Corey Eber

Plasma level of interferon γ induced protein 10 is a marker of sarcoidosis disease activity.

RATIONALE Sarcoidosis is an idiopathic granulomatous disorder with heterogeneous clinical manifestations and variable prognosis. Monitoring disease activity is important to identify patients requiring treatment. Several cytokines have previously been shown to be elevated in the serum of patients with sarcoidosis and may be useful biomarkers of disease activity. OBJECTIVES To identify novel biomarkers of sarcoidosis disease activity. To identify the relationship between plasma cytokines, disease severity and prognosis. METHODS The study was approved by the institutional review board. Plasma concentration of 19 cytokines was measured in 112 subjects with chronic sarcoidosis and 52 matched controls, using the bead-based Milliplex xMAP multiplex technology. Plasma levels of individual cytokines were compared between the two groups, and between the groups with clinically active vs. inactive disease. Sensitivity, specificity and receiver operating characteristics curves were used to evaluate biomarker performance. Linear regression analyses were performed to identify associations between cytokine levels, pulmonary function tests and changes in pulmonary function. MEASUREMENTS AND MAIN RESULTS Subjects with sarcoidosis had higher plasma levels of interferon gamma induced protein 10 (IP-10) and tumor necrosis factor α (TNFα). IP-10 had the highest sensitivity and specificity in identifying active disease. Higher levels of IP-10 and TNFα were associated with greater disease severity and better prognosis. CONCLUSIONS IP-10 is a potentially useful biomarker of sarcoidosis and its severity.

JOURNAL CLUB: Evidence of Interstitial Lung Disease on Low-Dose Chest CT Images: Prevalence, Patterns, and Progression

OBJECTIVE The purposes of this study were to determine the prevalence of interstitial lung disease (ILD) in a cohort undergoing low-dose CT screening for lung cancer, to identify the CT patterns of fibrosis, and to determine prognostic factors of disease progression. MATERIALS AND METHODS The study drew from a database of 951 participants in a lung cancer screening program between 2010 and 2014. Three thoracic radiologists reviewed CT scans to identify the ILD findings, defined as traction bronchiectasis, ground-glass opacities with traction bronchiectasis, reticulations with traction bronchiectasis, and honeycombing. Evidence of ILD was considered present if at least two of three reviewing radiologists agreed. Age, smoking history, and CT evidence of emphysema were also documented. RESULTS Of the 951 participants, 63 (6.6%) had CT evidence of ILD, and 16 of the 63 (1.7% of the total cohort) had honeycombing. Significant univariate predictors of ILD were male sex (p = 0.003), older age (p < 0.0001), higher number of pack-years of cigarette smoking (p = 0.0003), and greater severity of emphysema (p = 0.004), but only age and male sex remained significant in the multivariate analysis. The most common pattern of ILD was peripheral fibrosis without honeycombing involving multiple lobes. The presence of honeycombing was significantly associated with progression of fibrosis score (p = 0.0001) and extent of fibrosis (p = 0.005). CONCLUSION A potential added benefit of CT screening is earlier diagnosis of ILD in older smokers, who are at increased risk. Radiologists should recognize the earliest findings of ILD and understand the importance of early recognition.

Idiopathic Interstitial Pneumonias: A Radiology-Pathology Correlation Based on the Revised 2013 American Thoracic Society-European Respiratory Society Classification System

The idiopathic interstitial pneumonias (IIPs) are a group of diffuse lung diseases that share many similar radiologic and pathologic features. According to the revised 2013 American Thoracic Society-European Respiratory Society classification system, these entities are now divided into major IIPs (idiopathic pulmonary fibrosis, idiopathic nonspecific interstitial pneumonia, respiratory bronchiolitis-associated interstitial lung disease, desquamative interstitial pneumonia, cryptogenic organizing pneumonia, and acute interstitial pneumonia), rare IIPs (idiopathic lymphoid interstitial pneumonia, idiopathic pleuroparenchymal fibroelastosis), and unclassifiable idiopathic interstitial pneumonias. Some of the encountered radiologic and histologic patterns can also be seen in the setting of other disorders, which makes them a diagnostic challenge. As such, the accurate classification of IIPs remains complex and is best approached through a collaboration among clinicians, radiologists, and pathologists, as the treatment and prognosis of these conditions vary greatly.

The general radiologist's role in breast cancer risk assessment: breast density measurement on chest CT☆

To determine if general radiologists can accurately measure breast density on low-dose chest computed tomographic (CT) scans, two board-certified radiologists with expertise in mammography and CT scan interpretation, and seven general radiologists performed retrospective review of 100 womens low-dose chest CT scans. CT breast density grade based on Breast Imaging Reporting and Data System grades was independently assigned for each case. Kappa statistic was used to compare agreement between the expert consensus grading and those of the general radiologists. Kappa statistics were 0.61-0.88 for the seven radiologists, showing substantial to excellent agreement and leading to the conclusion that general radiologists can be trained to determine breast density on chest CT.

Baseline and annual repeat rounds of screening: implications for optimal regimens of screening

AbstractObjectivesDifferences in results of baseline and subsequent annual repeat rounds provide important information for optimising the regimen of screening.MethodsA prospective cohort study of 65,374 was reviewed to examine the frequency/percentages of the largest noncalcified nodule (NCN), lung cancer cell types and Kaplan–Meier (K-M) survival rates, separately for baseline and annual rounds.ResultsOf 65,374 baseline screenings, NCNs were identified in 28,279 (43.3%); lung cancer in 737 (1.1%). Of 74,482 annual repeat screenings, new NCNs were identified in 4959 (7%); lung cancer in 179 (0.24%). Only adenocarcinoma was diagnosed in subsolid NCNs. Percentages of lung cancers by cell type were significantly different (p < 0.0001) in the baseline round compared with annual rounds, reflecting length bias, as were the ratios, reflecting lead times. Long-term K-M survival rate was 100% for typical carcinoids and for adenocarcinomas manifesting as subsolid NCNs; 85% (95% CI 81–89%) for adenocarcinoma, 74% (95% CI 63–85%) for squamous cell, 48% (95% CI 34–62%) for small cell. The rank ordering by lead time was the same as the rank ordering by survival rates.ConclusionsThe significant differences in the frequency of NCNs and frequency and aggressiveness of diagnosed cancers in baseline and annual repeat need to be recognised for an optimal regimen of screening.Key Points• Lung cancer aggressiveness varies considerably by cell type and nodule consistency. • Kaplan–Meier survival rates varied by cell type between 100% and 48%. • The percentages of lung cancers by cell type in screening rounds reflect screening biases. • Rank ordering by cell type survival is consistent with that by lead times. • Empirical evidence provides critical information for the regimen of screening.

Bilateral Pneumothoraces after Unilateral Lung Biopsy. A Case of “Buffalo Chest”?

An 81-year-old man with a productive cough was found to have multiple bilateral pulmonary nodules and was referred for biopsy. Under computed tomography guidance, fine-needle aspiration of a right lower lobe nodule led to a diagnosis of lung adenocarcinoma (Figure 1). A small pneumothorax developed on the right and, despite the fact that the left lung and mediastinum were not manipulated during the procedure, extended into the left hemithorax. Both pneumothoraces resolved without intervention. “Buffalo chest” is a term derived from the animal’s peculiar anatomy in which there is only one contiguous pleural space containing both lungs. Previous reports in the literature (approximately 10–15 cases) are almost universally in patients with prior thoracic surgery causing disruption of the mediastinal barrier (i.e., esophagectomy [1], heart–lung transplant [2], pneumonectomy), with only a few existing “congenital pleuro-pleural communication” cases (3). Bilateral pneumothoraces have also been described after unilateral procedures in patients prone to spontaneous pneumothoraces (1, 4) and in patients with sarcoma metastases receiving chemotherapy (5). This patient had no prior surgical history or emphysematous/cystic lung disease, raising the possibility of a congenital condition, despite a seemingly intact mediastinum on computed tomography. Disruption of the mediastinal pleura from lung metastases is another etiology to consider, as has been previously hypothesized (5). n

Correction to: Baseline and annual repeat rounds of screening: implications for optimal regimens of screening

The original version of this article unfortunately contained a mistake. The conflict of interest was incorrect.