OBJECTIVES. Solitary Solid Spiculated Nodule. What would you do next? Case Based Discussion: State of the Art Management of Lung Nodules.
|
|
- Lewis Todd
- 5 years ago
- Views:
Transcription
1 Organ Imaging : September OBJECTIVES Case Based Discussion: State of the Art Management of Lung Nodules Dr. Elsie T. Nguyen Dr. Kazuhiro Yasufuku 1. To review guidelines for follow up and management of solid and sub solid nodules 2. To review low dose CT chest technique 3. To highlight some pitfalls when reporting the chest CT 4. To describe various options for surgical management of nodules Case 1 64 year old woman with chronic cough, CT chest completed to rule out bronchiectasis as a cause 35 pack year history of smoking, quit 5 years ago No constitutional symptoms No SOB, chest pain, or hemoptysis No other significant medical history Solitary Solid Spiculated Nodule No adenopathy Moderate emphysema No other findings What would you do next? Algorithm for initial detection of Solitary Pulmonary Nodule A) Follow up chest CT in 3 months B) Let it go C) CT guided biopsy D) Bronchoscopy E) PET CT Chest. 2013;143(3):
2 Algorithm for evaluation of solid nodules SOLITARY PULMONARY NODULE Recommendations for Follow up and Management of Nodules Detected Incidentally at Non screening CT McMahon et al. Radiology 237, November 2005; Lobectomy is the Standard Anatomical lobectomy with systematic hilar lymph node dissection is the standard of surgical treatment for lung cancer Different Approaches Thoracotomy VATS Ann Thorac Surg 1995; 60(3): Minimally Invasive (VATS) Lobectomy VATS Lobectomy Technique VATS Instruments Endoscopic Staplers J Thorac Cardiovasc Surg 2010;139: Same work on the inside Different incision on the outside
3 VATS Lobectomy Oncologic Outcome There are no studies that report or suggest a difference in ability to achieve complete resection in patients with stage I or II NSCLC da Vinci Robotic Lobectomy There is evidence that there is equivalence in selected patients with stage IIIA after induction therapy Robotic Lobectomy Robotic Lobectomy Oncologic results Multi institutional retrospective review (n=325) Majority clinical stage I (IA, 247; IB, 63) Conversion rate: 8% (27/325) Morbidity 25.2% (82/325) Mortality 0.3% (1/325) Major complication rate 3.7% (12/325) p stage: IA, 54%, IB, 22%, IIA, 13%, IIB, 5%, IIIA, 6% Overall 5 year survival 80% (CI 73 88) IA 91%, IB 88%, II 49% Park. J Thorac Cardiovasc Surg 2012;143: CALGB Phase III Randomized Trial of Lobectomy vs Sublobar Resection for Small (<2cm) Peripheral NSCLC Surgery Confirmation of NSCLC on Path N0 status on frozen section (4R, 7, 10R on right) (5or6, 7, 10L on left) VATS Segmental Resection Lobectomy Randomization Limited Resection Extensive central lobular emphysema (upper lobe predominant) 18x14mm peripheral ill defined nodule Stage IA, NSCLC
4 Case 2 59 year old woman investigated with CT chest for? Interstitial lung disease in 2009 History of mixed connective tissue disease Due to a finding in the RUL, follow up CT chest examinations were completed Asymptomatic Normal PFTs Case 2 Low Dose CT chest Technique: 135 kv, 50 ma, dose usually 1 2 msv No contrast Helical acquisition 3mm reconstruction FOV cm Case 2 59F RUL abnormality Case Always compare with most recent previous as well as baseline examination to detect small changes in density or overall size for sub solid nodules (GGO), new solid component Changes occur very slowly as they are slow growing lesions Make sure you are comparing similar slice reconstructions (3mm versus 5mm) Can Texture Analysis Help? Texture and Volumetric Analysis Differentiation of AAH/AIS/min invasive vs invasive adenocarcinoma Better assessment of change over time Pure GGO Sub Solid 4
5 What would you do next? A) Follow up chest CT in 3 months B) Lobectomy C) CT guided FNA biopsy D) Microcoil localization prior to VATS E) PET CT Case 2 RUL Growing Sub Solid Nodule Next step may vary depending on institution and availability/expertise locally in radiology and thoracic surgery Sub solid nodules have higher risk of malignancy than solid nodules Growing sub solid nodules especially with enlarging solid component should be resected Algorithm for evaluation of sub-solid nodules Subsolid nodules differential diagnosis 30 70% of subsolid nodules resolve on short term follow up If they do persist: high probability of being malignant V.Patel et al. Chest. 2013;143(3): GGO Resolution in 3 months Definitions of Sub solid Nodules Pure ground glass nodule (GGN): A focal area of increased lung attenuation that does not completely obscure the lung parenchyma The margins of normal structures such as vessels remain outlined, and there are no areas of soft tissue density 5
6 Definitions of subsolid nodules Sub solid nodule: A focal opacity containing both solid and ground glass components Areas of parenchymal architecture are obscured within Malignancy Risk in Sub Solid Nodules Early Lung Cancer Action Project (ELCAP) 34% of subsolid nodules were malignant vs. 7% solid nodules Sub solid (part solid) Nodules: 63% malignant Ground Glass Nodules: 18 % malignant Noguchi M et al Cancer 1995 June 15; 75 (12): Henschke et al Am J Roentgenol May; 178(5): PREINVASIVE LESIONS Atypical adenomatous hyperplasia Considered precursor to adenocarcinoma Proliferation of Type II Pneumocytes or Clara Cell like cells with mild to moderate cellular atypia Usually <5 mm PREINVASIVE LESIONS Adenocarcinoma in situ (formerly BAC) Adenocarcinoma in situ (AIS) Pre invasive lesions <3cm Pure lepidic growth No stromal, vascular, lymphatic or pleural invasion Need complete histologic sampling for diagnosis Usually non mucinous MINIMALLY INVASIVE LESIONS Minimally invasive adenocarcinoma 6
7 Minimally invasive adenocarcinoma (MIA) Invasive lesions Lepidic predominant <5 mm stromal invasion No lymphatic, vascular or pleural invasion Need complete histologic sampling for diagnosis Lepidic predominance Papillary predominance Acinar predominance Micropapillary predominance Travis W et al J Thorac Oncol 2011; 6(2): Solid predominant with mucin production J Thorac Imaging Volume 27, Number 6, November 2012 Radiologic Implications of New Lung Adenocarcinoma Classification Sub solid nodules: Differential Diagnosis Adenocarcinoma spectrum Pulmonary Lymphoma Benign etiology: Infection Focal fibrosis or scarring Focal inflammatory process: Organising pneumonia, eosinophilic lung disease or Non specific interstitial pneumonia (NSIP) GROUND GLASS AND SUB SOLID NODULES Fleischner Society Guidelines Naidich DP et al Radiology (1): Case 3 85F with ovarian cancer What would you do next? A) Follow up chest CT in 3 months B) RUL, LUL and LLL Lobectomy C) CT guided FNA biopsy D) Microcoil localization prior to VATS E) PET CT 7
8 Diagnostic Approach to Pulmonary Nodules Minimally Invasive Biopsy Bronchoscopic biopsy CT guided FNA Surgical biopsy VATS Thoracotomy VATS (Video assisted thoracoscopic surgery) Procedure of choice for surgical biopsy of peripheral pulmonary nodule Limitation Identification of the nodule Lack of digital palpation in small, non solid deep nodules May require conversion to thoracotomy Surgical Biopsy Issues VATS Visible with VATS if within 5mm of the visceral pleura Nodules deeper than 5mm need to be palpated for localization prior to resection Non solid nodules, especially GGO, are difficult to palpate Localizing Techniques VATS Intraoperative imaging CT Thoracic ultrasound Preoperative CT guided marking Liquid material (contrast media, colored adhesive agents, dyes) Radionuclides Wires (hookwires, microcoils) Preoperative bronchoscopic marking Dye Fiducials Radiology 2002; 225: Microcoil Technique Microcoil Technique Pleural marking nodules<3cm within 3 cm of pleural surface non palpable (GGO,subsolid, too deep) No pleural marking 8
9 Case 3 85F with ovarian cancer OBJECTIVES 2010 Part solid nodule was resected with microcoil localization and VATS Dx: minimally invasive adenoca other nodules showed slow growth To review guidelines for follow up and management of solid and sub solid nodules 2. To review low dose CT chest technique 3. To highlight some pitfalls when reporting the chest CT 4. To describe various options for surgical management of nodules Take Home Points Thank you! Guidelines for CT follow up of incidental solid nodules is different from sub solid nodules Sub solid nodules are slow growing; always compare with oldest CT chest available PET CT is often negative due to low metabolic activity Variation in slice reconstruction can vary appearance of nodules Sub solid nodules have higher risk of malignancy than solid nodules Thoracic surgery should be consulted as many noninvasive options exist for both diagnosis and treatment CT Patterns Among IASLC/ATS/ERS Lung Adenocarcinoma Subtypes Predominant Histologic Subtype Nonmucinous AIS MIA Appearance on CT Scan Most often pure GGN or partly solid nodule with solid component < 5 mm Lepidic (nonmucinous) Most often partly solid nodule with solid component > 5 mm or solid nodule; less commonly pure GGN Papillary Acinar Micropapillary Solid Invasive mucinous adenocarcinoma Solid nodule Solid nodule Unknown Solid Consolidation, air bronchograms; less often pure GGN V Patel et al. Chest. 2013; 143(3):
10 Differential diagnosis GGO Evaluation with CT MALT MALT 7 years later Subsolid nodules best evaluated with thin section images < 2.5 mm Quantify solid vs. ground glass components 10
Thoracic CT pattern in lung cancer: correlation of CT and pathologic diagnosis
19 th Congress of APSR PG of Lung Cancer (ESAP): Update of Lung Cancer Thoracic CT pattern in lung cancer: correlation of CT and pathologic diagnosis Kazuma Kishi, M.D. Department of Respiratory Medicine,
More informationThe Spectrum of Management of Pulmonary Ground Glass Nodules
The Spectrum of Management of Pulmonary Ground Glass Nodules Stanley S Siegelman CT Society 10/26/2011 No financial disclosures. Noguchi M et al. Cancer 75: 2844-2852, 1995. 236 surgically resected peripheral
More informationPulmonary Nodules & Masses
Pulmonary Nodules & Masses A Diagnostic Approach Heber MacMahon The University of Chicago Department of Radiology Disclosure Information Consultant for Riverain Technology Minor equity in Hologic Royalties
More informationThe small subsolid pulmonary nodules. What radiologists need to know.
The small subsolid pulmonary nodules. What radiologists need to know. Poster No.: C-1250 Congress: ECR 2016 Type: Educational Exhibit Authors: L. Fernandez Rodriguez, A. Martín Díaz, A. Linares Beltrán,
More informationI appreciate the courtesy of Kusumoto at NCC for this presentation. What is Early Lung Cancers. Early Lung Cancers. Early Lung Cancers 18/10/55
I appreciate the courtesy of Kusumoto at NCC for this presentation. Dr. What is Early Lung Cancers DEATH Early period in its lifetime Curative period in its lifetime Early Lung Cancers Early Lung Cancers
More informationUpdate on 2015 WHO Classification of Lung Adenocarcinoma 1/3/ Mayo Foundation for Medical Education and Research. All rights reserved.
1 Our speaker for this program is Dr. Anja Roden, an associate professor of Laboratory Medicine and Pathology at Mayo Clinic as well as consultant in the Anatomic Pathology Laboratory and co-director of
More informationUniportal video-assisted thoracoscopic surgery segmentectomy
Case Report on Thoracic Surgery Page 1 of 5 Uniportal video-assisted thoracoscopic surgery segmentectomy John K. C. Tam 1,2 1 Division of Thoracic Surgery, National University Heart Centre, Singapore;
More informationLUNG NODULES: MODERN MANAGEMENT STRATEGIES
Department of Radiology LUNG NODULES: MODERN MANAGEMENT STRATEGIES Christian J. Herold M.D. Department of Biomedical Imaging and Image-guided Therapy Medical University of Vienna Vienna, Austria Pulmonary
More informationThe 2015 World Health Organization Classification for Lung Adenocarcinomas: A Practical Approach
The 2015 World Health Organization Classification for Lung Adenocarcinomas: A Practical Approach Dr. Carol Farver Director, Pulmonary Pathology Pathology and Laboratory Medicine Institute Objectives Discuss
More informationAdam J. Hansen, MD UHC Thoracic Surgery
Adam J. Hansen, MD UHC Thoracic Surgery Sometimes seen on Chest X-ray (CXR) Common incidental findings on computed tomography (CT) chest and abdomen done for other reasons Most lung cancers discovered
More informationXiaohuan Pan 1,2 *, Xinguan Yang 1,2 *, Jingxu Li 1,2, Xiao Dong 1,2, Jianxing He 2,3, Yubao Guan 1,2. Original Article
Original Article 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?
More informationThe revised lung adenocarcinoma classification an imaging guide
Review Article The revised lung adenocarcinoma classification an imaging guide Natasha Gardiner 1, Sanjay Jogai 2, Adam Wallis 3 1 Specialty Registrar in Clinical Radiology, Wessex Deanery, UK; 2 Consultant
More informationEvidence based approach to incidentally detected subsolid pulmonary nodule. DM SEMINAR July 27, 2018 Harshith Rao
Evidence based approach to incidentally detected subsolid pulmonary nodule DM SEMINAR July 27, 2018 Harshith Rao Outline Definitions Etiologies Risk evaluation Clinical features Radiology Approach Modifications:
More informationManagement of Multiple Pure Ground-Glass Opacity Lesions in Patients with Bronchioloalveolar Carcinoma
ORIGINAL ARTICLE Management of Multiple Pure Ground-Glass Opacity Lesions in Patients with Bronchioloalveolar Carcinoma Hong Kwan Kim, MD,* Yong Soo Choi, MD,* Jhingook Kim, MD, PhD,* Young Mog Shim, MD,
More informationGUIDELINES FOR PULMONARY NODULE MANAGEMENT : RECENT CHANGES AND UPDATES
Venice 2017 GUIDELINES FOR PULMONARY NODULE MANAGEMENT : RECENT CHANGES AND UPDATES Heber MacMahon MB, BCh Department of Radiology The University of Chicago Disclosures Consultant for Riverain Medical
More informationCorrelation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma
Original Article Correlation in histological subtypes with high resolution computed tomography signatures of early stage lung adenocarcinoma Yingying Miao 1,2 *, Jianya Zhang 1,2 *, Jiawei Zou 1,2, Qingqing
More informationCT Screening for Lung Cancer for High Risk Patients
CT Screening for Lung Cancer for High Risk Patients The recently published National Lung Cancer Screening Trial (NLST) showed that low-dose CT screening for lung cancer reduces mortality in high-risk patients
More informationHRCT features distinguishing minimally invasive adenocarcinomas from invasive adenocarcinomas appearing as mixed ground-glass nodules
Original Article HRCT features distinguishing minimally invasive adenocarcinomas from invasive adenocarcinomas appearing as mixed ground-glass nodules Wei Yu 1, Zhaoyu Wang 2, Liyong Qian 2, Shanjun Wang
More informationLow-dose CT Lung Cancer Screening Guidelines for Pulmonary Nodules Management Version 2
Low-dose CT Lung Cancer Screening Guidelines for Pulmonary Nodules Management Version 2 The Committee for Management of CT-screening-detected Pulmonary Nodules 2009-2011 The Japanese Society of CT Screening
More informationGround Glass Opacities
Ground Glass Opacities A pathologist s perspective Marie-Christine Aubry, M.D. Professor of Pathology Mayo Clinic Objectives Discuss the proposed new pathologic classification of adenocarcinoma with historical
More informationPULMONARY NODULES AND MASSES : DIAGNOSTIC APPROACH AND NEW MANAGEMENT GUIDELINES. https://tinyurl.com/hmpn2018
PULMONARY NODULES AND MASSES : DIAGNOSTIC APPROACH AND NEW MANAGEMENT GUIDELINES Heber MacMahon MB, BCh Department of Radiology The University of Chicago https://tinyurl.com/hmpn2018 Disclosures Consultant
More informationTreatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard
Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard AATS General Thoracic Surgery Symposium May 5, 2010 Thomas A. D Amico MD Professor of Surgery, Duke University Medical
More informationSteering Committee. Waiting on photo. Paul A. Bunn, Jr., MD Kavita Garg, MD Kim Geisinger, MD Fred R. Hirsch, Gregory Riely, MD, PhD.
Steering Committee Paul A. Bunn, Jr., MD Kavita Garg, MD Kim Geisinger, MD Fred R. Hirsch, Gregory Riely, MD, PhD MD, PhD Waiting on photo Paul Van Schil, MD, PhD William D. Travis, MD Ming-Sound Tsao,
More informationGuidelines for the Management of Pulmonary Nodules Detected by Low-dose CT Lung Cancer Screening
Guidelines for the Management of Pulmonary Nodules Detected by Low-dose CT Lung Cancer Screening 1. Introduction In January 2005, the Committee for Preparation of Clinical Practice Guidelines for the Management
More informationLung Cancer Diagnosis for Primary Care
Lung Cancer Diagnosis for Primary Care Daniel Nader, DO, FCCP Cancer Treatment Center of America Case 1 In which of the following situations would the U.S. Preventive Services Task Force (USPSTF) recommend
More informationLarry Tan, MD Thoracic Surgery, HSC. Community Cancer Care Educational Conference October 27, 2017
Larry Tan, MD Thoracic Surgery, HSC Community Cancer Care Educational Conference October 27, 2017 To describe patient referral & triage for the patient with suspected lung cancer To describe the initial
More informationCT findings in multifocal or diffuse non-mucinous bronchioloalveolar carcinoma (BAC)
CT findings in multifocal or diffuse non-mucinous bronchioloalveolar carcinoma (BAC) Poster No.: C-2192 Congress: ECR 2014 Type: Educational Exhibit Authors: I. Sandu, A. R. Popita, I.-A. Brumboiu; Cluj-Napoca/RO
More informationCT findings in multifocal or diffuse non-mucinous bronchioloalveolar carcinoma (BAC)
CT findings in multifocal or diffuse non-mucinous bronchioloalveolar carcinoma (BAC) Poster No.: C-2192 Congress: ECR 2014 Type: Educational Exhibit Authors: I. Sandu, A. R. Popita, I.-A. Brumboiu; Cluj-Napoca/RO
More informationLungebevarende resektioner ved lungecancer metode og resultater
Dept. of Cardiothoracic Surgery Lungebevarende resektioner ved lungecancer metode og resultater Henrik Jessen Hansen Dept. of Cardiothoracic Surgery RT 2152, The National University Hospital. Copenhagen,
More informationThe IASLC/ATS/ERS classification of lung adenocarcinoma-a surgical point of view
Review Article The IASLC/ATS/ERS classification of lung adenocarcinoma-a surgical point of view Wentao Fang 1, Yangwei Xiang 1, Chenxi Zhong 1, Qunhui Chen 2 1 Department of Thoracic Surgery, 2 Department
More informationPathology and Prognosis of Persistent Stable Pure Ground-Glass Opacity Nodules After Surgical Resection
GENERAL THORACIC Pathology and Prognosis of Persistent Stable Pure Ground-Glass Opacity Nodules After Surgical Resection Sukki Cho, MD, HeeChul Yang, MD, Kwhanmien Kim, MD, and Sanghoon Jheon, MD Department
More informationThoracoscopic wedge resection and segmentectomy for smallsized pulmonary nodules
Perspective on Thoracic Surgery Thoracoscopic wedge resection and segmentectomy for smallsized pulmonary nodules Hirohisa Kato, Hiroyuki Oizumi, Jun Suzuki, Akira Hamada, Hikaru Watarai, Kenta Nakahashi,
More informationSlide 1. Slide 2. Slide 3. Investigation and management of lung cancer Robert Rintoul. Epidemiology. Risk factors/aetiology
Slide 1 Investigation and management of lung cancer Robert Rintoul Department of Thoracic Oncology Papworth Hospital Slide 2 Epidemiology Second most common cancer in the UK (after breast). 38 000 new
More informationFDG PET/CT in Lung Cancer Read with the experts. Homer A. Macapinlac, M.D.
FDG PET/CT in Lung Cancer Read with the experts Homer A. Macapinlac, M.D. Patient with suspected lung cancer presents with left sided chest pain T3 What is the T stage of this patient? A) T2a B) T2b C)
More informationCT Screening for Lung Cancer: Frequency and Significance of Part-Solid and Nonsolid Nodules
Claudia I. Henschke 1 David F. Yankelevitz 1 Rosna Mirtcheva 1 Georgeann McGuinness 2 Dorothy McCauley 1 0lli S. Miettinen 3 for the ELCAP Group Received June 19, 2001; accepted after revision November
More informationAccomplishes fundamental surgical tenets of R0 resection with systematic nodal staging for NSCLC Equivalent survival for Stage 1A disease
Segmentectomy Made Simple Matthew J. Schuchert and Rodney J. Landreneau Department of Cardiothoracic Surgery University of Pittsburgh Medical Center Financial Disclosures none Why Consider Anatomic Segmentectomy?
More informationEducational Objectives. Managing Lung Cancer From the Solitary Pulmonary Nodule to Complex Cases: A Multidisciplinary Approach.
Managing Lung Cancer From the Solitary Pulmonary Nodule to Complex Cases: A Multidisciplinary Approach Robert A. Meguid, MD, MPH, FACS Assistant Professor of Cardiothoracic Surgery Surgical Director, Surgical
More informationLung Cancer Screening: To Screen or Not to Screen?
Lung Cancer Screening: To Screen or Not to Screen? Lorriana Leard, MD Co-Director of UCSF Lung Cancer Screening Program Vice Chief of Clinical Activities UCSF Pulmonary, Critical Care, Allergy & Sleep
More informationNavigational bronchoscopy-guided dye marking to assist resection of a small lung nodule
Case Report on Aerodigestive Endoscopy Navigational bronchoscopy-guided dye marking to assist resection of a small lung nodule Jennifer L. Sullivan 1, Michael G. Martin 2, Benny Weksler 1 1 Division of
More informationYOUR LUNG CANCER PATHOLOGY REPORT
UNDERSTANDING SERIES YOUR LUNG CANCER PATHOLOGY REPORT 1-800-298-2436 LungCancerAlliance.org A GUIDE FOR THE PATIENT 1 CONTENTS What is a Pathology Report?...2 The Basics...3 Sections of a Pathology Report...6
More informationIncremental value of contrast enhanced computed tomography on diagnostic accuracy in evaluation of small pulmonary ground glass nodules
Original Article Incremental value of contrast enhanced computed tomography on diagnostic accuracy in evaluation of small pulmonary ground glass nodules Ming Li 1 *, Feng Gao 1 *, Jayender Jagadeesan 2,
More informationCase Scenario 1. The patient agreed to a CT guided biopsy of the left upper lobe mass. This was performed and confirmed non-small cell carcinoma.
Case Scenario 1 An 89 year old male patient presented with a progressive cough for approximately six weeks for which he received approximately three rounds of antibiotic therapy without response. A chest
More informationApproach to Pulmonary Nodules
Approach to Pulmonary Nodules Edwin Jackson, Jr., DO Assistant Professor-Clinical Director, James Early Detection Clinic Department of Internal Medicine Division of Pulmonary, Allergy, Critical Care and
More informationIASLC 2011/WHO 2015 CLASSIFICATION OF LUNG ADENOCARCINOMAS
Serban Negoita Dylan Holt Marsha Dunn IASLC 2011/WHO 2015 CLASSIFICATION OF LUNG ADENOCARCINOMAS DEMOGRAPHIC PATTERNS, TRENDS, AND IMPLICATIONS FOR CANCER SURVEILLANCE Outline Relevance of lung adenocarcinoma
More informationLung /4/18. Please submit all questions concerning the webinar content through the Q&A panel.
Lung NAACCR 2018 2019 WEBINAR SERIES 1 Q&A Please submit all questions concerning the webinar content through the Q&A panel. If you have participants watching this webinar at your site, please collect
More informationInvasive Pulmonary Adenocarcinomas versus Preinvasive Lesions Appearing as Ground-Glass Nodules: Differentiation by Using CT Features 1
Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights. Sang Min Lee, MD
More informationFinancial disclosure COMMON DIAGNOSES IN HRCT. High Res Chest HRCT. HRCT Pre test. I have no financial relationships to disclose. Anatomy Nomenclature
Financial disclosure I have no financial relationships to disclose. Douglas Johnson D.O. Cardiothoracic Imaging Gaston Radiology COMMON DIAGNOSES IN HRCT High Res Chest Anatomy Nomenclature HRCT Sampling
More informationLung Tumor Cases: Common Problems and Helpful Hints
Lung Tumor Cases: Common Problems and Helpful Hints Brandon T. Larsen, MD, PhD Senior Associate Consultant Department of Laboratory Medicine and Pathology Mayo Clinic Arizona Arizona Society of Pathologists
More informationLung imaging. Sebastian Ley 1,2
CLINICAL YEAR IN REVIEW LUNG IMAGING Lung imaging Sebastian Ley 1,2 Affiliations: 1 Dept of Diagnostic and Interventional Radiology, Chirurgische Klinik Dr. Rinecker, Munich, Germany. 2 Dept of Clinical
More informationInnovations in Lung Cancer Diagnosis and Surgical Treatment
Transcript Details This is a transcript of a continuing medical education (CME) activity accessible on the ReachMD network. Additional media formats for the activity and full activity details (including
More informationROBOT SURGEY AND MINIMALLY INVASIVE TREATMENT FOR LUNG CANCER
ROBOT SURGEY AND MINIMALLY INVASIVE TREATMENT FOR LUNG CANCER Giulia Veronesi European Institute of Oncology Milan Lucerne, Samo 24 th - 25 th January, 2014 DIAGNOSTIC REVOLUTION FOR LUNG CANCER - Imaging
More informationLung. 10/24/13 Chest X-ray: 2.9 cm mass like density in the inferior lingular segment worrisome for neoplasm. Malignancy cannot be excluded.
Lung Case Scenario 1 A 54 year white male presents with a recent abnormal CT of the chest. The patient has a history of melanoma, kidney, and prostate cancers. 10/24/13 Chest X-ray: 2.9 cm mass like density
More informationobjectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University
objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University To determine the regions of physiologic activity To understand
More informationVATS Metastasectomy. Inderpal (Netu) S. Sarkaria, MD, FACS
VATS Metastasectomy Inderpal (Netu) S. Sarkaria, MD, FACS Vice Chairman, Clinical Affairs Director, Robotic Thoracic Surgery Co-Director, Esophageal and Lung Surgery Institute Disclosures Speaking & Education:
More informationYong Qiang 1, Lei Zhang 1, Nan Yang 1, Jian Xu 1, De-Min Li 1, Tangfeng Lv 2, Ping Zhan 2, Yong Song 2, Zhong-Dong Li 1, Hao Li 3.
Original Article Diagnostic and therapeutic value of computed tomography guided coil placement after digital subtraction angiography guided videoassisted thoracoscopic surgery resection for solitary pulmonary
More informationResults of Wedge Resection for Focal Bronchioloalveolar Carcinoma Showing Pure Ground-Glass Attenuation on Computed Tomography
Results of Wedge Resection for Focal Bronchioloalveolar Carcinoma Showing Pure Ground-Glass Attenuation on Computed Tomography Shun-ichi Watanabe, MD, Toshio Watanabe, MD, Kazunori Arai, MD, Takahiko Kasai,
More informationNon-Small Cell Lung Carcinoma - Myers
Role of Routine Histology and Special Testing in Managing Patients with Non- Small Cell Lung Carcinoma Jeffrey L. Myers, M.D. A. James French Professor Director, Anatomic Pathology & MLabs University of
More informationI9 COMPLETION INSTRUCTIONS
The I9 Form is completed for each screening exam at T0, T1, and T2. At T0 (baseline), the I9 documents comparison review of the baseline screen (C2 Form) with any historical images available. At T1 and
More informationCase Scenario 1: Breast
Case Scenario 1: Breast A 63 year old white female presents with a large mass in her left breast. 4/15/13 Mammogram/US: 1. Left breast mammographic and sonographic at 3:00 measuring 7.1 cm highly suggestive
More informationWith recent advances in diagnostic imaging technologies,
ORIGINAL ARTICLE Management of Ground-Glass Opacity Lesions Detected in Patients with Otherwise Operable Non-small Cell Lung Cancer Hong Kwan Kim, MD,* Yong Soo Choi, MD,* Kwhanmien Kim, MD,* Young Mog
More informationCharles Mulligan, MD, FACS, FCCP 26 March 2015
Charles Mulligan, MD, FACS, FCCP 26 March 2015 Review lung cancer statistics Review the risk factors Discuss presentation and staging Discuss treatment options and outcomes Discuss the status of screening
More informationC2 COMPLETION INSTRUCTIONS
The C2 Form is completed for each screening exam at T0, T1, and T2. The C2 Form is to be completed by each of the following ACRIN-NLST study staff: the research associate (study coordinator), CT technologist,
More informationPredictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer
Original Article Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer Feichao Bao, Ping Yuan, Xiaoshuai Yuan, Xiayi Lv, Zhitian Wang, Jian Hu Department
More informationChest Radiology Interpretation: Findings of Tuberculosis
Chest Radiology Interpretation: Findings of Tuberculosis Get out your laptops, smart phones or other devices pollev.com/chestradiology Case #1 1 Plombage Pneumonia Cancer 2 Reading the TB CXR Be systematic!
More informationLung cancer is the most common cause of cancer death in
ORIGINAL ARTICLE Are There Imaging Characteristics Associated with Epidermal Growth Factor Receptor and Mutations in Patients with Adenocarcinoma of the Lung with Bronchioloalveolar Features? Catherine
More informationNatural History of Pure Ground-Glass Opacity After Long-Term Follow-up of More Than 2 Years
Natural History of Pure Ground-Glass Opacity After Long-Term Follow-up of More Than 2 Years Ken Kodama, MD, Masahiko Higashiyama, MD, Hideoki Yokouchi, MD, Koji Takami, MD, Keiko Kuriyama, MD, Yoko Kusunoki,
More informationObjectives. Why? Why? Background 11/5/ % incurable disease at presentation Locally advanced disease Metastasis. 14% 5 year survival
Objectives Appraise lung cancer screening trials results Review screening guidelines Lung Cancer Screening: Past, Present and Future Chi Wan Koo, MD Koo.chiwan@mayo.edu Discuss recommendations essential
More informationPulmonary Nodules. Michael Morris, MD
Pulmonary Nodules Michael Morris, MD Case 45 year old healthy male Smokes socially Normal physical exam Pre-employment screening remote +PPD screening CXR nodular opacity Case 45 year old healthy male
More informationThoracic Surgery; An Overview
Thoracic Surgery What we see Thoracic Surgery; An Overview James P. Locher, Jr, MD Methodist Cardiovascular and Thoracic Surgery Lung cancer Mets Fungus and TB Lung abcess and empyema Pleural based disease
More informationLung Cancer screening :
Lung Cancer screening : Pro-Contra SAMO interdisciplinary workshop on chest tumors 27 and 28 january 2017 Prof L.P.Nicod Sevice de pneumologie CHUV-Lausanne -CH Lung Cancer How big is the problem? Epidemiology
More informationTHE BENEFITS OF BIG DATA
THE BENEFITS OF BIG DATA Disclosures I am a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on CT scans of the chest which are owned by Cornell
More informationPrognostic prediction of clinical stage IA lung cancer presenting as a pure solid nodule
Original Article Prognostic prediction of clinical stage IA lung cancer presenting as a pure solid nodule Jong Hui Suh 1, Jae Kil Park 2, Youngkyu Moon 2 1 Department of Thoracic & Cardiovascular Surgery,
More informationNew lung lesion in a 55 year-old male treated with chemoradiation for non-small cell lung carcinoma
July 2016 New lung lesion in a 55 year-old male treated with chemoradiation for non-small cell lung carcinoma Contributed by: Laurel Rose, MD, Resident Physician, Indiana University School of Medicine,
More informationSurgery for early stage NSCLC
1-3 March 2017, Manchester, UK Surgery for early stage NSCLC Dominique H. Grunenwald, MD, PhD Professor Emeritus in Thoracic and Cardiovascular surgery Pierre & Marie Curie University. Paris. France what
More informationEarly-stage locally advanced non-small cell lung cancer (NSCLC) Clinical Case Discussion
Early-stage locally advanced non-small cell lung cancer (NSCLC) Clinical Case Discussion Pieter Postmus The Clatterbridge Cancer Centre Liverpool Heart and Chest Hospital Liverpool, United Kingdom 1 2
More informationReasons for conversion during VATS lobectomy: what happens with increased experience
Review Article on Thoracic Surgery Page 1 of 5 Reasons for conversion during VATS lobectomy: what happens with increased experience Dario Amore, Davide Di Natale, Roberto Scaramuzzi, Carlo Curcio Division
More informationNon Small Cell Lung Cancer Histopathology ד"ר יהודית זנדבנק
Non Small Cell Lung Cancer Histopathology ד"ר יהודית זנדבנק 26.06.09 Lecture outlines WHO histological classification Macro/Micro assessment Early diagnosis Minimal pathology Main subtypes SCC, AdCa, LCLC
More informationLung Cancer Clinical Guidelines: Surgery
Lung Cancer Clinical Guidelines: Surgery 1 Scope of guidelines All Trusts within Manchester Cancer are expected to follow this guideline. This guideline is relevant to: Adults (18 years and older) with
More informationStage I synchronous multiple primary non-small cell lung cancer: CT findings and the effect of TNM staging with the 7th and 8th editions on prognosis
Original Article Stage I synchronous multiple primary non-small cell lung cancer: CT findings and the effect of TNM staging with the 7th and 8th editions on prognosis Jingxu Li, Xinguan Yang, Tingting
More informationImpact of immunostaining of pulmonary and mediastinal cytology
Impact of immunostaining of pulmonary and mediastinal cytology Harman Sekhon MD, PhD Director of Cytopathology Head of Ottawa-site Ontario Tumour Bank June 20, 2014 Disclaimer Pfizer: Honorarium-Advisory
More informationExpert Round Table with Drs. Anne Tsao and Alex Farivar Part 1: Elderly Man with Indolent Bronchioloalveolar Carcinoma
Expert Round Table with Drs. Anne Tsao and Alex Farivar Part 1: Elderly Man with Indolent Bronchioloalveolar Carcinoma February 2010 I d like to welcome everyone, thanks for coming out to our lunch with
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our
More informationLung cancer Surgery. 17 TH ESO-ESMO MASTERCLASS IN CLINICAL ONCOLOGY March, 2017 Berlin, Germany
17 TH ESO-ESMO MASTERCLASS IN CLINICAL ONCOLOGY 24-29 March, 2017 Berlin, Germany Lung cancer Surgery Sven Hillinger MD, Thoracic Surgery, University Hospital Zurich Case 1 59 y, female, 40 py, incidental
More informationScreening for Lung Cancer: Are We There Yet?
Screening for Lung Cancer: Are We There Yet? Kavita Garg, MD Professor of Radiology University of CO, Denver Mountain States Cancer Conference Nov 6 th 2010 The Epidemiology of Lung Cancer Tobacco is the
More informationHow Long Should Small Lung Lesions of Ground-Glass Opacity be Followed?
Original Article How Long Should Small Lung Lesions of Ground-Glass Opacity be Followed? Yoshihisa Kobayashi, MD,* Takayuki Fukui, MD,* Simon Ito, MD,* Noriyasu Usami, MD,* Shunzo Hatooka, MD,* Yasushi
More informationLung Neoplasia II Resection specimens Pathobasic. Lukas Bubendorf Pathology
Lung Neoplasia II Resection specimens Pathobasic Lukas Bubendorf Pathology Agenda Preneoplastic lesions Histological subtypes of lung cancer Histological patterns of AC Cells of origin and characteristic
More informationCharacteristics of Subsolid Pulmonary Nodules Showing Growth During Follow-up With CT Scanning
CHEST Original Research Characteristics of Subsolid Pulmonary Nodules Showing Growth During Follow-up With CT Scanning Haruhisa Matsuguma, MD ; Kiyoshi Mori, MD ; Rie Nakahara, MD ; Haruko Suzuki, MD ;
More informationLung Cancers Manifesting as Part-Solid Nodules in the National Lung Screening Trial
Cardiopulmonary Imaging Original Research Yip et al. Lung Cancers Manifesting as Part-Solid Nodules Cardiopulmonary Imaging Original Research Rowena Yip 1 Claudia I. Henschke 1 Dong Ming Xu 1 Kunwei Li
More information10/17/2016. Nuts and Bolts of Thoracic Radiology. Objectives. Techniques
Nuts and Bolts of Thoracic Radiology October 20, 2016 Carleen Risaliti Objectives Understand the basics of chest radiograph Develop a system for interpreting chest radiographs Correctly identify thoracic
More informationMediastinal Staging. Samer Kanaan, M.D.
Mediastinal Staging Samer Kanaan, M.D. Overview Importance of accurate nodal staging Accuracy of radiographic staging Mediastinoscopy EUS EBUS Staging TNM Definitions T Stage Size of the Primary Tumor
More informationLung Cancer Role of Surgery. Ricardo M. Terra Associate Professor of Thoracic Surgery University of Sao Paulo Medical School
Lung Cancer Role of Surgery Ricardo M. Terra Associate Professor of Thoracic Surgery University of Sao Paulo Medical School Disclosure Scientific Consultant/Advisory Board: Johnson&Johnson Educational
More informationImaging Considerations for the Diagnosis and Management of Bronchioloalveolar Carcinoma. Sara Alcorn, HMS-4 Dr. Gillian Lieberman March 2010
Imaging Considerations for the Diagnosis and Management of Bronchioloalveolar Carcinoma Sara Alcorn, HMS-4 Dr. Gillian Lieberman March 2010 Overview Presentation of index patient History of present illness
More informationRodney C Richie MD FACP FCCP DBIM Texas Life and EMSI
Rodney C Richie MD FACP FCCP DBIM Texas Life and EMSI Pulmonary Nodules Well-circumscribed, radiographic opacities measuring 3 cm in diameter Surrounded by aerated lung Not associated with atelectesis
More informationRuijin robotic thoracic surgery: S segmentectomy of the left upper lobe
Case Report Page 1 of 5 Ruijin robotic thoracic surgery: S 1+2+3 segmentectomy of the left upper lobe Han Wu, Su Yang, Wei Guo, Runsen Jin, Yajie Zhang, Xingshi Chen, Hailei Du, Dingpei Han, Kai Chen,
More informationLearning Objectives. 1. Identify which patients meet criteria for annual lung cancer screening
Disclosure I, Taylor Rowlett, DO NOT have a financial interest /arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context
More information8/22/2016. Major risk factors for the development of lung cancer are: Outline
Carcinomas of the Lung: Changes in Staging, Adenocarcinoma Classification and Genetics Grace Y. Lin, M.D., Ph.D. Outline Background Staging of Lung Cancer: Review of the 2010 7 th Edition of the AJCC Cancer
More informationShould minimally invasive lung adenocarcinoma be transferred from stage IA1 to stage 0 in future updates of the TNM staging system?
Original Article Should minimally invasive lung adenocarcinoma be transferred from stage to stage 0 in future updates of the TNM staging system? Tianxiang Chen 1,2#, Jizhuang Luo 3#, Haiyong Gu 3, Yu Gu
More informationAmerican College of Radiology ACR Appropriateness Criteria
American College of Radiology ACR Criteria Radiologic Management of Thoracic Nodules and Masses Variant 1: Middle-aged patient (35 60 years old) with an incidental 1.5-cm lung nodule. The lesion was smooth.
More informationSolid part size is an important predictor of nodal metastasis in lung cancer with a subsolid tumor
Cho et al. BMC Pulmonary Medicine (2018) 18:151 https://doi.org/10.1186/s12890-018-0709-2 RESEARCH ARTICLE Solid part size is an important predictor of nodal metastasis in lung cancer with a subsolid tumor
More informationSmall Pulmonary Nodules: Our Preliminary Experience in Volumetric Analysis of Doubling Times
Small Pulmonary Nodules: Our Preliminary Experience in Volumetric Analysis of Doubling Times Andrea Borghesi, MD Davide Farina, MD Roberto Maroldi, MD Department of Radiology University of Brescia Brescia,
More information