| 1. Alvarez Martinez CJ, Bastarrika Aleman G, Disdier Vicente C, et al. Guideline on management of solitary pulmonary nodule. Arch Bronconeumol. 50(7):285-93, 2014 Jul. |
Review/Other-Dx |
N/A |
To discuss the proposed recommendations to be used to be a tool to facilitate decision-making in patients with a solitary pulmonary nodule (SPN). |
The first assessment, which includes a chest computed tomography scan, separates a group of patients with extrapulmonary neoplasm or a high surgical risk who require individualized management. Another two groups of patients are patients with SPN up to 8mm and those who have a subsolid SPN, for which specific recommendations are established. SPN larger than 8mm are classified according to their probability of malignancy into low (less than 5%), where observation is recommended, high (higher than 65%), which are managed with a presumptive diagnosis of localized stage carcinoma, and intermediate, where positron emission tomography-computed tomography has high yield for reclassifying them into high or low probability. In cases of intermediate or high probability of malignancy, transbronchial needle aspiration or biopsy of the nodule may be an option. Radiologic observation with low radiation computed tomography without contrast is recommended in SPN with low probability of malignancy, and resection with videothoracoscopy in undiagnosed cases with intermediate or high probability of malignancy. |
4 |
| 2. Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. [Review]. Chest. 143(5 Suppl):e93S-e120S, 2013 May. |
Review/Other-Dx |
N/A |
To update previous evidence-based recommendations for evaluation and management of individuals with solid pulmonary nodules and to generate new recommendations for those with nonsolid nodules. |
We formulated recommendations for evaluating solid pulmonary nodules that measure > 8 mm in diameter, solid nodules that measure = 8 mm in diameter, and subsolid nodules. The recommendations stress the value of assessing the probability of malignancy, the utility of imaging tests, the need to weigh the benefits and harms of different management strategies (nonsurgical biopsy, surgical resection, and surveillance with chest CT imaging), and the importance of eliciting patient preferences. |
4 |
| 3. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008; 246(3):697-722. |
Review/Other-Dx |
N/A |
Glossary of terms for thoracic imaging. |
N/A |
4 |
| 4. Ko JP, Azour L. Management of Incidental Lung Nodules. [Review]. Semin Ultrasound CT MR. 39(3):249-259, 2018 Jun. |
Review/Other-Dx |
N/A |
To discuss the management of Incidental Lung Nodules |
No results stated in the abstract. |
4 |
| 5. Patel VK, Naik SK, Naidich DP, et al. A practical algorithmic approach to the diagnosis and management of solitary pulmonary nodules: part 1: radiologic characteristics and imaging modalities. Chest 2013;143:825-39. |
Review/Other-Dx |
N/A |
To describe the determination of pretest probability of malignancy and an algorithmic approach to the diagnosis of solitary pulmonary nodule (SPN). |
No results stated in the abstract. |
4 |
| 6. Gould MK, Tang T, Liu IL, et al. Recent Trends in the Identification of Incidental Pulmonary Nodules. Am J Respir Crit Care Med. 192(10):1208-14, 2015 Nov 15. |
Observational-Dx |
200,000 patients |
To examine recent trends in pulmonary nodule identification. |
Between 2006 and 2012, more than 200,000 adult members underwent 415,581 chest CT examinations. The annual frequency of chest CT imaging increased from 1.3 to 1.9% for all adult members, whereas the frequency of nodule identification increased from 24 to 31% for all scans performed. The annual rate of chest CT increased from 15.4 to 20.7 per 1,000 person-years, and the rate of nodule identification increased from 3.9 to 6.6 per 1,000 person-years, whereas the rate of a new lung cancer diagnosis remained stable. By extrapolation, more than 4.8 million Americans underwent at least one chest CT scan and 1.57 million had a nodule identified, including 63,000 who received a new lung cancer diagnosis within 2 years. |
2 |
| 7. Mortani Barbosa EJ Jr, Kelly K. Statistical modeling can determine what factors are predictive of appropriate follow-up in patients presenting with incidental pulmonary nodules on CT. Eur J Radiol. 128:109062, 2020 Jul. |
Observational-Dx |
200 patients |
To assess the performance of statistical modeling in predicting follow-up adherence of incidentally detected pulmonary nodules (IPN) on CT, based on patient variables (PV), radiology report related variables (RRRV) and physician-patient communication variables (PPCV). |
Adherence was low, with or without recommendations provided in the radiology report (23.4 %-27.4 %). Whether the referring physician ordered follow-up was the dominant predictor of adherence in all models. The following variables were statistically significant predictors of whether referring physician ordered follow-up: recommendations provided in the radiology report, smoking status, patient context and nodule size (FDR logworth of respectively 21.18, 11.66, 2.35, 1.63, p < 0.05). Prediction accuracy varied from 72 % (PV) to 93 % (PPCV, all variables). |
2 |
| 8. Madariaga ML, Lennes IT, Best T, et al. Multidisciplinary selection of pulmonary nodules for surgical resection: Diagnostic results and long-term outcomes. J Thorac Cardiovasc Surg. 159(4):1558-1566.e3, 2020 04. |
Observational-Dx |
747 patients |
To discuss the Multidisciplinary selection of pulmonary nodules for surgical resection. |
Of 747 patients evaluated in the PNLCSC, 129 (17.2%) underwent surgical intervention. The surgical cohort consisted of 104 (80.6%) incidental and 25 (19.3%) screening patients followed over a mean of 122 and 70 days, respectively. More benign lesions were excised in the incidental group (20.2%, 21/104)-representing 3.3% (21/632) of all incidental nodules evaluated-than in the screening group (4%, 1/25) (P = .038). Operative mortality was zero. Among 99 patients with primary lung cancer, 87% (screening) and 86.8% (incidental) were pathologic stage Ia. Complete follow-up was available in 725 of 747 (97%), and no patient developed progressive disease. Disease-free survival at 5 years was 74.9% (incidental) and 89.3% (screening) (P = .48). |
2 |
| 9. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 284(1):228-243, 2017 07. |
Review/Other-Dx |
N/A |
To discuss the Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images |
No results was stated in the abstract. |
4 |
| 10. Bueno J, Landeras L, Chung JH. Updated Fleischner Society Guidelines for Managing Incidental Pulmonary Nodules: Common Questions and Challenging Scenarios. Radiographics. 38(5):1337-1350, 2018 Sep-Oct. |
Review/Other-Dx |
N/A |
To describe eight scenarios that illustrate the challenges potentially encountered when applying the new guidelines to pulmonary nodule management. |
No results stated in the abstract |
4 |
| 11. American College of Radiology Committee on Lung-RADS®. Lung-RADS Assessment Categories version1.1. Available at https://www.acr.org/-/media/ACR/Files/RADS/Lung-RADS/LungRADSAssessmentCategoriesv1-1.pdf . |
Review/Other-Dx |
N/A |
Assessment categories for lung cancer screening. |
N/A |
4 |
| 12. Munden RF, Black WC, Hartman TE, et al. Managing Incidental Findings on Thoracic CT: Lung Findings. A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2021;18:1267-79. |
Review/Other-Dx |
N/A |
To report the Managing Incidental Findings on Thoracic CT: Lung Findings. |
No results stated in the abstract. |
4 |
| 13. Endo K, Kaneko A, Horiuchi Y, Kasuga N, Ishizaki U, Sakai S. Detectability of pulmonary nodules on chest radiographs: bone suppression versus standard technique with single versus dual monitors for visualization. Jpn J Radiol. 38(7):676-682, 2020 Jul. |
Observational-Dx |
100 patients |
To evaluate the diagnostic accuracy of bone suppression imaging (BSI) in the detection of pulmonary nodules on chest radiographs (CXRs) and the effect of visualization method (single or dual monitors) on diagnostic accuracy. |
When BSI was added, the area under the receiver operating characteristic curve (AUC) improved with dual monitors and a single monitor. The AUC was not significantly different between the dual-monitor and single-monitor sessions; however, the specificity with BSI and dual monitors decreased. The total interpretation time was significantly shorter with a single monitor than with dual monitors. |
2 |
| 14. Monnier-Cholley L, Arrive L, Porcel A, et al. Characteristics of missed lung cancer on chest radiographs: a French experience. Eur Radiol 2001;11:597-605. |
Review/Other-Dx |
30 patients |
To report 30 cases of missed lung cancers and describe characteristics of each case. Reasons for misdiagnosis were analyzed from the report. Each radiograph was subsequently reviewed by a panel of two experts who quantified several parameters regarding image analysis and film quality. |
Lesions were not described in 67% of the cases and were misinterpreted as benign processes in 33% of cases. Comparison to previous chest radiographs and clinical information were seldom available on the report. Size of the lesions varied between 1 and 7 cm, location was primarily apical and paramediastinal, normal anatomy was highly or moderately complex in 87%, and distracting lesions were present in 63% of the cases. Image quality was considered perfect in 3 cases only. Among all the factors responsible for missed lung cancer, certain factors can be improved as film quality, comparison with previous radiographs, and better awareness of clinical information. |
4 |
| 15. Shah PK, Austin JH, White CS, et al. Missed non-small cell lung cancer: radiographic findings of potentially resectable lesions evident only in retrospect. Radiology 2003;226:235-41. |
Observational-Dx |
40 patients |
To assess for change in the 1990s in the failure of detection at chest radiography of potentially resectable non-small cell lung cancer (NSCLC) lesions compared with experience in the previous decade. |
Twenty-five (62%) undetected NSCLCs were in men and 15 (38%) were in women, yielding a ratio not significantly different from that for the sex distribution of NSCLC according to national data (chi(2) = 0.22, P =.64). Median patient age was 62 years (range, 37-87 years). Median diameter of the missed cancers was 1.9 cm. Missed cancers were most commonly located in the upper lobes (right, 45%; left, 28%; total, 72%), especially in the apical and posterior segments/subsegments (60% of all the missed cancers). A clavicle obscured 22% of the missed cancers. Eighty-five percent of the missed cancers were in peripheral locations. |
2 |
| 16. Stitik FP, Tockman MS. Radiographic screening in the early detection of lung cancer. Radiol Clin North Am 1978;16:347-66. |
Observational-Dx |
10,362 patients |
to detect early lung cancer in a high risk outpatient volunteer population is in progress. |
A review of the radiographs of patients with lung cancer identified on the initial screen, or in retrospect, has led to the following conclusions: (1) Independent double reading is important in a screening project. (2) There are no reliable radiographic criteria to distinguish early lung cancer from benign disease. (3) The lateral chest radiograph is useful in the high risk patient. From these conclusions the authors have three recommendations for the practicing radiologist. (1) Since double reading improves sensitivity, attempt to doubly read a chest radiograph by removing your eyes from the film and look at it a second time before finalizing your report. (2) Consider any newly appearing, noncalcified lesion in the chest radiograph of a high risk individual as primary lung cancer until proven otherwise. (3) Consider the "routine chest radiograph" in a high risk patient as a challenge to detect early lung cancer rather than the drudgery of day to day clinical practice. |
2 |
| 17. Miyoshi T, Yoshida J, Aramaki N, et al. Effectiveness of Bone Suppression Imaging in the Detection of Lung Nodules on Chest Radiographs: Relevance to Anatomic Location and Observer's Experience. J Thorac Imaging. 32(6):398-405, 2017 Nov. |
Observational-Dx |
80 patients |
To evaluate the effectiveness of bone suppression imaging (BSI) software in lung-nodule detection on chest radiographs (CXRs) in relation to nodule location and observer's experience. |
The average area under the curve (AUC) for the observers' receiver operating characteristic significantly improved from 0.867 to 0.900 (P=0.004) with the use of the BSI software. The average AUC for experienced pulmonologists improved from 0.877 to 0.924 (P=0.017) for lung nodules located in the apical and peripheral areas but not for those in the inner area. The average AUC for residents improved regardless of nodule location. |
2 |
| 18. Cai J, Xu D, Liu S, Cham MD. The Added Value of Computer-aided Detection of Small Pulmonary Nodules and Missed Lung Cancers. [Review]. J Thorac Imaging. 33(6):390-395, 2018 Nov. |
Review/Other-Dx |
N/A |
To introduce the basic techniques and then summarized the up-to-date applications of CAD systems in clinical and research programs and in the low-dose lung cancer screening trials, especially in the detection of small pulmonary nodules and missed lung cancers. |
No results stated in the abstract |
4 |
| 19. Godoy MC, Kim TJ, White CS, et al. Benefit of computer-aided detection analysis for the detection of subsolid and solid lung nodules on thin- and thick-section CT. AJR Am J Roentgenol. 200(1):74-83, 2013 Jan. |
Observational-Dx |
N/A |
To evaluate the impact of computer-aided detection (CAD) on the identification of subsolid and solid lung nodules on thin- and thick-section CT. |
For 155 nodules (mean, 5.5 mm; range, 4.0-27.5 mm)-74 solid nodules, 22 part-solid (part-solid nodules), and 59 GGO nodules-CAD stand-alone sensitivity was 80%, 95%, and 71%, respectively, with three false-positives on average (0-12) per CT study. Reader(thin) + CAD(thin) sensitivities were higher than reader(thin) for solid nodules (82% vs 57%, p < 0.001), part-solid nodules (97% vs 81%, p = 0.0027), and GGO nodules (82% vs 69%, p < 0.001) for all readers (p < 0.001). Respective sensitivities for reader(thick), reader(thick) + CAD(thick), reader(thick) + CAD(thin) were 40%, 58% (p < 0.001), and 77% (p < 0.001) for solid nodules; 72%, 73% (p = 0.322), and 94% (p < 0.001) for part-solid nodules; and 53%, 58% (p = 0.008), and 79% (p < 0.001) for GGO nodules. For reader(thin), false-positives increased from 0.64 per case to 0.90 with CAD(thin) (p < 0.001) but not for reader(thick); false-positive rates were 1.17, 1.19, and 1.26 per case for reader(thick), reader(thick) + CAD(thick), and reader(thick) + CAD(thin), respectively. |
2 |
| 20. Rubin GD. Lung nodule and cancer detection in computed tomography screening. [Review]. J Thorac Imaging. 30(2):130-8, 2015 Mar. |
Review/Other-Dx |
N/A |
To provide an introduction to the current understanding of these varied issues as we enter the era of widespread lung cancer screening. |
No results stated in the abstract. |
4 |
| 21. Lo SB, Freedman MT, Gillis LB, White CS, Mun SK. JOURNAL CLUB: Computer-Aided Detection of Lung Nodules on CT With a Computerized Pulmonary Vessel Suppressed Function. AJR Am J Roentgenol. 210(3):480-488, 2018 Mar. |
Review/Other-Dx |
324 patients |
To evaluate radiologists' performance in detecting actionable nodules on chest CT when aided by a pulmonary vessel image-suppressed function and a computer-aided detection (CADe) system. |
In a stand-alone test, the VIS/CADe system detected 89.5% and 82.0% of malignant nodules and all nodules no smaller than 5 mm, respectively. The false-positive rate per CT study was 0.58. For the reader study, the mean area under the LROC curve (LROCAUC) for the detection of lung cancer significantly increased from 0.633 when unaided by VIS/CADe to 0.773 when aided by VIS/CADe (p < 0.01). For the detection of all clinically actionable nodules, the mean LROC-AUC significantly increased from 0.584 when unaided by VIS/CADe to 0.692 when detection was aided by VIS/CADe (p < 0.01). Radiologists detected 80.0% of cancers with VIS/CADe versus 64.45% of cancers unaided (p < 0.01); specificity decreased from 89.9% to 84.4% (p < 0.01). Radiologist interpretation time significantly decreased by 26%. |
4 |
| 22. Milanese G, Eberhard M, Martini K, Vittoria De Martini I, Frauenfelder T. Vessel suppressed chest Computed Tomography for semi-automated volumetric measurements of solid pulmonary nodules. Eur J Radiol. 101:97-102, 2018 Apr. |
Observational-Dx |
93 patients |
To evaluate whether vessel-suppressed computed tomography (VSCT) can be reliably used for semi-automated volumetric measurements of solid pulmonary nodules, as compared to standard CT (SCT) |
Standard of reference nodule volume ranged from 13 to 366 mm3. The mean overestimation between readers was 3 mm3 and 2.9 mm3 on SCT and VSCT, respectively. Semi-automated volumetric measurements on VSCT showed substantial agreement with the standard of reference (Lin's CCC = 0.990 for Reader 1; 0.985 for Reader 2). The upper and lower LoA between readers' measurements were (16.3, -22.4 mm3) and (15.5, -21.4 mm3) for SCT and VSCT, respectively. |
2 |
| 23. Sim Y, Chung MJ, Kotter E, et al. Deep Convolutional Neural Network-based Software Improves Radiologist Detection of Malignant Lung Nodules on Chest Radiographs. Radiology. 294(1):199-209, 2020 01. |
Review/Other-Dx |
N/A |
To compare the performance of radiologists in detecting malignant pulmonary nodules on chest radiographs when assisted by deep learning-based DCNN software with that of radiologists or DCNN software alone in a multicenter setting. |
The average sensitivity of radiologists improved (from 65.1% [1375 of 2112; 95% confidence interval {CI}: 62.0%, 68.1%] to 70.3% [1484 of 2112; 95% CI: 67.2%, 73.1%], P < .001) and the number of false-positive findings per radiograph declined (from 0.2 [488 of 2400; 95% CI: 0.18, 0.22] to 0.18 [422 of 2400; 95% CI: 0.16, 0.2], P < .001) when the radiologists re-reviewed radiographs with the DCNN software. For the 12 radiologists in this study, 104 of 2400 radiographs were positively changed (from false-negative to true-positive or from false-positive to true-negative) using the DCNN, while 56 of 2400 radiographs were changed negatively. Conclusion Radiologists had better performance with deep convolutional network software for the detection of malignant pulmonary nodules on chest radiographs than without. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Jacobson in this issue. |
4 |
| 24. Yoo H, Kim KH, Singh R, Digumarthy SR, Kalra MK. Validation of a Deep Learning Algorithm for the Detection of Malignant Pulmonary Nodules in Chest Radiographs. JAMA netw. open. 3(9):e2017135, 2020 09 01. |
Observational-Dx |
5485 participants |
To elevate the role of chest radiographs for the diagnosis of lung cancer. |
A total of 5485 participants (mean [SD] age, 61.7 [5.0] years; 3030 men [55.2%]) were included, with a median follow-up duration of 6.5 years (interquartile range, 6.1-6.9 years). For the nodule data set, the sensitivity and specificity of the AI algorithm for the detection of pulmonary nodules were 86.2% (95% CI, 77.8%-94.6%) and 85.0% (95% CI, 81.9%-88.1%), respectively. For the detection of all cancers, the sensitivity was 75.0% (95% CI, 62.8%-87.2%), the specificity was 83.3% (95% CI, 82.3%-84.3%), the positive predictive value was 3.8% (95% CI, 2.6%-5.0%), and the negative predictive value was 99.8% (95% CI, 99.6%-99.9%). For the detection of malignant pulmonary nodules in all images of the full T0 data set, the sensitivity was 94.1% (95% CI, 86.2%-100.0%), the specificity was 83.3% (95% CI, 82.3%-84.3%), the positive predictive value was 3.4% (95% CI, 2.2%-4.5%), and the negative predictive value was 100.0% (95% CI, 99.9%-100.0%). In digital radiographs of the nodule data set, the AI algorithm had higher sensitivity (96.0% [95% CI, 88.3%-100.0%] vs 88.0% [95% CI, 75.3%-100.0%]; P = .32) and higher specificity (93.2% [95% CI, 89.9%-96.5%] vs 82.8% [95% CI, 77.8%-87.8%]; P = .001) for nodule detection compared with the NLST radiologists. For malignant pulmonary nodule detection on digital radiographs of the full T0 data set, the sensitivity of the AI algorithm was higher (100.0% [95% CI, 100.0%-100.0%] vs 94.1% [95% CI, 82.9%-100.0%]; P = .32) compared with the NLST radiologists, and the specificity (90.9% [95% CI, 89.6%-92.1%] vs 91.0% [95% CI, 89.7%-92.2%]; P = .91), positive predictive value (8.2% [95% CI, 4.4%-11.9%] vs 7.8% [95% CI, 4.1%-11.5%]; P = .65), and negative predictive value (100.0% [95% CI, 100.0%-100.0%] vs 99.9% [95% CI, 99.8%-100.0%]; P = .32) were similar to those of NLST radiologists. |
2 |
| 25. Erasmus JJ, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions. Radiographics 2000;20:43-58. |
Review/Other-Dx |
N/A |
To discuss the Morphologic evaluation for differentiation of benign and malignant lesions. Radiographics |
No results stated in the abstract. |
4 |
| 26. Truong MT, Ko JP, Rossi SE, et al. Update in the evaluation of the solitary pulmonary nodule. [Review]. Radiographics. 34(6):1658-79, 2014 Oct. |
Review/Other-Dx |
N/A |
To discuss the update in the evaluation of the solitary pulmonary nodule. |
The widespread use of multidetector computed tomography (CT) has increased the detection of SPNs. Although clinical assessment of patients' risk factors for malignancy--such as age, smoking history, and history of malignancy--is important to determine appropriate treatment, in the recently published Fleischner guidelines for subsolid nodules, smoking history does not factor into their recommendations for management because there is an increasing incidence of lung adenocarcinoma in younger and nonsmoking patients. At imaging evaluation, obtaining prior chest radiographs or CT images is useful to assess nodule growth. Further imaging evaluation, including CT enhancement studies and positron emission tomography (PET), helps determine the malignant potential of solid SPNs. For subsolid nodules, initial follow-up CT is performed at 3 months to determine persistence, because lesions with an infectious or inflammatory cause can resolve in the interval. CT enhancement studies are not applicable for subsolid nodules, and PET is of limited utility because of the low metabolic activity of these lesions. Because of the likelihood that persistent subsolid nodules represent adenocarcinoma with indolent growth, serial imaging reassessment for a minimum of 3 years and/or obtaining tissue samples for histologic analysis are recommended. In the follow-up of subsolid SPNs, imaging features that indicate an increased risk for malignancy include an increase in size, an increase in attenuation, and development of a solid component. |
4 |
| 27. Cohen JG, Reymond E, Jankowski A, et al. Lung adenocarcinomas: correlation of computed tomography and pathology findings. [Review]. Diagn Interv Imaging. 97(10):955-963, 2016 Oct. |
Review/Other-Dx |
N/A |
To understand the basics of the up-to-date adenocarcinoma pathological classifications, radio-pathological correlations and how to use them in the clinical setting, as well as other imaging-related correlations (radiogenomics, quantitative analysis, PET-CT). |
No results stated in the abstract. |
4 |
| 28. Callister ME, Baldwin DR, Akram AR, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax. 70 Suppl 2:ii1-ii54, 2015 Aug. |
Review/Other-Dx |
N/A |
To discuss the British Thoracic Society guidelines for the investigation and management of pulmonary nodules. |
No results state din the abstract. |
4 |
| 29. Jeong YJ, Lee KS, Jeong SY, et al. Solitary pulmonary nodule: characterization with combined wash-in and washout features at dynamic multi-detector row CT. Radiology. 2005; 237(2):675-683. |
Observational-Dx |
107 patients |
To prospectively assess the accuracy of combined wash-in and washout characteristics at dynamic contrast material-enhanced MDCT in distinguishing benign from malignant SPNs. |
There were 49 malignant and 58 benign nodules. When diagnostic criteria for malignancy of both wash-in of 25 HU or greater and washout of 5-31 HU were applied, sensitivity, specificity, and accuracy for malignancy were 94% (46/49 nodules), 90% (52/58 nodules), and 92% (98/107 nodules), respectively. Of 58 benign nodules, 27 showed less than 25 HU wash-in, 14 showed persistent contrast enhancement without washout and with wash-in of 25 HU or greater and 11 showed washout greater than 31 HU and wash-in of 25 HU or greater. Evaluation of SPNs by analyzing combined wash-in and washout characteristics at dynamic contrast-enhanced MDCT showed 92% accuracy for distinguishing benign nodules from malignant nodules. |
2 |
| 30. Swensen SJ, Viggiano RW, Midthun DE, et al. Lung nodule enhancement at CT: multicenter study. Radiology. 2000; 214(1):73-80. |
Observational-Dx |
356 patients |
To test the hypothesis that absence of statistically significant lung nodule enhancement (=15 HU) at CT is strongly predictive of benignity. |
The prevalence of malignancy was 48%. Malignant neoplasms enhanced (median: 38.1 HU; range: 14.0 to 165.3 HU) significantly more than granulomas and benign neoplasms (median: 10.0 HU; range: -20.0 to 96.0 HU; P<0.001). With 15 HU as the threshold, the sensitivity was 98%, the specificity was 58%, and accuracy was 77%. The PPV was 68% and the NPV was 96%. If a threshold of 10 HU was selected, the sensitivity would be 100%, specificity 50.3%, accuracy 74.2%, PPV 65% and NPV 100%. |
2 |
| 31. Yi CA, Lee KS, Kim EA, et al. Solitary pulmonary nodules: dynamic enhanced multi-detector row CT study and comparison with vascular endothelial growth factor and microvessel density. Radiology. 2004; 233(1):191-199. |
Observational-Dx |
131 patients |
To evaluate enhancement dynamic of benign and malignant nodules at MDCT. |
With 30 HU or more of net enhancement as a cutoff value in differentiation of malignant and benign nodules, sensitivity for malignant nodules was 99% (69/70 malignant nodules), specificity was 54% (33/61 benign nodules), PPV was 71% (69/97 malignant readings), NPV was 97% (33/34 benign readings), and accuracy was 78% (102/131 nodules). Peak attenuation was correlated positively with extent of microvessel density (r = 0.369, P=.006) and vascular endothelial growth factor staining (r = 0.277, P=.042). Malignant nodules showed significantly higher vascular endothelial growth factor expression (P=.009) than that of benign nodules. Dynamic enhancement with MDCT shows high sensitivity and NPVs for diagnosis of malignant nodules but low specificity because of highly enhancing benign nodules. Extent of enhancement reflects underlying nodule angiogenesis. |
2 |
| 32. Yi CA, Lee KS, Kim BT, et al. Tissue characterization of solitary pulmonary nodule: comparative study between helical dynamic CT and integrated PET/CT. J Nucl Med 2006;47:443-50. |
Observational-Dx |
119 patients |
To compare the diagnostic accuracy of helical dynamic (HD) CT (HDCT) and integrated PET/CT for pulmonary nodule characterization. |
There were 79 malignant and 40 benign nodules. The sensitivity, specificity, and accuracy for malignancy on HDCT were 81% (64/79 nodules), 93% (37/40), and 85% (101/119), respectively, whereas those on integrated PET/CT were 96% (76/79), 88% (35/40), and 93% (111/119), respectively (P = 0.008, 0.727, and 0.011, respectively). All malignant nodules were interpreted correctly on either HDCT or PET/CT. |
2 |
| 33. Chilet-Rosell E, Parker LA, Hernandez-Aguado I, et al. Differences in the clinical management of women and men after detection of a solitary pulmonary nodule in clinical practice. European Radiology. 30(8):4390-4397, 2020 Aug. |
Observational-Dx |
25,422 patients |
To explore differences in the clinical management of men and women in the 5 years after detecting a solitary pulmonary nodule (SPN) by chest radiograph or CT in routine clinical practice. |
Women were more likely than men to have follow-up rather than immediate intervention (aRR = 1.8, CI 1.3-2.7, p = 0.002), particularly in those who underwent CT (aRR = 4.2, CI 1.9-9.3, p < 0.001). The median time between SPN detection and lung cancer diagnosis was higher in women (4.2 months, interquartile range (IQR) 5.1) than in men (1.5 months, IQR 16.2). The mean cumulative effective dose was 21.3 mSv, 19.4 mSv in men and 23.9mv in women (p = 0.023). |
2 |
| 34. Bohlsen D, Talakic E, Fritz GA, Quehenberger F, Tillich M, Schoellnast H. First pass dual input volume CT-perfusion of lung lesions: The influence of the CT- value range settings on the perfusion values of benign and malignant entities. Eur J Radiol. 85(6):1109-14, 2016 Jun. |
Observational-Dx |
48 patients |
To assess the influence of the lower threshold for segmentation of the volume of interest on the perfusion values in first-pass dual input volume CT-perfusion of lung lesions. |
Median PAF was significantly higher in malignant lesions than in benign lesions for all settings (53-96 versus 29-62mL/min/100mL, P<0.05). There was no significant difference in BAF between malignant and benign lesions. Median PAF of all lesions was significantly influenced by the CT value range setting (P<0.05), whereas the values increased from setting 1 to 4. Intraobserver analysis as well as interobserver analysis of PAF at setting 4 showed excellent reliability (Cronbach's alpha 0.98 and 0.95, respectively, P<0.01). |
2 |
| 35. Cohen JG, Goo JM, Yoo RE, et al. The effect of late-phase contrast enhancement on semi-automatic software measurements of CT attenuation and volume of part-solid nodules in lung adenocarcinomas. Eur J Radiol. 85(6):1174-80, 2016 Jun. |
Observational-Dx |
50 patients |
To evaluate the differences in semi-automatic measurements of CT attenuation and volume of part-solid nodules (PSNs) between unenhanced and enhanced CT scans. |
All parameters except for the mean attenuation of the solid components, were significantly increased on enhanced CT (p<0.05). For the whole nodule, the mean relative differences were as follows: the longest diameter, 1.4% (limits of agreement, -6.2-9.1); volume, 2.4% (-26.7-31.4); mass, 7.0% (-11.3-25.2); mean attenuation, 2.7% (-5.6-11). For the nodule's solid component, those differences were as follow: the longest diameter, 6.9% (-34.4-48.2); volume, 17.9% (-77.8-113.7); mass, 18.8% (-77.8-115.4). The differences of measures between the unenhanced and enhanced CT were not significantly different between two groups of adenocarcinoma in situ/minimally invasive adenocarcinomas and invasive adenocarcinomas (p>0.05). |
2 |
| 36. Christensen JA, Nathan MA, Mullan BP, Hartman TE, Swensen SJ, Lowe VJ. Characterization of the solitary pulmonary nodule: 18F-FDG PET versus nodule-enhancement CT. AJR Am J Roentgenol. 2006; 187(5):1361-1367. |
Observational-Dx |
42 nodules |
To compare nodule-enhancement CT and FDG-PET in the characterization of SPN. |
Nodule-enhancement CT was positive in all 25 malignant nodules and in 12 benign nodules, with sensitivity and specificity of 100% and 29%, respectively, and with a PPV and NPV of 68% and 100%, respectively. Qualitative FDG-PET interpretations were positive in 24/25 malignant nodules and in 4 benign nodules. FDG-PET was considered negative in one malignant nodule and in 13/17 benign nodules. This correlates with a sensitivity and specificity of 96% and 76%, respectively, and with a PPV and NPV of 86% and 93%, respectively. Original prospective FDG-PET and semiquantitative SUV analysis showed sensitivity, specificity, PPV, and NPV of 88%, 76%, 85%, and 81% and 84%, 82%, 88%, and 78%, respectively. Due to its much higher specificity and only slightly reduced sensitivity, FDG-PET is preferable to nodule-enhancement CT in evaluating indeterminate pulmonary nodules. However, nodule-enhancement CT remains useful due to its high NPV, convenience, and lower cost. Qualitative FDG-PET interpretation provided the best balance of sensitivity and specificity when compared with original prospective interpretation or SUV analysis. |
2 |
| 37. Swensen SJ, Yamashita K, McCollough CH, et al. Lung nodules: dual-kilovolt peak analysis with CT--multicenter study. Radiology 2000;214:81-5. |
Observational-Dx |
240 patients |
To test the following hypothesis: The greater the increase in the mean computed tomographic (CT) number of a radiologically indeterminate lung nodule from the CT number on a 140-kVp CT image to that on an 80-kVp CT image, the more likely the nodule is benign (ie, contains calcium). |
There were 86 (55%) benign and 71 (45%) malignant nodules. The median increase in the nodule mean CT number from the CT number on 140-kVp images to that on 80-kVp images was 2 HU for benign nodules and 3 HU for malignant nodules. This difference was not statistically significant. The area under the receiver operating characteristic curve was 0.505. |
2 |
| 38. Chae EJ, Song JW, Seo JB, Krauss B, Jang YM, Song KS. Clinical utility of dual-energy CT in the evaluation of solitary pulmonary nodules: initial experience. Radiology. 2008; 249(2):671-681. |
Observational-Dx |
49 patients |
To determine the clinical utility of dual-energy CT in evaluating SPNs. |
CT numbers on virtual nonenhanced and nonenhanced weighted average images and CT numbers on the iodine-enhanced image and the degree of enhancement showed good agreements (intraclass correlation coefficients: 0.83 and 0.91, respectively). Diagnostic accuracy for malignancy by using CT numbers on iodine-enhanced image was comparable to that by using the degree of enhancement (sensitivity, 92% and 72%; specificity, 70% and 70%; accuracy, 82.2% and 71.1%, respectively). On virtual nonenhanced image, 85.0% (17/20) of calcifications in the SPN and 97.8% (44/45) of calcifications in the lymph nodes were detected, and the apparent sizes were smaller than those on the nonenhanced weighted average image. Radiation dose (average dose-length product, 240.77 mGy cm) was not significantly different from that of single-energy CT (P=.67). Dual-energy CT allows measurement of the degree of enhancement and detection of calcifications without additional radiation dose. |
3 |
| 39. American College of Radiology. ACR Appropriateness Criteria®: Clinically Suspected Pulmonary Arteriovenous Malformation (PAVM). Available at: https://acsearch.acr.org/docs/3094113/Narrative/. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. |
No abstract available. |
4 |
| 40. Nair VS, Sundaram V, Gould MK, Desai M. Use of [(18)F]Fluoro-2-deoxy-d-glucose Positron Emission Tomographic Imaging in the National Lung Screening Trial. Chest. 150(3):621-30, 2016 09. |
Observational-Dx |
1,556 patients |
To analyze participants in the National Lung Screening Trial (NLST) with positive screening test results and identified individuals with a PET scan performed prior to lung cancer diagnosis (diagnostic PET). |
Diagnostic PET imaging was performed in 1,556 of 14,195 patients (11%) with positive screen results; 331 of these (21%) were inappropriate. PET scan use by endemic fungal disease area was comparable although patients from the Northeast/Southeast were twice as likely as the West to have a diagnostic PET. Trial arm, older age, sex, nodule size = 0.8 cm, upper lobe location, and spiculated margin were variables positively associated with use. Trial arm, older age, and spiculated margin were positively associated with appropriate use. Only 561 diagnostic PETs (36%) were recommended by a radiologist and 284 PETs performed for nodules < 0.8 cm (86%) were ordered despite no recommendation from a radiologist. |
2 |
| 41. Erasmus JJ, McAdams HP, Patz EF, Jr., Coleman RE, Ahuja V, Goodman PC. Evaluation of primary pulmonary carcinoid tumors using FDG PET. AJR Am J Roentgenol 1998;170:1369-73. |
Review/Other-Dx |
N/A |
To determine the spectrum of positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) findings in patients who have primary pulmonary carcinoid tumors. |
No results stated in the abstract. |
4 |
| 42. Yap CS, Schiepers C, Fishbein MC, Phelps ME, Czernin J. FDG-PET imaging in lung cancer: how sensitive is it for bronchioloalveolar carcinoma? Eur J Nucl Med Mol Imaging 2002;29:1166-73. |
Observational-Dx |
41 patients |
To investigate the accuracy of PET for diagnosing and staging of bronchioloalveolar carcinoma (BAC). |
We studied 41 patients eventually found to have adenocarcinoma with a bronchioloalveolar growth pattern who were referred for characterization or staging of lung lesions with whole-body FDG-PET between January 1998 and March 2001: there were 11 males (27%) and 30 females (73%), with a mean age of 66.0+/-10.9 (range =44-84 years). Patients were imaged using ECAT EXACT or HR+ systems. All patients had non-attenuation-corrected scans, while transmission data for attenuation correction were also available for 12 patients (29%). PET correctly identified BAC in 41 of the 46 (89%) lesions and 39 of the 41 patients (95%). By pathology, 25 patients (61%) were found to have unifocal or nodular lesions; this pattern was correctly identified by PET in 20 patients (80%) and by CT in 18 (72%). PET correctly identified 7 (44%) of 16 patients (39%) who had multicentric or diffuse BAC, and CT identified 11 (69%). Of the 35 patients whose lymph node status was verified pathologically, PET was correct in 27 (77%) and CT in 24 (69%). PET missed 67% of the rare tumors that had a pure BAC pattern with no invasive component. It is concluded that the diagnostic performance of whole-body FDG-PET is similar in most patients with lesions with a BAC pattern and in other non-small cell lung cancer types. PET is less accurate in patients with rare BAC tumors that have no invasive component. |
2 |
| 43. Sathekge MM, Maes A, Pottel H, Stoltz A, van de Wiele C. Dual time-point FDG PET-CT for differentiating benign from malignant solitary pulmonary nodules in a TB endemic area. S Afr Med J 2010;100:598-601. |
Observational-Dx |
32 patients |
To assess its diagnostic accuracy for differentiating benign from malignant SPNs in a tuberculosis (TB)-endemic area. |
Histological examination showed that 14 lesions were malignant and 16 benign, 12 of which were TB. SUVmax for benign and malignant lesions were 11.02 (standard deviation (SD) 6.6) v. 10.86 (SD 8.9); however, when tuberculomas were excluded from the analysis, a significant difference in mean SUV1max values between benign and malignant lesions was observed (p=0.0059). Using an SUVmax cut-off value of 2.5, a sensitivity of 85.7% and a specificity of 25% was obtained. Omitting the TB patients from analysis resulted in a sensitivity of 85.7% and a specificity of 100%. Mean %DSUV of benign lesions did not differ significantly from mean %DSUV of malignant lesions (17.1% (SD 16.3%) v. 19.4% (SD 23.7%)). Using a cut-off of %DSUV>10% as indicative of malignancy, a sensitivity of 85.7% and a specificity of 50% was obtained. Omitting the TB patients from the analysis yielded a sensitivity of 85.7% and a specificity of 75%. |
2 |
| 44. Deppen SA, Blume JD, Kensinger CD, et al. Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis. [Review]. JAMA. 312(12):1227-36, 2014 Sep 24. |
Meta-analysis |
1923 articles (257 Eligible articles) |
To estimate the diagnostic accuracy of FDG-PET for pulmonary nodules suspicious for lung cancer in regions where infectious lung disease is endemic and compare the test accuracy in regions where infectious lung disease is rare. |
Heterogeneity for sensitivity (I2 = 87%) and specificity (I2 = 82%) was observed across studies. The pooled (unadjusted) sensitivity was 89% (95% CI, 86%-91%) and specificity was 75% (95% CI, 71%-79%). There was a 16% lower average adjusted specificity in regions with endemic infectious lung disease (61% [95% CI, 49%-72%]) compared with nonendemic regions (77% [95% CI, 73%-80%]). Lower specificity was observed when the analysis was limited to rigorously conducted and well-controlled studies. In general, sensitivity did not change appreciably by endemic infection status, even after adjusting for relevant factors. |
Good |
| 45. Reyes N, Onadeko OO, Luraschi-Monjagatta Mdel C, et al. Positron emission tomography in the evaluation of pulmonary nodules among patients living in a coccidioidal endemic region. Lung. 192(4):589-93, 2014 Aug. |
Observational-Dx |
27 patients |
To compare by PET/CT the (18)FDG uptake in pulmonary nodules likely due to coccidioidomycosis to that of nodules shown to be malignant among patients living in a coccidioidal endemic region. |
Among 245 diagnostic biopsies where the subject had a previous PET/CT, 15 (6.1 %) were either coccidioidal (n = 12) or granulomatous without an identified organism (n = 3). The median maximum standard unit of uptake (SUV(max)) on PET/CT of coccidioidal or granulomatous lesions was 2.0 compared to 9.8 for malignant lesions (P < 0.001). The maximum diameter of the coccidioidal or granulomatous nodules was 2.1 cm compared to 3.0 cm for the malignant lesions (P = 0.009). On multivariable analysis, an elevated SUV(max) was the only distinguishing feature between the malignant and the granulomatous lesions (OR 1.28, 95 % CI 1.05-1.55; P = 0.013). |
2 |
| 46. Fendler WP, Czernin J, Herrmann K, Beyer T. Variations in PET/MRI Operations: Results from an International Survey Among 39 Active Sites. J Nucl Med 2016;57:2016-21. |
Review/Other-Dx |
N/A |
To focus discussions on common interests of the PET/MRI community. |
Responses were collected from 39 international sites that operated PET/MRI for a median of 30 mo (range, 2-62 mo). Most installations were located in public institutions with an academic focus (n = 26, 67%). Systems were primarily operated by nuclear medicine departments (n = 13, 33%), jointly by nuclear medicine and radiology (n = 11, 28%), and radiology only (n = 10, 26%). PET/MRI operation was equally focused on clinic routine and research (47% vs. 45% of sites, respectively). Sites reported a strong focus on oncology (76% of research and 88% of clinical applications). Other applications included neurology (9% clinical, 12% research) and cardiology (3% clinical, 6% research). Perceived superiority over PET/CT was identified as the strongest driver for clinical adoption. Over half the operators expect PET/MRI to excel in clinical routine within 3-5 y. Emerging key applications for future PET/MRI use were cardiovascular disease and imaging of inflammation. |
4 |
| 47. Biondetti P, Vangel MG, Lahoud RM, et al. PET/MRI assessment of lung nodules in primary abdominal malignancies: sensitivity and outcome analysis. Eur J Nucl Med Mol Imaging. 48(6):1976-1986, 2021 06. |
Observational-Dx |
126 patients |
To evaluate PET/MR lung nodule detection compared to PET/CT or CT, to determine growth of nodules missed by PET/MR, and to investigate the impact of missed nodules on clinical management in primary abdominal malignancies. |
A total of 505 nodules (mean 4 mm, range 1-23 mm) were detected by SCI in 89/126 patients (66M:60F, mean age 60 years). PET/MR detected 61 nodules for a sensitivity of 28.1% for patient and 12.1% for nodule, with higher sensitivity for > 7 mm nodules (< 30% and > 70% respectively, p < 0.05). 75/337 (22.3%) of the nodules missed on PET/MR (follow-up mean 736 days) demonstrated growth. In patients positive for nodules at SCI and negative at PET/MR, missed nodules did not influence patients' management. |
2 |
| 48. Dahlsgaard-Wallenius SE, Hildebrandt MG, Johansen A, et al. Hybrid PET/MRI in non-small cell lung cancer (NSCLC) and lung nodules-a literature review. [Review]. Eur J Nucl Med Mol Imaging. 48(2):584-591, 2021 02. |
Review/Other-Dx |
3138 articles |
To investigate the published literature on PET/MRI for clinical staging in NSCLC or lung nodule detection specifically addressing diagnostic accuracy and technical issues. |
A total of 3138 publications were identified from which 116 published 2012-2018 were included. Of these, nine studies addressed PET/MRI in NSCLC (4) or lung nodule detection (5). Overall, PET/MRI did not provide advantages in preoperative T- and N-staging in NSCLC compared to PET/CT. The data on M-staging were too few for conclusions to be drawn. The lung nodule detection rate of PET/MRI was comparable to that of PET/CT for FDG-avid nodules larger than 10 mm, but the sensitivity of PET/MRI for detection of non-FDG-avid nodules smaller than 5 mm was low. |
4 |
| 49. Riola-Parada C, Garcia-Canamaque L, Perez-Duenas V, Garcerant-Tafur M, Carreras-Delgado JL. Simultaneous PET/MRI vs PET/CT in oncology. A systematic review. [Review]. Rev Esp Med Nucl Imagen Mol. 35(5):306-12, 2016 Sep-Oct. |
Review/Other-Dx |
57 articles |
To evaluate the diagnostic performance of simultaneous PET/MRI in oncology compared with that of PET/CT, based upon the available evidence. |
A total of 57 articles were obtained that included various diseases: head and neck cancer (5), lung cancer and lung nodules (13), colorectal cancer (1), liver lesions (2), abdominal incidentalomas (1), neuroendocrine tumours (2), thyroid carcinoma (2), breast cancer (3), gynaecological cancer (2), prostate cancer (4), lymphoma (2), multiple myeloma (1), bone metastases (3), intracranial tumours (2), paediatric oncology (1) and various tumours (13). Diagnostic performance of simultaneous PET/MRI was similar or even better to that of PET/CT in most oncological diseases. However, PET/CT was superior for small lung nodule detection. |
4 |
| 50. Sawicki LM, Grueneisen J, Buchbender C, et al. Evaluation of the Outcome of Lung Nodules Missed on 18F-FDG PET/MRI Compared with 18F-FDG PET/CT in Patients with Known Malignancies. J Nucl Med. 57(1):15-20, 2016 Jan. |
Observational-Dx |
50 patients |
To evaluate the outcome of these small lung nodules missed by (18)F-FDG PET/MRI. |
Fifty-one oncologic patients (mean age ± SD, 56.6 ± 14.0 y; 29 women, 22 men; tumor stages, I [n = 7], II [n = 7], III [n = 9], IV [n = 28]) who underwent (18)F-FDG PET/CT and subsequent (18)F-FDG PET/MRI on the same day were retrospectively enrolled. Images were analyzed by 2 interpreters in random order and separate sessions with a minimum of 4 wk apart. A maximum of 10 lung nodules was identified for each patient on baseline imaging. The presence, size, and presence of focal tracer uptake was noted for each lung nodule detected on (18)F-FDG PET/CT and (18)F-FDG PET/MRI using a postcontrast T1-weighted 3-dimensional gradient echo volume-interpolated breath-hold examination sequence with fat suppression as morphologic dataset. Follow-up CT or (18)F-FDG PET/CT (mean time to follow-up, 11 mo; range, 3-35 mo) was used as a reference standard to define each missed nodule as benign or malignant based on changes in size and potential new tracer uptake. Nodule-to-nodule comparison between baseline and follow-up was performed using descriptive statistics. |
2 |
| 51. Kolderman NC, Cheti DR, Hasbrook CD, et al. Pneumothorax Rate and Diagnostic Adequacy of Computed Tomography-guided Lung Nodule Biopsies Performed With 18 G Versus 20 G Needles: A Cross-Sectional Study. J Thorac Imaging. 35(4):265-269, 2020 Jul. |
Observational-Dx |
550 patients |
To compare the complication and diagnostic adequacy rates between 2 needle sizes: 18 G and 20 G in CT-guided lung nodule biopsies. |
There was no significant difference in pneumothorax rate between 18 G (n=125) versus 20 G (n=425) (rates: 25.6% vs. 28.7%; P=0.50; odds ratio [OR]=0.86; 95% confidence interval [CI]=0.54-1.35), chest tube insertion rate (4.8% vs. 5.6%; P=0.71; OR=0.84; 95% CI=0.34-2.11), or diagnostic adequacy (95% vs. 93%; P=0.36; OR=1.51; 95% CI=0.61-3.72). Multiple logistic regression analysis demonstrated emphysema along the biopsy path (OR=3.12; 95% CI=1.63-5.98) and nodule distance from the pleural surface =4 cm (OR=1.85; 95% CI=1.05-3.28) to be independent risk factors for pneumothorax. |
2 |
| 52. Liu GS, Wang SQ, Liu HL, Liu Y, Fu YF, Shi YB. Computed Tomography-Guided Biopsy for Small (<=20 mm) Lung Nodules: A Meta-Analysis. J Comput Assist Tomogr. 44(6):841-846, 2020 Nov/Dec. |
Meta-analysis |
25 articles |
To evaluate the diagnostic accuracy of computed tomography (CT)-guided biopsy for small lung nodules (SLNs) (=20 mm) and to assess related complication rates. |
In total, we identified 25 relevant studies for incorporation into this meta-analysis, incorporating 2922 total CT-guided lung biopsy. Pooled technical success rates, diagnostic accuracy, pneumothorax rates, and hemoptysis rates were 94% (95% confidential interval [CI], 0.91-0.98), 90% (95% CI, 0.88-0.93), 19% (95% CI:, 0.15-0.24), and 12% (95% CI, 0.08-0.15), respectively. We observed significant heterogeneity among these studies for all 4 of these parameters (I = 90.0%, 82.7%, 88.6%, and 88.4%, respectively). When we conducted a meta-regression analysis, we did not identify any variables that influenced diagnostic accuracy or technical success, pneumothorax, or hemoptysis rates. Publication bias risk analyses suggested that there was relatively little risk of publication bias pertaining to pneumothorax rates (P = 0.400) or hemoptysis rates (P = 0.377). In contrast, we detected a high risk of publication bias pertaining to reported technical success rates (P = 0.007) and diagnostic accuracy (P = 0.000). |
Good |
| 53. Portela de Oliveira E, Souza CA, Inacio JR, et al. Imaging-guided Percutaneous Biopsy of Nodules <=1 cm: Study of Diagnostic Performance and Risk Factors Associated With Biopsy Failure. J Thorac Imaging. 35(2):123-128, 2020 Mar. |
Observational-Dx |
133 patients |
To evaluate diagnostic yield, accuracy, and safety of computed tomography (CT)-guided needle biopsy in the diagnosis of subcentimeter lung nodules. |
Biopsy specimens were adequate for diagnosis in 116/133(87%) cases; the diagnostic yield for malignant and benign lesions was 93% and 65%, respectively. Final benign diagnosis was the strongest independent risk factor for biopsy failure. In multivariate logistic regression, fine-needle aspiration was an independent risk factor for diagnostic failure. Core needle biopsy was an independent risk factor for pneumothorax, and core needle biopsy, number of passes, and age were independent risk factors for pneumothorax requiring tube drainage. |
2 |
| 54. Ohno Y, Kauczor HU, Hatabu H, Seo JB, van Beek EJR, International Workshop for Pulmonary Functional Imaging (IWPFI). MRI for solitary pulmonary nodule and mass assessment: Current state of the art. [Review]. J Magn Reson Imaging. 47(6):1437-1458, 2018 06. |
Review/Other-Dx |
N/A |
To focus on these recent advances in MRI for pulmonary nodule detection and pulmonary nodule and mass evaluation by using noncontrast-enhanced and contrast-enhanced techniques as well as new molecular imaging methods such as chemical exchange saturation transfer imaging for a comparison with other modalities such as single or multidetector row CT, 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), and/or PET/CT. |
No results stated in the abstract |
4 |
| 55. Zhang HF, Zeng XT, Xing F, Fan N, Liao MY. The diagnostic accuracy of CT-guided percutaneous core needle biopsy and fine needle aspiration in pulmonary lesions: a meta-analysis. Clin Radiol. 71(1):e1-10, 2016 Jan. |
Meta-analysis |
19 studies |
To determine and compare the diagnostic value of computed tomography (CT)-guided percutaneous core needle biopsy (PCNB) and percutaneous fine-needle aspiration biopsy (PNAB) in pulmonary lesions. |
Nineteen publications, including 21 independent studies, met the inclusion criteria. Of them, 15 studies were included in the PCNB group and six studies in the PNAB group. The pooled SEN, SPE, DOR, PLR, NLR, and SROC were 0.95, 0.99, 54.72, 0.06, 821.90, and 0.98 in the PCNB group and 0.90, 0.99, 24.71, 0.14, 210.72, and 0.98 in the PNAB group, respectively. |
Good |
| 56. Heerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol 2017;27:138-48. |
Meta-analysis |
32 articles |
To meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors. |
For core biopsy, 32 articles (8,133 procedures) were included and for FNA, 17 (4,620 procedures). Pooled overall complication rates for core biopsy and FNA were 38.8 % (95 % CI: 34.3-43.5 %) and 24.0 % (95 % CI: 18.2-30.8 %), respectively. Major complication rates were 5.7 % (95 % CI: 4.4-7.4 %) and 4.4 % (95 % CI: 2.7-7.0 %), respectively. Overall complication rate was higher for core biopsy compared to FNA (p < 0.001). For FNA, larger needle diameter was a risk factor for overall complications, and increased traversed lung parenchyma and smaller lesion size were risk factors for major complications. For core biopsy, no significant risk factors were identified. |
Good |
| 57. Cha MJ, Park HJ, Paek MY, et al. Free-breathing ultrashort echo time lung magnetic resonance imaging using stack-of-spirals acquisition: A feasibility study in oncology patients. Magn Reson Imaging. 51:137-143, 2018 09. |
Observational-Dx |
32 patients |
To investigate the diagnostic accuracy of lung magnetic resonance imaging (MRI) with a free-breathing three-dimensional ultrashort echo time spoiled gradient echo sequence using a stack-of-spirals acquisition (spiral 3D UTE) for pulmonary nodule detection at 3 T in oncology patients. |
The mean acquisition duration of the spiral 3D UTE was 327 s (range, 300-465 s). The pulmonary vessels and bronchi were visible nearly consistently up to the sub-sub-segmental branch levels on spiral 3D UTE (96.9% [31/32] and 90.6% [29/32], respectively). >90% of the spiral 3D UTE images had an acceptable or good mediastinal evaluation; >80% had good or excellent overall image quality. Fifty nodules (6.1 ± 5.9 mm) were identified in 13 patients on CT; the overall nodule detection rate of spiral 3D UTE was 86% (43/50). All 20 nodules = 5 mm in diameter were identified on spiral 3D UTE (100%). |
2 |
| 58. Heye T, Sommer G, Miedinger D, Bremerich J, Bieri O. Ultrafast 3D balanced steady-state free precession MRI of the lung: Assessment of anatomic details in comparison to low-dose CT. J Magn Reson Imaging. 42(3):602-9, 2015 Sep. |
Observational-Dx |
20 patients |
To evaluate the anatomical details offered by a new single breath-hold ultrafast 3D balanced steady-state free precession (uf-bSSFP) sequence in comparison to low-dose chest computed tomography (CT). |
The uf-bSSFP detection rate of pulmonary nodules (32 nodules visible on CT and MRI, median diameter 3.9 mm) was 45.5% with 21 false-positive findings (pooled data of both readers). Uf-bSSFP detected 71.2% of branching points visible on CT data. The mean distance between peripheral vasculature and pleural surface was 13.0 ± 4.2 mm (MRI) versus 8.5 ± 3.3 mm (CT) on thin slices and 8.6 ± 3.9 mm (MRI) versus 4.6 ± 2.5 mm (CT) on MIPs. Median image quality and sharpness were rated 4 each. |
2 |
| 59. Ohno Y, Koyama H, Yoshikawa T, et al. Standard-, Reduced-, and No-Dose Thin-Section Radiologic Examinations: Comparison of Capability for Nodule Detection and Nodule Type Assessment in Patients Suspected of Having Pulmonary Nodules. Radiology 2017;284:562-73. |
Observational-Dx |
52 patients |
To compare the capability of pulmonary thin-section magnetic resonance (MR) imaging with ultrashort echo time (UTE) with that of standard- and reduced-dose thin-section computed tomography (CT) in nodule detection and evaluation of nodule type. |
There was no significant difference (F = 0.70, P = .59) in figure of merit between methods (standard-dose CT, 0.86; reduced-dose CT, 0.84; MR imaging with UTE, 0.86). There was no significant difference in sensitivity between methods (standard-dose CT vs reduced-dose CT, P = .50; standard-dose CT vs MR imaging with UTE, P = .50; reduced-dose CT vs MR imaging with UTE, P >.99). Intermethod agreement was excellent (standard-dose CT vs reduced-dose CT, ? = 0.98, P < .001; standard-dose CT vs MR imaging with UTE, ? = 0.98, P < .001; reduced-dose CT vs MR imaging with UTE, ? = 0.99, P < .001). Conclusion Pulmonary thin-section MR imaging with UTE was useful in nodule detection and evaluation of nodule type, and it is considered at least as efficacious as standard- or reduced-dose thin-section CT. |
2 |
| 60. Schroeder T, Ruehm SG, Debatin JF, Ladd ME, Barkhausen J, Goehde SC. Detection of pulmonary nodules using a 2D HASTE MR sequence: comparison with MDCT. AJR Am J Roentgenol. 2005; 185(4):979-984. |
Observational-Dx |
30 patients |
To determine the diagnostic performance of MRI based on a HASTE sequence for the detection of pulmonary nodules in comparison with MDCT. |
Compared with the sensitivity of CT, the sensitivity values for the HASTE MR sequence were as follows: 73% for lesions <3 mm, 86.3% for lesions between 3 and 5 mm, 95.7% for lesions between 6 and 10 mm, and 100% for lesions >10 mm. The overall sensitivity of the HASTE sequence for the detection of all pulmonary lesions was 85.4%. An MRI examination that consists of a HASTE sequence allows one to detect, exclude, or monitor pulmonary lesions that are =5 mm. Suspicious lesions <5 mm still need to be validated using CT. |
2 |
| 61. Regier M, Schwarz D, Henes FO, et al. Diffusion-weighted MR-imaging for the detection of pulmonary nodules at 1.5 Tesla: intraindividual comparison with multidetector computed tomography. J Med Imaging Radiat Oncol 2011;55:266-74. |
Observational-Dx |
25 patients |
To investigate the feasibility of diffusion-weighted imaging (DWI) MRI for detecting pulmonary nodules at 1.5 Tesla in comparison with standard multidetector computed tomography (MDCT). |
At MDCT, a total of 71 pulmonary noduIes was found (size 3-5mm, n=16; 6-9mm, n=22; =10mm, n=33). For the DWI MR-sequence, a sensitivity of 86.4% was calculated for nodules ranging 6-9mm and 97% for nodules =10mm. In contrast, only 43.8% of lesions =5mm was detected. The separate analysis of each hemithorax for the presence of at least one pulmonary nodule revealed a specificity rate, PPV and NPV of DWI-MR of 92.3%, 96% and 80%, respectively. |
2 |
| 62. Basso Dias A, Zanon M, Altmayer S, et al. Fluorine 18-FDG PET/CT and Diffusion-weighted MRI for Malignant versus Benign Pulmonary Lesions: A Meta-Analysis. Radiology 2019;290:525-34. |
Meta-analysis |
37 studies |
To perform a meta-analysis of the literature to compare the diagnostic performance of fluorine 18 fluorodeoxyglucose PET/CT and diffusion-weighted (DW) MRI in the differentiation of malignant and benign pulmonary nodules and masses. |
Thirty-seven studies met the inclusion criteria, with a total of 4224 participants and 4463 lesions (3090 malignant lesions [69.2%]). In the primary analysis of joint DW MRI and PET/CT studies (n = 6), DW MRI had a pooled sensitivity and specificity of 83% (95% CI: 75%, 89%) and 91% (95% CI: 80%, 96%), respectively, compared with 78% (95% CI: 70%, 84%) (P = .01 vs DW MRI) and 81% (95% CI: 72%, 88%) (P = .056 vs DW MRI) for PET/CT. DW MRI yielded an AUC of 0.93 (95% CI: 0.90, 0.95), versus 0.86 (95% CI: 0.83, 0.89) for PET/CT (P = .001). The diagnostic odds ratio of DW MRI (50 [95% CI: 19, 132]) was superior to that of PET/CT (15 [95% CI: 7, 32]) (P = .006). Conclusion The diagnostic performance of diffusion-weighted MRI is comparable or superior to that of fluorine 18 fluorodeoxyglucose PET/CT in the differentiation of malignant and benign pulmonary lesions |
Good |
| 63. Koo CW, White DB, Lingineni RK, et al. Magnetic Resonance Imaging of Part-solid Nodules: A Pilot Study. J Thorac Imaging. 31(1):2-10, 2016 Jan. |
Observational-Dx |
28 patients |
To assess whether magnetic resonance imaging (MRI) characteristics can distinguish benign from malignant part-solid pulmonary nodules and predict the aggressiveness of the latter. To compare MRI-derived parameters with morphologic and physiological values derived from conventional examinations such as computed tomography and positron emission tomography/computed tomography. |
Only ADC values correlated with malignancy (P<0.05). ADC=1.28 µm/ms predicted malignancy with 83.3% sensitivity (area under the curve 0.79). ADC and T2* correlated with adenocarcinoma subtypes (P<0.05). No MRI parameters predicted tumor differentiation (P>0.11). SUVmax did not correlate with any MRI parameters (P>0.56). Visibility on T1-weighted images correlated with the percentage of solid components (P<0.03). T1 and T2 values showed significant correlation with HU measurements of the entire nodule (P<0.001 and P<0.024, respectively) and HU measurements of solid components (P=0.031 and 0.008, respectively). |
2 |
| 64. Bartholmai BJ, Koo CW, Johnson GB, et al. Pulmonary nodule characterization, including computer analysis and quantitative features. [Review]. J Thorac Imaging. 30(2):139-56, 2015 Mar. |
Review/Other-Dx |
N/A |
To discuss the Pulmonary nodule characterization, including computer analysis and quantitative features. |
No results state din the abstract. |
4 |
| 65. Schaefer JF, Vollmar J, Schick F, et al. Solitary pulmonary nodules: dynamic contrast-enhanced MR imaging--perfusion differences in malignant and benign lesions. Radiology. 2004; 232(2):544-553. |
Observational-Dx |
58 patients |
To evaluate dynamic MRI in the evaluation of SPN’s. |
Frequency of malignancy was 53% (27/51 nodules). Malignant nodules showed stronger enhancement with a higher maximum peak and a faster slope (P<.001). Significant washout (>0.1% increase in signal intensity per second) was found only in malignant lesions (14/27 lesions). Sensitivity, specificity, and accuracy were 96%, 88%, and 92%, respectively, for maximum peak; 96%, 75%, and 86% for slope; and 52%, 100%, and 75% for washout. When curve profiles and morphologic enhancement patterns were combined, sensitivity increased to 100%. Dynamic MRI delineates significant kinetic and morphologic differences in vascularity and perfusion between malignant and benign SPNs. Washout seems to be highly specific for malignancy. |
2 |
| 66. Coolen J, Vansteenkiste J, De Keyzer F, et al. Characterisation of solitary pulmonary lesions combining visual perfusion and quantitative diffusion MR imaging. Eur Radiol 2014;24:531-41. |
Observational-Dx |
54 patients |
To evaluate the diagnostic accuracy of dynamic contrast-enhanced (DCE) magnetic resonance (MR) and diffusion-weighted imaging (DWI) sequences for defining benignity or malignancy of solitary pulmonary lesions (SPL). |
In the feasibility group, 11 benign and 43 malignant SPL were included. Using the combination of conventional MR sequences with visual interpretation of DCE-MR curves resulted in a sensitivity, specificity and accuracy of 100%, 55% and 91%, respectively. These results can be improved by DWI (with a cut-off value of 1.52 × 10(-3) mm(2)/s for ADChigh) leading to a sensitivity, specificity and accuracy of 98%, 82% and 94%, respectively. In the validation group these results were confirmed. |
2 |
| 67. Hussien AF, Jeudy J, Kligerman SJ, White CS. Thoracic Incidental Findings in Preoperative Computed Tomography Evaluation for Transcatheter Aortic Valve Implantation (TAVI). J Thorac Imaging. 31(3):183-8, 2016 May. |
Review/Other-Dx |
209 patients |
To examine incidental findings in 209 consecutive patients (96 women and 113 men; mean age, 70 y) with aortic stenosis undergoing preoperative cardiothoracic CT evaluation for TAVI during a 3-year period. |
Incidental findings, both significant and nonsignificant, were observed in 85.6% of patients (179/209). Noncalcified pulmonary nodules were the most common incidental finding occurring in 59/209 (28.2%) patients, followed by pleural effusion and emphysema both of which occurred in 34/209 (16.3%) patients, respectively. |
4 |
| 68. Markowiak T, Holzamer A, Hilker M, et al. Incidental thoracic findings in computed tomography scans before transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg. 28(4):559-565, 2019 04 01. |
Observational-Dx |
976 patients |
To investigate the impact of auxiliary findings on the patients' mid-term survival, which might affect the treatment strategy. |
The median age of all patients was 79 years; 51.9% (n = 507) were women. Approximately 37% (n = 361) of patients showed 1 of the determined findings. An SPN =5 mm was diagnosed in 16.4% (n = 160) of patients. Four of them developed lung cancer and 2 nodules were identified as metastases during follow-up. In addition, 12% (n = 117) of the patients had thoracic LAP. Whereas SPN had no significant effect on the overall survival rate, evidence of LAP turned out to be a statistically significant factor regarding 4-year survival (P = 0.001; hazard ratio 1.66; 95% confidence internal 1.19-2.31). |
2 |
| 69. Robertson J, Nicholls S, Bardin P, Ptasznik R, Steinfort D, Miller A. Incidental Pulmonary Nodules Are Common on CT Coronary Angiogram and Have a Significant Cost Impact. Heart Lung Circ. 28(2):295-301, 2019 Feb. |
Observational-Dx |
358 patients |
To describe the frequency and characteristics of lung nodules on CTCA in an Australian tertiary hospital, and to assess cost impacts. |
Of the 2479 CTCAs included, full-field imaging revealed nodules in 358 patients (13.9%). The nodules were generally small (73% <6mm), multiple (63%) and in the lower lobe (83.4%). There was no significant difference when stratified for smoking, with 60% of nodules detected in never-smokers. A minimum of 445 subsequent scans was required for nodule surveillance, resulting in an additional overall cost of $63.62 per CTCA. Limited-Field-of-View (L-FOV) would have identified only 22 nodules, with a cost of $6.14 for every CTCA performed, a cost saving of $57 per patient. |
2 |
| 70. Scholtz JE, Lu MT, Hedgire S, et al. Incidental pulmonary nodules in emergent coronary CT angiography for suspected acute coronary syndrome: Impact of revised 2017 Fleischner Society Guidelines. J Cardiovasc Comput Tomogr. 12(1):28-33, 2018 Jan - Feb. |
Review/Other-Dx |
2066 patients |
To evaluate whether the 2017 Fleischner Society guidelines may result in a decrease of follow-up testing of incidental PN as compared to prior guidelines in patients undergoing coronary CTA. |
The registry included 2066 patients (female 45.1%, 52.9 ± 11.0 years), of which 578 (28.0%) reported PN. 438 of those (21.2%) were eligible for guideline-based follow-up evaluation. 205 (4 6.8%) were classified as high-risk for lung cancer. 2017 guidelines reduced the number of individuals requiring follow-up by 64.5%, from 264 (12.8%) to 94 patients (4.5%) when compared to prior guidelines (p < 0.001). The minimum number of follow-up chest CTs decreased by 55.8% from 430 to 190 (p < 0.001). |
4 |
| 71. Schmidt LH, Vietmeier B, Kaleschke G, et al. Thoracic Malignancies and Pulmonary Nodules in Patients under Evaluation for Transcatheter Aortic Valve Implantation (TAVI): Incidence, Follow Up and Possible Impact on Treatment Decision. PLoS ONE. 11(5):e0155398, 2016. |
Observational-Dx |
484 patients |
To evaluate for incidentally discovered solitary pulmonary nodules (SPN). |
In the entire study population, SPN = 5 mm were found in 87 patients (18%). These patients were compared to 150 patients who were incidentally collected from the 397 patients without SPN or with SPN < 5 mm (control group). After a median follow-up of 455 days, lung cancer was diagnosed in only two patients. Neither SPN = 5 mm (p = 0.579) nor SPN > 8 mm (p = 0.328) were significant predictors of overall survival. |
2 |
| 72. Lacson R, Prevedello LM, Andriole KP, et al. Factors associated with radiologists' adherence to Fleischner Society guidelines for management of pulmonary nodules. J. Am. Coll. Radiol.. 9(7):468-73, 2012 Jul. |
Review/Other-Dx |
N/A |
To evaluate adherence to the FSG, adjusting for demographic and clinical variables that may contribute to adherence. |
Three hundred fifteen reports were identified to have pulmonary nodules, 75 of which were for patients with concurrent malignancies or aged < 35 years. Of the remaining 240 reports, 34% of recommendations for pulmonary nodules were adherent to the FSG. Nodule size demonstrated an association with guideline adherence, with adherence highest in the >4-mm to 6-mm nodule group (P = .04) and progressively diminishing for smaller and bigger nodules. |
4 |
| 73. Rinaldi MF, Bartalena T, Giannelli G, et al. Incidental lung nodules on CT examinations of the abdomen: prevalence and reporting rates in the PACS era. Eur J Radiol 2010;74:e84-8. |
Observational-Dx |
243 patients |
To retrospectively evaluate prevalence, reporting rates and clinical implications of incidental pulmonary nodules detected in multidetector computed tomography (MDCT) abdominal studies. |
An average of 8.2 cm of lung parenchyma was imaged in each patient. 213 noncalcified nodules (NCNs) were identified in 95 patients (39.1%) but only 8 patients (8.4%) had it mentioned in the final report. Comparison CT studies were available for 44 out of the 95 positive patients showing disappearance of the nodules in 2 cases, no interval change in 26 and progression in size and/or number in 16 patients, in whom a final diagnosis of metastasis or primary lung cancers was achieved. |
2 |
| 74. Wu CC, Cronin CG, Chu JT, et al. Incidental pulmonary nodules detected on abdominal computed tomography. J Comput Assist Tomogr. 36(6):641-5, 2012 Nov-Dec. |
Observational-Dx |
413 patients |
To review the characteristics and outcome of incidental pulmonary nodules reported on abdominal computed tomography (CT). |
Of the 413 patients, 56% had benign nodules, 11% had malignant nodules, and the remaining 33% had insufficient follow-up. There was a statistically significant difference (P < 0.05) in the age of the patients, history of malignancy, and size of the incidental nodule between benign and malignant groups. No malignant nodules were found in patients younger than 59 years who did not have a known or suspected malignancy. |
2 |
| 75. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
