sarcoidosis like disease mimicking metastases during adjuvant ipilimumab therapy in advanced melanoma patient ct scan and mri help in managing difficult clinical decision

The onset of an autoimmune, sarcoidosis-like reaction during or after treatment with immunomodulatory drugs as Ipilimumab is an atypical but renowned eventuality. Awareness of this scenario and its radiological features helps the Radiologist to avoid misdiagnosis of disease progression. In this case report, we present a patient operated for advanced cutaneous melanoma of the left forearm who developed hilar adenopathies with lung and splenic nodules during therapy with Ipilimumab in adjuvant setting. These findings were at first referred to as disease recurrences. Based on discrepancies between imaging, clinic and blood test findings we decided to put the patient on strict follow-up which showed a spontaneous complete regression on the visceral lesions few months after Ipilimumab withheld

Diagnostic yield and accuracy of image-guided percutaneous core needle biopsy of paediatric solid tumours: An experience from Italy

Abstract Background Percutaneous core needle biopsy (PCNB) has become an accepted method to collect tumour tissue samples given its safety, minimal invasiveness, high accuracy and cost-effectiveness. Procedure It is a single centre, retrospective evaluation of 213 ultrasound (US) or computed tomography (CT) guided PCNBs of paediatric solid tumours performed from 2005 to 2017. Safety, diagnostic yield, accuracy, and efficacy assessments of the PCNB procedure were performed. Univariate logistic models were applied to assess the relation of the diagnostic yield with patient, procedure and lesion features. Results The image-guide was US in 91.08% of biopsies; the needle gauge was ≥16 G in 69.01% of the biopsies. The anatomical site of lesion was deep in 113 biopsies (53.05%). The nature of the lesion was the only factor associated with diagnostic yield (OR: 4.04; 95% CI 1.23–13.28; p: 0.022), with benign lesion as an unfavourable factor. Complication incidence was 1.41%. Overall, the diagnostic yield of PCNB was 93.90% (95% CI: 89.79-96.71%), the diagnostic accuracy was 96.86% (95% CI: 93.29–98.84%) and the diagnostic efficacy was 93.33% (95% CI: 86.75–97.28%). Sensitivity was 97.94% (95% CI: 92.75–99.75%) and specificity 100% (95% CI: 66.37–100%). Conclusion PCNB can be recommended as the first-choice method for solid tumours diagnosis in paediatric, adolescent and young adult patients because of its high diagnostic success, safety and accessibility

Stopping Smoking Reduces Mortality in Low-Dose Computed Tomography Screening Participants

Abstract Introduction The National Lung Screening Trial has achieved a 7% reduction in total mortality with low-dose computed tomography (LDCT) screening as compared with in the chest radiography arm. Other randomized trials are under way, comparing LDCT screening with no intervention. None of these studies was designed to investigate the impact of smoking habits on screening outcome. In the present study, we tested the effect of stopping smoking on the overall mortality of participants undergoing repeated LDCT screening for many years. Methods Between 2000 and 2010, 3381 smokers aged 50 years or older were enrolled in two LDCT screening programs. On the basis of the last follow-up information, subjects were divided into two groups: current smokers throughout the screening period and former smokers. Results With a median follow-up time of 9.7 years and a total of 32,857 person-years (PYs) of follow-up, a total of 151 deaths were observed in the group of 1797 current smokers (17,846 PYs) versus 109 among 1584 former smokers (15,011 PYs), corresponding to mortality rates of 8.46 and 7.26 for every 1000 PYs, respectively. Compared with current smokers, former smokers had an adjusted mortality hazard ratio of 0.61 (95% confidence interval: 0.44–0.83), with a 39% reduction in mortality. A similar reduction in mortality was observed in the subset of 712 late quitters, with a hazard ratio of 0.65 (95% confidence interval: 0.44–0.96). Conclusions Stopping smoking significantly reduces the overall mortality of smokers enrolled in LDCT screening programs. The beneficial effect of stopping smoking on total mortality appears to be threefold to fivefold greater than the one achieved by earlier detection in the National Lung Screening Trial

Relationship between lung cancer and pulmonary emphysema

Purpose: To determine the relationship between lung cancer and emphysema by using high-precision 3D image analysis tools on volumetric thin-section CT data. Methods and Materials: Low-dose thin-section CT emphysema features of sub- jects with either symptomatic or screening-trial detected lung cancer (n = 124) were compared with those of 987 controls recruited by the same lung cancer screening trial. All CT scans were obtained according to the same protocol and analysed with a prototypical emphysema detection software (MeVis research), which provides a region-based assessment of the following parameters: lung volumes, mean lung density, emphysema index and four classes of emphysema clusters with different volumes. Multiple regression models were used to assess emphysema features as potential risk factor for lung cancer, after allowance for gender, age, body mass index (BMI), smoking history, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. Results: We found no compelling evidence to suggest that any emphysema feature was associated with lung cancer. No differences in terms of emphysema phenotype were observed between subjects with screening-detected lung cancer and those with cancer detected outside the screening trial. The likelihood of lung cancer was signi cantly higher amongst those with air ow obstruction on spirometry (odds ratio = 0.91, 95% con dence interval [CI] 0.88-0.93). Conclusion: These results show an increased risk of lung cancer associated with airway obstruction. However, emphysema per se is not associated with an increased risk of lung cancer

Fully automated calcium scoring predicts all-cause mortality at 12 years in the MILD lung cancer screening trial.

Coronary artery calcium (CAC) is a known risk factor for cardiovascular (CV) events and mortality but is not yet routinely evaluated in low-dose computed tomography (LDCT)-based lung cancer screening (LCS). The present analysis explored the capacity of a fully automated CAC scoring to predict 12-year mortality in the Multicentric Italian Lung Detection (MILD) LCS trial. The study included 2239 volunteers of the MILD trial who underwent a baseline LDCT from September 2005 to January 2011, with a median follow-up of 190 months. The CAC score was measured by a commercially available fully automated artificial intelligence (AI) software and stratified into five strata: 0, 1-10, 11-100, 101-400, and > 400. Twelve-year all-cause mortality was 8.5% (191/2239) overall, 3.2% with CAC = 0, 4.9% with CAC = 1-10, 8.0% with CAC = 11-100, 11.5% with CAC = 101-400, and 17% with CAC > 400. In Cox proportional hazards regression analysis, CAC > 400 was associated with a higher 12-year all-cause mortality both in a univariate model (hazard ratio, HR, 5.75 [95% confidence interval, CI, 2.08-15.92] compared to CAC = 0) and after adjustment for baseline confounders (HR, 3.80 [95%CI, 1.35-10.74] compared to CAC = 0). All-cause mortality significantly increased with increasing CAC (7% in CAC ≤ 400 vs. 17% in CAC > 400, Log-Rank p-value 400 (Grey's test p 400 predicted 12-year non-cancer mortality in a univariate model (sub-distribution hazard ratio, SHR, 10.62 [95% confidence interval, CI, 1.43-78.98] compared to CAC = 0), but the association was no longer significant after adjustment for baseline confounders. In conclusion, fully automated CAC scoring was effective in predicting all-cause mortality at 12 years in a LCS setting

Comparison of ultra-low dose chest CT scanning protocols for the detection of pulmonary nodules: a phantom study

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Gene Signatures Stratify Computed Tomography Screening Detected Lung Cancer in High-Risk Populations

Background: Although screening programmes of smokers have detected resectable early lung cancers more frequently than expected, their efficacy in reducing mortality remains debatable. To elucidate the biological features of computed tomography (CT) screening detected lung cancer, we examined the mRNA signatures on tumours according to the year of detection, stage and survival. Methods: Gene expression profiles were analysed on 28 patients (INT–IEO training cohort) and 24 patients of Multicentre Italian Lung Detection (MILD validation cohort). The gene signatures generated from the training set were validated on the MILD set and a public deposited DNA microarray data set (GSE11969). Expression of selected genes and proteins was validated by real-time RT-PCR and immunohistochemistry. Enriched core pathway and pathway networks were explored by GeneSpring GX10. Findings: A 239-gene signature was identified according to the year of tumour detection in the training INT–IEO set and correlated with the patients' outcomes. These signatures divided the MILD patients into two distinct survival groups independently of tumour stage, size, histopathological type and screening year. The signatures can also predict survival in the clinically detected cancers (GSE11969). Pathway analyses revealed tumours detected in later years enrichment of the PI3K/PTEN/AKT pathway, with up-regulation of PDPK1, ITGB1 and down-regulation of FOXO1A. Analysis of normal lung tissue from INT–IEO cohort produced signatures distinguishing patients with early from late detected tumours. Interpretation: The distinct pattern of “indolent” and “aggressive” tumour exists in CT-screening detected lung cancer according to the gene expression profiles. The early development of an aggressive phenotype may account for the lack of mortality reduction by screening observed in some cohorts