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• A large number of high resolutions thorax CT scans collected for suspected SARS-CoV-2 infection. • The use of an advanced software guarantees a great accuracy to calculate organ doses and effective doses. • Monitoring in real time all the dosimetric aspects of COVID-19 outbreak. • Cancer risk estimation according to the BEIR VII. The aim of this work was to evaluate the dosimetric impact of high-resolution thorax CT during COVID-19 outbreak in the University Hospital of Parma. In two months we have performed a huge number of thorax CT scans collecting effective and equivalent organ doses and evaluating also the lifetime attributable risk (LAR) of lung and other major cancers. From February 24th to April 28th, 3224 high-resolution thorax CT were acquired. For all patients we have examined the volumetric computed tomography dose index (CTDIvol), the dose length product (DLP), the size-specific dose estimate (SSDE) and effective dose (E 103) using a dose tracking software (Radimetrics Bayer HealthCare). From the equivalent dose to organs for each patient, LAR for lung and major cancers were estimated following the method proposed in BEIR VII which considers age and sex differences. Study population included 3224 patients, 1843 male and 1381 female, with an average age of 67 years. The average CTDIvol, SSDE and DLP, and E 103 were 6.8 mGy, 8.7 mGy, 239 mGy·cm and 4.4 mSv respectively. The average LAR of all solid cancers was 2.1 cases per 10,000 patients, while the average LAR of leukemia was 0.2 cases per 10,000 patients. For both male and female the organ with a major cancer risk was lung. Despite the impressive increment in thoracic CT examinations due to COVID-19 outbreak, the high resolution low dose protocol used in our hospital guaranteed low doses and very low risk estimation in terms of LAR. [ABSTRACT FROM AUTHOR]

The Multicentric Italian Lung Detection (MILD) trial demonstrated that prolonged low-dose computed tomography (LDCT) screening could achieve a 39% reduction in lung cancer (LC) mortality. We have here evaluated the long-term results of annual vs. biennial LDCT and the impact of screening intensity on overall and LC-specific mortality at 10 years. Between 2005 and 2018, the MILD trial prospectively randomised the 2376 screening arm participants to annual (n = 1190) or biennial (n = 1186) LDCT, for a median screening period of 6.2 years and 23,083 person-years of follow-up. The primary outcomes were 10-year overall and LC-specific mortality, and the secondary end-points were the frequency of advanced-stage and interval LCs. The biennial LDCT arm showed a similar overall mortality (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.57–1.12) and LC-specific mortality at 10 years (HR 1.10, 95% CI 0.59–2.05), as compared with the annual LDCT arm. Biennial screening saved 44% of follow-up LDCTs in subjects with negative baseline LDCT, and 38% of LDCTs in all participants, with no increase in the occurrence of stage II-IV or interval LCs. The MILD trial provides original evidence that prolonged screening beyond five years with biennial LDCT can achieve an LC mortality reduction comparable to annual LDCT, in subjects with a negative baseline examination. • MILD trial randomized Annual vs Biennial screening. • Biennial screening is safe in subjects with a negative baseline LDCT. • Biennial screening avoided 38% of LDCTs. • Screening intervals can be based on individual risk profile. [ABSTRACT FROM AUTHOR]

We present the case of a 43-year-old Italian woman with a left undiagnosed pleural effusion, which in subsequent months presented a clinically unexpected evolution with the appearance at first of a right wrist tenosynovitis and subsequently a bilateral lung involvement caused by M. Tuberculosis . With this case report, we would like to underline the importance of making a correct diagnosis of any pleural effusion as soon as possible by at least a thoracocentesis. If untreated, tuberculosis may easily disseminate to other organs. Some considerations and suggestions for antibiotic treatment of pleural effusion will also be given, since many antibiotics have some anti-tuberculosis effect and may delay the diagnosis of this infectious disease. [ABSTRACT FROM AUTHOR]

Summary: Background: to describe clinical, radiologic and pathologic features of lung lesions in Birt-Hogg-Dubè syndrome (BHDS) (MIM 135150). Method: review of 12 patients of BHDS from 3 unrelated Italian families evaluated at GB Morgagni Hospital, Forlì, from 2005 to 2010. Results: mean age (±SD) at diagnosis was 44.6 (±16) years, 8 (66%) were male. All three index cases presented with a history of recurrent pneumothorax and/or cystic lung lesions evaluated by CT scan request by referring pulmonary physicians, none were diagnosed to have BHDS at the time of initial pulmonary evaluation. One of the three cases was a middle-aged female patient with a clinical phenotype indistinguishable from lymphangioleiomyomatosis (LAM), characterized by cystic lung lesions and kidney angiomyolipoma. In one case of BHDS presenting with recurrent pneumothorax and a solitary lung nodule, surgical lung resection revealed a pulmonary histiocytoma. In one case a novel mutation of BHD gene was detected (c.771 del, exon 7). Conclusions: BHDS is associated with cystic lung disease largely under-recognized by pulmonary physicians and can mimic LAM and may be associated with lung tumor, pulmonary histiocytoma. In one case we found a novel mutation in exon 7, c.771 del (ref.seq. NM_144997.5) never reported before. [ABSTRACT FROM AUTHOR]

The comparison between chest x-ray (CXR) and computed tomography (CT) images is commonly required in clinical practice to assess the evolution of chest pathological manifestations. Intrinsic differences between the two techniques, however, limit reader confidence in such a comparison. CT average intensity projection (AIP) reconstruction allows obtaining "synthetic" CXR (s-CXR) images, which are thought to have the potential to increase the accuracy of comparison between CXR and CT imaging. We aim at assessing the diagnostic performance of s-CXR imaging in detecting common pleuro-parenchymal abnormalities. 142 patients who underwent chest CT examination and CXR within 24 hours were enrolled. CT was the standard of reference. Both conventional CXR (c-CXR) and s-CXR images were retrospectively reviewed for the presence of consolidation, nodule/mass, linear opacities, reticular opacities, and pleural effusion by 3 readers in two separate sessions. Sensitivity, specificity, accuracy and their 95% confidence interval were calculated for each reader and setting and tested by McNemar test. Inter-observer agreement was tested by Cohen's K test and its 95%CI. Overall, s-CXR sensitivity ranged 45–67% for consolidation, 12–28% for nodule/mass, 17–33% for linear opacities, 2–61% for reticular opacities, and 33–58% for pleural effusion; specificity 65–83%, 83–94%, 94–98%, 93–100% and 79–86%; accuracy 66–68%, 74–79%, 89–91%, 61–65% and 68–72%, respectively. K values ranged 0.38–0.50, 0.05–0.25, -0.05–0.11, -0.01–0.15, and 0.40–0.66 for consolidation, nodule/mass, linear opacities, reticular opacities, and pleural effusion, respectively. S-CXR images, reconstructed with AIP technique, can be compared with conventional images in clinical practice and for educational purposes. • CT average intensity projection reconstruction allows obtaining "synthetic" CXR. • s-CXR yielded a diagnostic performance similar to conventional CXR. • s-CXR can be compared with conventional CXR images in clinical practice. [ABSTRACT FROM AUTHOR]

Abstract: A 62-year-old asymptomatic woman was referred for an abdominal multidetector CT (MDCT) scan to evaluate a renal angyomiolipoma. Upper MDCT images revealed multiple, bilateral pulmonary cystic lesion in the costo-phrenic sulci and a thin-section MDCT scan of the chest was consequently performed. Thin-section MDCT showed several thin-walled cysts uniformly distributed throughout the lung parenchyma consistent with lymphangioleiomyomatosis (LAM). This radiological approach secured a definite diagnosis of LAM, thus avoiding further invasive procedures. [ABSTRACT FROM AUTHOR]

A North American trial reported a significant reduction of lung cancer mortality and overall mortality as a result of annual screening using low-dose computed tomography (LDCT). European trials prospectively tested a variety of possible screening strategies. The main topics of current discussion regarding the optimal screening strategy are pre-test selection of the high-risk population, interval length of LDCT rounds, definition of positive finding, and post-test apportioning of lung cancer risk based on LDCT findings. Despite the current lack of statistical evidence regarding mortality reduction, the European independent diverse strategies offer a multi-perspective view on screening complexity, with remarkable indications for improvements in cost-effectiveness and harm-benefit balance. The UKLS trial reported the advantage of a comprehensive and simple risk model for selection of patients with 5% risk of lung cancer in 5 years. Subjective risk prediction by biological sampling is under investigation. The MILD trial reported equal efficiency for biennial and annual screening rounds, with a significant reduction in the total number of LDCT examinations. The NELSON trial introduced volumetric quantification of nodules at baseline and volume-doubling time (VDT) for assessment of progression. Post-test risk refinement based on LDCT findings (qualitative or quantitative) is under investigation. Smoking cessation remains the most appropriate strategy for mortality reduction, and it must therefore remain an integral component of any lung cancer screening programme. [ABSTRACT FROM AUTHOR]

Abstract: Hyperparathyroidism induces high level of serum calcium, with mobilization from bone. Consequence of this process is the deposition in the soft tissue. In the lung deposition of calcium induces restrictive changes with hypoxemia. Two different cases of hyperparathyroidism are shown in this report in which high level of calcium has induced early and late parenchymal changes. [Copyright &y& Elsevier]

Large randomized trials have demonstrated that lung cancer (LC) screening with low-dose computed tomography (LDCT) reduces LC mortality in heavy smokers. We previously showed in the MILD screening trial that the combination of a prespecified circulating microRNA (miRNA) signature classifier (MSC) and LDCT improves the accuracy of LDCT alone. The primary aim of the prospective BioMILD study was to assess the additional value of the blood MSC assay at the time of baseline LDCT with the goal of personalizing LC screening intervals. The study enrolled 4119 volunteers from January 2013 to March 2016, with a median follow-up of 5.3 years. Baseline LDCT and miRNAs stratified participants into four groups: CT−/MSC− (n = 2664; 64.7%); CT−/MSC+ (n = 800; 19.4%); CT+/MSC− (n = 446; 10.8%); and CT+/MSC+ (n = 209; 5.1%). As per the protocol, those in the CT−/MSC− and CT−/MSC+ groups were allocated to LDCT repeat at 3-year and 1-year intervals; CT+ participants were allocated for 1-year or earlier intervals on the basis of LDCT features independent of MSC results. CT+ participants had a 15.8-fold higher 4-year LC incidence than CT− participants (95% confidence interval 10.34-24.05), and MSC+ participants had a 2.0-fold higher 4-year LC incidence than MSC− participants (95% confidence interval 1.40-2.90); there was no evidence that the MSC effect differed between CT+ and CT− participants. LC incidence at 4 years was 0.8% in CT−/MSC−, 1.1% in CT−/MSC+, 10.8% in CT+/MSC−, and 20.1% in CT+/MSC+ participants. LC mortality rates at 5 years in the four risk groups were 0.5 in CT−/MSC−, 1.5 in CT−/MSC+, 4.2 in CT+/MSC−, and 10.1 in CT+/MSC+. The combined use of LDCT and blood miRNAs at baseline predicts individual LC incidence and mortality, with a major effect of MSC for LDCT-positive individuals. These findings may have important implications in personalizing screening intervals. • Baseline LDCT and blood microRNAs define individual lung cancer risk profiles. • Targeted LDCT intervals reduce unnecessary repeat LDCT. • A biomarker-based risk test showed a major added value for CT+ participants. [ABSTRACT FROM AUTHOR]

The European Society of Radiology (ESR) and European Respiratory Society (ERS) published their joint statement paper on lung cancer screening (LCS), on 12 February 2020. This document joins and completes previous recommendations on LCS with specific emphasis on the analysis of issues encountered in the practical implementation of LCS in the community. Major milestones to enable the most efficient and equal dissemination of LCS are recognised as engagement of all stakeholders (e.g. candidate/participant, general practitioners, up to the specialised LCS facility), quality assurance, and primary prevention in the form of provision of counselling for smoking cessation. [ABSTRACT FROM AUTHOR]

Background The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at 10 years. Design The Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4099 participants, to a screening arm (n  = 2376), with further randomization to annual (n  = 1190) or biennial (n  = 1186) LDCT for a median period of 6 years, or control arm (n  = 1723) without intervention. Between 2005 and 2018, 39 293 person-years of follow-up were accumulated. The primary outcomes were 10-year overall and LC specific mortality. Landmark analysis was used to test the long-term effect of LC screening, beyond 5 years by exclusion of LCs and deaths that occurred in the first 5 years. Results The LDCT arm showed a 39% reduced risk of LC mortality at 10 years [hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.39–0.95], compared with control arm, and a 20% reduction of overall mortality (HR 0.80; 95% CI 0.62–1.03). LDCT benefit improved beyond the 5th year of screening, with a 58% reduced risk of LC mortality (HR 0.42; 95% CI 0.22–0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49–0.94). Conclusions The MILD trial provides additional evidence that prolonged screening beyond 5 years can enhance the benefit of early detection and achieve a greater overall and LC mortality reduction compared with NLST trial. ClinicalTrials.gov identifier NCT02837809. [ABSTRACT FROM AUTHOR]