures sufficient tumor margins, and reserves healthy pulmonary parenchyma to the utmost extent, providing reliable technical support for thoracoscopic anatomical segmentectomy.