Archivos De Bronconeumologia最新文献

英文中文

Radiomics and Clinical Data for the Diagnosis of Incidental Pulmonary Nodules and Lung Cancer Screening: Radiolung Integrative Predictive Model 用于诊断偶发肺结节和肺癌筛查的放射组学和临床数据：放射肺综合预测模型。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.027

Introduction

Early diagnosis of lung cancer (LC) is crucial to improve survival rates. Radiomics models hold promise for enhancing LC diagnosis. This study assesses the impact of integrating a clinical and a radiomic model based on deep learning to predict the malignancy of pulmonary nodules (PN).

Methodology

Prospective cross-sectional study of 97 PNs from 93 patients. Clinical data included epidemiological risk factors and pulmonary function tests. The region of interest of each chest CT containing the PN was analysed. The radiomic model employed a pre-trained convolutional network to extract visual features. From these features, 500 with a positive standard deviation were chosen as inputs for an optimised neural network. The clinical model was estimated by a logistic regression model using clinical data. The malignancy probability from the clinical model was used as the best estimate of the pre-test probability of disease to update the malignancy probability of the radiomic model using a nomogram for Bayes’ theorem.

Results

The radiomic model had a positive predictive value (PPV) of 86%, an accuracy of 79% and an AUC of 0.67. The clinical model identified DLCO, obstruction index and smoking status as the most consistent clinical predictors associated with outcome. Integrating the clinical features into the deep-learning radiomic model achieves a PPV of 94%, an accuracy of 76% and an AUC of 0.80.

Conclusions

Incorporating clinical data into a deep-learning radiomic model improved PN malignancy assessment, boosting predictive performance. This study supports the potential of combined image-based and clinical features to improve LC diagnosis.

简介肺癌的早期诊断对提高生存率至关重要。放射组学模型有望提高肺癌诊断率。本研究评估了基于深度学习的临床和放射组学模型对预测肺结节（PN）恶性程度的影响：方法：对 93 名患者的 97 个肺结节进行前瞻性横断面研究。临床数据包括流行病学风险因素和肺功能测试。对包含肺结节的每张胸部 CT 的感兴趣区进行分析。放射学模型采用预先训练好的卷积网络来提取视觉特征。从这些特征中选择 500 个标准偏差为正的特征作为优化神经网络的输入。临床模型通过使用临床数据的逻辑回归模型进行估算。临床模型中的恶性肿瘤概率被用作检测前疾病概率的最佳估计值，并利用贝叶斯定理的提名图更新放射线组学模型的恶性肿瘤概率：放射学模型的阳性预测值（PPV）为 86%，准确率为 79%，AUC 为 0.67。临床模型发现，DLCO、阻塞指数和吸烟状况是与预后相关的最一致的临床预测因素。将临床特征整合到深度学习放射学模型中，PPV 为 94%，准确率为 76%，AUC 为 0.80：将临床数据整合到深度学习放射学模型中可改善PN恶性肿瘤评估，提高预测性能。这项研究证明了基于图像和临床特征的组合在改善 LC 诊断方面的潜力。

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引用次数: 0

Sex-specific Difference for Small Cell Lung Cancer from Immunotherapy Advancement 免疫疗法的发展对小细胞肺癌的性别差异。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.025

Background

The treatment of lung cancer has witnessed significant progress, leading to improved survival rates among patients. It is important to assess the individual contributions of non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) to overall lung-cancer incidence and mortality trends based population, especially sex difference.

Methods

We analyzed lung cancer mortality based on subtype, gender, and calendar year. The Joinpoint software was used to identify any changes in incidence and trends in mortality.

Results

Incidence and incidence-based mortality declined from 2001 to 2019 both NSCLC and SCLC annually. The most significant decrease occurred between 2016 and 2019 with annual percent change of 5.71%. From 2012 to 2016, the incidence-based mortality of SCLC in women changed by 2.7% in tandem with incidence decreased 2.84%. Remarkably, the incidence-based mortality for women declined notably by 5.23% between 2016 and 2019, even as the incidence showed a less extent of decreasing (-2.59%). The survival rate for women was 15.2% in 2001, 19.3% in 2016, it had increased to 21.3% in 2018 but similar trends not in men. The survival curve showed the change in survival outcomes over time among men and women (median overall survival: 13 vs 23months) receiving immunotherapy for SCLC.

Conclusion

Population-level mortality from NSCLC and SCLC in the United States fell sharply from 2016 to 2019 as incidence deceased, and survival improved substantially. Our analysis suggests that approval for and use of immunotherapy may explain the mortality reduction observed during this period, with significant benefits especially for SCLC patient in women.

背景：肺癌的治疗取得了重大进展，提高了患者的生存率。评估非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC）对基于人群的整体肺癌发病率和死亡率趋势的贡献，尤其是性别差异，非常重要：我们根据亚型、性别和日历年分析了肺癌死亡率。结果：发病率和基于发病率的死亡率均有所下降：从 2001 年到 2019 年，NSCLC 和 SCLC 的发病率和基于发病率的死亡率逐年下降。最明显的下降发生在 2016 年至 2019 年，年变化百分比为 5.71%。从2012年到2016年，女性SCLC的发病死亡率下降了2.7%，与此同时，发病率也下降了2.84%。值得注意的是，在2016年至2019年期间，女性发病死亡率显著下降了5.23%，而发病率的下降幅度较小（-2.59%）。女性的存活率在 2001 年为 15.2%，2016 年为 19.3%，2018 年增至 21.3%，但男性的存活率却没有类似的趋势。生存曲线显示了接受免疫疗法治疗SCLC的男性和女性的生存结果随时间的变化（中位总生存期：13个月 vs 23个月）：2016年至2019年，随着发病率的下降，美国NSCLC和SCLC的人群死亡率急剧下降，生存率大幅提高。我们的分析表明，免疫疗法的批准和使用可能是在此期间观察到死亡率下降的原因，尤其是对女性SCLC患者有显著益处。

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引用次数: 0

Radiomics and Clinical Data for the Diagnosis of Incidental Pulmonary Nodules and Lung Cancer Screening: Correspondence 用于诊断偶然肺结节和肺癌筛查的放射组学和临床数据：通信

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.06.016

引用次数: 0

When to Consider Invasive Lymph Node Staging in Non–Small-Cell Lung Cancer? A Novel Scoring System Utilising Metabolic Parameters in 18F-FDG PET/CT 何时考虑对非小细胞肺癌进行淋巴结浸润性分期？利用 18F-FDG PET/CT 代谢参数的新型评分系统。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.020

Objective

The maximum standardised uptake value (SUVmax) is a widely utilised metric in positron emission tomography/computed tomography for clinically staging non–small-cell lung cancer (NSCLC), yet the reliability of SUVmax remains controversial. We herein aimed to assess the effectiveness of semi-quantitative parameters, encompassing size, SUVmax, metabolic tumour volume (MTV), total lesion glycolysis (TLG) and heterogeneity factor (HF), in evaluating both primary tumours and lymph nodes (LNs) on positron emission tomography/computed tomography. A novel scoring system was devised to appraise the role of semi-quantitative parameters and visually evaluate LNs for nodal staging.

Materials and Methods

Patients with pathological NSCLC, diagnosed between 2014 and 2019 and clinically staged I-III, were enrolled in the study. Patient demographics, including age, sex, tumour location, diameter, tumour-node-metastasis stage, as well as SUVmax, MTV, TLG and HF parameters of primary tumours and LNs, were documented.

Results

The analysis comprised 319 patients and 963 LNs. Patients had a mean age of 61.62 years, with 91.5% being male. Adenocarcinoma exhibited a histological association with LN metastasis (P = 0.043). The study findings revealed that tumour size, SUVmax, MTV, TLG and HF did not significantly affect the detection of LN metastasis. Conversely, non-squamous cell carcinoma, LNs exhibiting higher FDG levels than the liver, LN size, SUVmax, MTV and TLG were identified as risk factors (P < 0.0001). The identified cut-off values were 1.05 cm for LN size, 4.055 for SUVmax, 1.805 cm³ for MTV and 5.485 for TLG. The scoring system incorporated these parameters, and visual assessment indicated that a score of ≥3 increased the risk of metastasis by 14.33 times.

Conclusion

We devised a novel scoring system and demonstrated that LNs with a score of ≥3 in patients with NSCLC have a high likelihood of metastasis. This innovative scoring system can serve as a valuable tool to mitigate excessive and extreme measures in the assessment of invasive pathological staging.

目的：最大标准化摄取值（SUVmax最大标准化摄取值（SUVmax）是正电子发射计算机断层扫描（Positron emission tomography/Computed tomography）中广泛使用的指标，用于非小细胞肺癌（NSCLC）的临床分期，但SUVmax的可靠性仍存在争议。我们在此旨在评估半定量参数（包括肿瘤大小、SUVmax、代谢肿瘤体积（MTV）、总病灶糖酵解（TLG）和异质性因子（HF））在正电子发射断层扫描/计算机断层扫描中评估原发肿瘤和淋巴结（LN）的有效性。研究人员设计了一套新的评分系统来评估半定量参数的作用，并对淋巴结进行直观评估，以进行结节分期：研究对象为2014年至2019年期间确诊的病理NSCLC患者，临床分期为I-III期。研究记录了患者的人口统计学特征，包括年龄、性别、肿瘤位置、直径、肿瘤-结节-转移分期，以及原发肿瘤和LN的SUVmax、MTV、TLG和HF参数：分析包括 319 名患者和 963 个 LN。患者平均年龄为61.62岁，91.5%为男性。腺癌在组织学上与淋巴结转移有关（P=0.043）。研究结果显示，肿瘤大小、SUVmax、MTV、TLG和HF对LN转移的检测无明显影响。相反，非鳞癌、表现出比肝脏更高的 FDG 水平的 LN、LN 大小、SUVmax、MTV 和 TLG 被确定为风险因素（MTV 的 P3 和 TLG 的 5.485）。评分系统纳入了这些参数，目测评估结果显示，得分≥3分的转移风险增加了14.33倍：我们设计了一套新颖的评分系统，并证明NSCLC患者LN评分≥3分的转移可能性很高。这种创新的评分系统可作为一种有价值的工具，在有创病理分期评估中减少过度和极端的措施。

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引用次数: 0

Non-Pharmacological Interventions During SARS-CoV-2 Pandemic: Effects on Pediatric Viral Respiratory Infections SARS-CoV-2 大流行期间的非药物干预措施：对小儿病毒性呼吸道感染的影响。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.019

Introduction

Viral lower respiratory tract infections frequently cause morbidity and mortality in children. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic led to isolation and hygiene measures, resulting in decreased respiratory virus transmission and pediatric admissions. This study aimed to assess the impact of these measures and their uplifting on respiratory virus circulation in children before and during the SARS-CoV-2 pandemic (January 2017-December 2022).

Methods

We conducted a weekly time series analysis of multiple virus molecular assays in children. This included those admitted to a university reference hospital's Pediatric Intensive Care Unit (PICU) and those with risk pathologies exhibiting fever and/or respiratory symptoms. We included patients aged 0-18 years residing in Catalonia and adjusted the positive results to account for diagnostic effort.

Results

We performed a total of 2991 respiratory virus tests during the period. Confinement significantly decreased the detection of all viruses, especially Rhinovirus (RV). After the deconfinement of children, the viral detection trend remained stable for all viruses, with no short-term impact on virus transmission. The mandatory implementation of facemasks in those aged ≥6 years led to decreased viral circulation, but we observed an influenza virus rebound after facemask removal. At that time, we also noticed an interrupted drop in the detection rates of RV and respiratory syncytial virus (RSV). The reopening of schools led to a progressive increase in viral detections, especially of Rhinovirus.

Conclusion

Non-pharmacological interventions significantly impact the circulation of respiratory viruses among children. We observed these effects even when some measures did not specifically target preschool-aged children.

导言：病毒性下呼吸道感染经常导致儿童发病和死亡。严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）大流行导致隔离和卫生措施，从而减少了呼吸道病毒传播和儿科住院人数。本研究旨在评估在SARS-CoV-2大流行之前和期间（2017年1月至2022年12月）这些措施及其上行对儿童呼吸道病毒循环的影响：我们对儿童的多种病毒分子检测进行了每周时间序列分析。其中包括入住大学参照医院儿科重症监护室（PICU）的儿童，以及有发热和/或呼吸道症状的高危病例。我们纳入了居住在加泰罗尼亚地区的 0-18 岁患者，并根据诊断工作调整了阳性结果：结果：在此期间，我们共进行了 2991 次呼吸道病毒检测。禁闭大大降低了所有病毒的检测率，尤其是鼻病毒（RV）。儿童解除禁闭后，所有病毒的检测趋势保持稳定，对病毒传播没有短期影响。强制要求年龄≥6 岁的儿童佩戴口罩后，病毒传播量有所下降，但我们观察到口罩摘除后流感病毒有所反弹。当时，我们还注意到 RV 和呼吸道合胞病毒（RSV）的检出率出现了间断性下降。学校重新开学后，病毒检测率逐渐上升，尤其是鼻病毒：结论：非药物干预措施对儿童呼吸道病毒的传播有很大影响。即使某些措施并非专门针对学龄前儿童，我们也观察到了这些影响。

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引用次数: 0

The Effect of Bronchoscopic Lung Volume Reduction on Hemidiaphragm Excursion 支气管镜肺容积缩小对半膈肌推移的影响

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.05.010

引用次数: 0

Protein Biomarkers in Lung Cancer Screening: Technical Considerations and Feasibility Assessment 肺癌筛查中的蛋白质生物标记物：技术考虑因素和可行性评估

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.07.007

Lung cancer remains the leading cause of cancer-related deaths worldwide, mainly due to late diagnosis and the presence of metastases. Several countries around the world have adopted nation-wide LDCT-based lung cancer screening that will benefit patients, shifting the stage at diagnosis to earlier stages with more therapeutic options. Biomarkers can help to optimize the screening process, as well as refine the TNM stratification of lung cancer patients, providing information regarding prognostics and recommending management strategies. Moreover, novel adjuvant strategies will clearly benefit from previous knowledge of the potential aggressiveness and biological traits of a given early-stage surgically resected tumor. This review focuses on proteins as promising biomarkers in the context of lung cancer screening. Despite great efforts, there are still no successful examples of biomarkers in lung cancer that have reached the clinics to be used in early detection and early management. Thus, the field of biomarkers in early lung cancer remains an evident unmet need.

A more specific objective of this review is to present an up-to-date technical assessment of the potential use of protein biomarkers in early lung cancer detection and management. We provide an overview regarding the benefits, challenges, pitfalls and constraints in the development process of protein-based biomarkers. Additionally, we examine how a number of emerging protein analytical technologies may contribute to the optimization of novel robust biomarkers for screening and effective management of lung cancer.

肺癌仍然是全球癌症相关死亡的主要原因，这主要是由于诊断较晚和存在转移。世界上有几个国家已经在全国范围内开展了基于 LDCT 的肺癌筛查，这将使患者受益，将诊断阶段转移到有更多治疗选择的早期阶段。生物标记物有助于优化筛查过程，完善肺癌患者的 TNM 分层，提供预后信息并推荐治疗策略。此外，新的辅助治疗策略将明显受益于之前对特定早期手术切除肿瘤的潜在侵袭性和生物特征的了解。本综述将重点讨论在肺癌筛查中作为有前途的生物标记物的蛋白质。尽管付出了巨大的努力，但目前仍没有成功的肺癌生物标志物应用于临床早期检测和早期治疗。因此，早期肺癌生物标志物领域的需求显然仍未得到满足。本综述的一个更具体的目的是对蛋白质生物标志物在早期肺癌检测和管理中的潜在应用进行最新的技术评估。我们概述了基于蛋白质的生物标记物开发过程中的益处、挑战、陷阱和制约因素。此外，我们还研究了一些新兴的蛋白质分析技术如何有助于优化新型稳健生物标记物，以筛查和有效管理肺癌。

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引用次数: 0

A Giant Malignant Solitary Fibrous Tumor of the Pleura 胸膜巨大恶性单发纤维瘤

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.07.015

引用次数: 0

Right Adrenal Metastasis of Lung Cancer Diagnosed via Endoscopic Ultrasound (EUS-B) by a Pulmonologist 肺科医生通过内窥镜超声波（EUS-B）诊断出肺癌右侧肾上腺转移。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.06.010

引用次数: 0

Use of Extracorporeal Carbon Dioxide Removal Therapy in an Intermediate Respiratory Care Unit 在中级呼吸护理病房使用体外二氧化碳清除疗法。

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia

Pub Date : 2024-10-01 DOI: 10.1016/j.arbres.2024.06.009

引用次数: 0

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