Yubao Guan

Video-Assisted Thoracoscopic Surgery (VATS) for Patients with Solitary Fibrous Tumors of the Pleura

Objectives: To present our experience of video-assisted thoracoscopic surgery (VATS) for patients with solitary fibrous tumors of the pleura (SFTPs) and to discuss the treatment of choice of such neoplasms. Methods: Between June 2000 and September 2008, 21 patients with SFTPs (9 men and 12 women) underwent VATS at our department. The mean age was 52.5 years (range, 33–76 years). Results: Surgical excision was performed in all patients. Surgical excision was performed by VATS in 15 patients (71.4%), by VATS plus a small thoracotomy (<5 cm) in 4 patients (19.0%), and by posterolateral thoracotomy accompanied by VATS in 2 patients (9.5%). Mean chest drain duration was 2.3 days (range, 1–4 days), and the mean hospital stay was 7.2 days (range, 4–15 days). There were 18 pathologically benign SFTP cases (85.7%) and 3 malignant SFTP cases (14.3%). There was no operative morbidity or mortality. No recurrence or metastasis of SFTPs developed during postoperative median follow-up period of 43 months. Conclusions: Complete resection and close follow-up for years after operation is recommended for SFTPs. VATS may play an important role in reducing the size of the thoracotomy incision in the treatment of SFTPs, which results in less invasive surgery.

Establishment of an orthotopic lung cancer model in nude mice and its evaluation by spiral CT

OBJECTIVE To establish a simple and highly efficient orthotopic animal model of lung cancer cell line A549 and evaluate the growth pattern of intrathoracic tumors by spiral CT. METHODS A549 cells (5×10(6) mL(-1)) were suspended and inoculated into the right lung of BALB/c nude mice via intrathoracic injection. Nude mice were scanned three times each week by spiral CT after inoculation of lung cancer cell line A549. The survival time and body weight of nude mice as well as tumor invasion and metastasis were examined. Tissue was collected for subsequent histological assay after autopsia of mice. RESULTS The tumor-forming rate of the orthotopic lung cancer model was 90%. The median survival time was 30.7 (range, 20-41) days. The incidence of tumor metastasis was 100%. The mean tumor diameter and the average CT value gradually increased in a time-dependent manner. CONCLUSIONS The method of establishing the orthotopic lung cancer model through transplanting A549 cells into the lung of nude mice is simple and highly successful. Spiral CT can be used to evaluate intrathoracic tumor growth in nude mice vividly and dynamically.

Pulmonary alveolar proteinosis: Quantitative CT and pulmonary functional correlations

OBJECTIVE We assessed the relationship between quantitative computer tomography (qCT) and the pulmonary function test (PFT) or blood gas analysis in pulmonary alveolar proteinosis (PAP) patients, as well as the utility of these analyses to monitor responses to whole lung lavage (WLL) therapy. METHODS Thirty-eight PAP patients simultaneously received a CT scan and PFT. Fifteen of these patients, undergoing sequential WLL for a total of 20 lavages, also underwent chest CT scans and blood gas analysis before and after WLL, and 14 of 15 patients underwent simultaneous PFT analysis. Differences between the qCT and PFT results were analyzed by canonical correlation. RESULTS PAP patients with low predicted values for FVC, FEV1, D(LCO) and D(LCO)/VA indicated small airspace volume and mean lung inflation, low airspace volume/total lung volume ratio and high mean lung density. Correlation and regression analysis revealed a strong correlation between D(LCO) and PaO(2) values with CT results. The qCT results indicated that WLL significantly decreased lung weights and mean lung densities, and improved the total airspace volume/total lung volume ratios and mean lung inflations. CONCLUSION Quantitative CT may be a sensitive tool for measuring the response of PAP patients to medical interventions such as WLL.

Computed tomography appearance of inflammatory myofibroblastic tumor in the mediastinum.

Objective This study aimed to improve the diagnosis of inflammatory myofibroblastic tumor (IMT) in the mediastinum by analysis of computed tomographic (CT) images. Materials and Methods Clinical data, CT, and pathological findings of 6 patients diagnosed with IMT in the mediastinum were retrospectively analyzed. Results Of the 6 patients, 5 were women, and mean age at diagnosis was 34 years. All the lesions were solid soft tissue masses and ranged in maximum diameter from 5.0 to 8.5 cm, which were located in the anterior (n = 1), middle (n = 2), and posterior mediastinum (n = 3). The anterior mediastinal tumor had a clear boundary. The tumors in the middle mediastinum had indistinct boundaries: one was invading the right wall of the trachea and the other was invading the esophageal wall. A tumor located in the right posterior mediastinum caused osteolysis of the adjacent ribs. A small amount of calcification was seen in the tumor in the right posterior-inferior mediastinum. After administration of contrast, all tumors showed varying degrees of contrast enhancement (range, 17–47 HU) on chest CT scan. Recurrence occurred in only 1 case. Conclusions The common CT appearance of IMT in the mediastinum is as a soft tissue mass with uniform density. All tumors show varying degrees of contrast enhancement. Some lesions have clear boundaries; others do not. Computed tomography examination can help to determine the areas involved by lesions and their relationships with adjacent tissues, which facilitates the prediction of the likely surgical requirements.

Gemcitabine plus cisplatin chemotherapy with concurrent para-toluenesulfonamide local injection therapy for peripherally advanced nonsmall cell lung cancer larger than 3 cm in the greatest dimension.

Para-toluenesulfonamide (PTS), active ingredient being PTS, is a new anticancer drug applied through local intratumoral injection. The aim of this phase II clinical trial was to investigate the response and toxicity of standard gemcitabine (GEM) plus cisplatin (CIS) chemotherapy with concurrent intratumoral injection of PTS in peripherally advanced nonsmall cell lung cancer. Patients received 1250 mg/m2 of GEM on day 1, 8, and 75 mg/m2 of CIS on day 1, every 21 days for four cycles. PTS was injected intratumorally through percutaneous injection under computed tomography guidance on days 5, 12, 15, and 18 of cycle 1, and repeated on days 5 and 12 of cycle 2 if a less than 50% necrotic area was achieved after the first cycle according to the computed tomography scan. Twelve (46.2%) patients had metastatic disease, whereas 14 (53.8%) patients had stage IIIB disease. All 26 patients were assessable for response. Overall response rate by intention-to-treat was 53.8% (95% confidence interval: 34.6–73.0%). Median progression-free survival and overall survival were 6.5 months (95% confidence interval: 3.8–10.2 months) and 14.5 months (10.0–18.0 months), respectively. One-year and 2-year survivals were 57.7 and 22.4%, respectively. The grade 3–4 hematologic adverse events were neutropenia in six patients (23.1%), anemia in three (11.5%), and thrombocytopenia in four patients (15.4%). Nonhematologic toxicities were generally mild and usually not dose-limiting. Although grade 1–2 emesis occurred in nine patients (34.6%), only one had grade 3 vomiting. Grade 1–2 cough, local pain, and peripheral neurotoxocity developed in 12 (46.2%), three (11.5%), and five (19.2%) patients, respectively. There were no treatment-related deaths. GEM/CIS chemotherapy with concurrent PTS local injection therapy is a well-tolerated modality with potential activity in previously untreated peripheral advanced nonsmall cell lung cancer patients.

Immune reconstitution from peripheral blood mononuclear cells inhibits lung carcinoma growth in NOD/SCID mice

Drug resistance and immune deficiency are important factors for the poor prognosis of lung carcinoma. The present study explored the possible protective effect of immune reconstitution from peripheral blood mononuclear cells (PBMCs) on multi-drug-resistant human lung carcinoma Am1010 cells in non-obese diabetic/severe combined immunodeficient (NOD/SCID) mice. The inoculated tumor fragments grew rapidly in the NOD/SCID mice. The growth was significantly inhibited by intraperitoneal injection of PBMCs. In the mice injected with PBMCs, numerous CD3+ and CD8+ cells, but less CD4+ cells, were found in spleen and tumor tissues. These data suggest that PBMC transplantation inhibits lung carcinoma progression via the reconstitution of the immune system, particularly of cytotoxic T lymphocytes.

Correlation of Pulmonary Function Indexes Determined by Low-Dose MDCT With Spirometric Pulmonary Function Tests in Patients With Chronic Obstructive Pulmonary Disease

OBJECTIVE The objective of our study was to evaluate the correlation between pulmonary function indexes determined by low-dose MDCT and those obtained from routine spirometric pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS Lung function of patients with COPD stages 0-III was evaluated by both MDCT and spirometric PFTs. Scanning was performed at maximum end-inspiration and maximum end-expiration. RESULTS A very strong correlation was found between extrapolated expiratory lung volume (LVex) and COPD stage (r = 0.802, p < 0.001) and between extrapolated LVex and the ratio of forced expiratory volume in 1 second and percentage forced vital capacity (FEV1/FVC%) (r = -0.831, p < 0.001). Moreover, strong positive correlations were found between inspiratory lung volume (LVin) and total lung capacity (TLC) (r = 0.658, p < 0.001), LVex and residual volume (RV) (r = 0.683, p < 0.001), extrapolated LVex and RV (r = 0.640, p < 0.001), LVex and RV/TLC (r = 0.602, p < 0.001), LVex/LVin and RV/TLC (r = 0.622, p < 0.001), extrapolated LVex and RV/TLC (r = 0.663, p < 0.001), and LVex and COPD stage (r = 0.697, p < 0.001). CONCLUSION Low-dose MDCT lung function indexes correlate well with spirometric PFT results, and the highest correlation is at end-expiration. Low-dose MDCT may be useful for evaluating lung function in patients with COPD.

Quantitative Low-Dose Computed Tomography of the Lung Parenchyma and Airways for the Differentiation between Chronic Obstructive Pulmonary Disease and Asthma Patients

Background: It is difficult to differentiate between chronic obstructive pulmonary disease (COPD) and asthma in clinics; therefore, for diagnostic purposes, imaging-based measurements could be beneficial to differentiate between the two diseases. Objectives: We aim to analyze quantitative measurements of the lung and bronchial parameters that are provided by low-dose computed tomography (CT) to differentiate COPD and asthma from an imaging perspective. Materials and Methods: 69 COPD patients, 52 asthma patients, and 20 healthy subjects were recruited to participate in CT imaging and pulmonary function tests (PFTs). Comparative analysis was performed to identify differences between COPD and asthma in CT measurements. PFT measurements enabled validation of the differentiation between COPD and asthma patients. Results: There were significant differences among the COPD, asthma, and healthy control groups. The differences were more significant among the following: inspiratory emphysema index (EI)-950 (%), expiratory lung volume, expiratory mean lung density (MLD), and expiratory EI-950 (%) and EI-850 (%). The COPD group had a significantly higher EI-950 (%) than the asthma group (p = 0.008). There were significant differences among the three groups in lumen area (LA), wall area (WA), total area, and Pi10WA. The asthma group had significantly higher WA%/WV% than both the COPD (p = 0.002) and the control group (p = 0.012). There was high sensitivity in EI-950 (%), EI-850 (%) and expiratory MLD in the parenchyma and high sensitivity in LA and Pi10WA in small airways in the differential diagnosis of COPD and asthma. Conclusion: To aid the diagnosis, CT can provide quantitative measurements to differentiate between COPD and asthma patients.

Malignant solitary pulmonary nodules: assessment of mass growth rate and doubling time at follow-up CT.

Background The differentiation of benign and malignant solitary pulmonary nodules (SPNs), especially subsolid nodules, is still challenging because of the small size, slow growth, and atypical imaging characteristics of these nodules. We aimed to determine the significance of mass growth rate (MGR) and mass doubling time (MDT) at follow-up CT of malignant SPNs. Methods This retrospective study included 167 patients (169 SPNs, diameter 8-30 mm). Among the 169 SPNs, 114 malignant SPNs were classified into three types: pure ground-glass nodules (pGGNs), part-solid nodules (pSNs), and solid nodules (SNs). These patients were followed up for at least 3 months. Three-dimensional manual segmentation was performed for all these nodules, and the intra- and inter-observer variabilities of diameter, volume, and mass measurement were assessed. From initial and follow-up CT scans, growth rates of the diameter, volume, and mass of the SPNs were compared. MDT and volume doubling time (VDT) were calculated and were compared among groups. Results Mass measurements had the best inter-observer consistency and intra-observer repeatability; the coefficients of variation of the mass measurements were the smallest. The mean growth rates of the diameter, volume, and mass of pGGNs, pSNs, and SNs significantly differed at different time points (P<0.001). Mean MDTs and VDTs of pGGNs, pSNs, and SNs were 655 vs. 848 days, 462 vs. 598 days, and 230 vs. 267 days, respectively (P<0.05). Conclusions Mass measurements are an objective and accurate indicator in SPN assessment. During a 2-year follow-up, the mean growth rates of the diameter, volume, and mass of pGGNs, pSNs, and SNs differed at different time points, the greatest difference was observed in mean MGR. Mean MDT of malignant SPNs is less than the mean VDT.

Is a 5-mm diameter an appropriate cut-off value for the diagnosis of atypical adenomatous hyperplasia and adenocarcinoma in situ on chest computed tomography and pathological examination?

Background Preinvasive lesions, such as atypical adenomatous hyperplasia (AAH) and adenocarcinoma in situ (AIS), usually appear as pure ground-glass nodules (pGGNs) on thin-section computed tomography (TSCT). AAH is usually less than 5 mm wide on imaging and pathological examinations. We aimed to determine whether a 5-mm cut-off value was appropriate for the diagnosis of AAH and AIS. Methods We retrospectively analyzed the performance of TSCT in evaluating 80 pathologically confirmed preinvasive lesions (33 AAH lesions in 31 patients and 47 AIS lesions in 45 patients). We compared the following characteristics between the AAH and AIS groups: lesion diameter, density, rim, lobulation, spiculation, vacuole sign, aerated bronchus sign, pleural indentation sign, and pathological findings. Results All 80 lesions appeared as pGGNs. On TSCT, the average diameter of AAH lesions (6.0±1.64 mm) was significantly smaller than that of AIS lesions (8.7±3.16 mm; P<0.001). The area under the curve (AUC) for diameter was 0.792, and the best diagnostic cut-off value was 6.99 mm. On gross pathological examination, the average diameter of AAH lesions (4.6±1.99 mm) was significantly smaller that of AIS lesions (6.8±2.06 mm; P<0.001). The AUC was 0.794, and the best diagnostic cut-off value was 4.5 mm. The vacuole sign was common in AIS (P=0.021). AAH did not significantly differ from AIS (P>0.05) in terms of average CT value, uniformity of density, morphology, rim, lobulation, spiculation, pleural indentation sign, and aerated bronchus sign. Conclusions Lesion size and the vacuole sign were beneficial in the diagnosis of AAH and AIS. The vacuole sign was common in AIS. The best diagnostic cut-off value of nodular diameter for differentiating between AAH and AIS was 6.99 mm on TSCT and 4.5 mm on gross pathology.