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Purpose The illness-death model (IDM) is a comprehensive approach to evaluate the relationship between relapse and death. This study aimed to illustrate the value of the IDM for identifying risk factors and evaluating predictive probabilities for relapse and death in patients with non–small cell lung cancer (NSCLC) in comparison with the disease-free survival (DFS) model.Materials and Methods We retrospectively analyzed 612 NSCLC patients who underwent a curative operation. Using the IDM, the risk factors and predictive probabilities for relapse, death without relapse, and death after relapse were simultaneously evaluated and compared to those obtained from a DFS model.Results The IDM provided more detailed risk factors according to the patient’s disease course, including relapse, death without relapse, and death after relapse, in patients with resected lung cancer. In the IDM, history of malignancy (other than lung cancer) was related to relapse and smoking history was associated with death without relapse; both were indistinguishable in the DFS model. In addition, the IDM was able to evaluate the predictive probability and risk factors for death after relapse; this information could not be obtained from the DFS model.Conclusion Compared to the DFS model, we found that the IDM provides more comprehensive information on transitions between states and disease stages and provides deeper insights with respect to understanding the disease process among lung cancer patients.

We aimed to assess whether recurrence patterns affect survival and to use a multi-state model to predict the prognosis of early stage non-small cell lung cancer in patients who underwent surgical resection.Patients with early stage non-small cell lung cancer who underwent surgical resection at two tertiary medical centers between 2010 and 2015 were retrospectively analyzed. A multi-state model was employed with one initial state (surgery), two intermediate states (locoregional recurrence, distant metastasis), and one absorbing state (death), comprising five transitions: surgery to locoregional recurrence, surgery to distant metastasis, surgery to death without recurrence, locoregional recurrence to death, and distant metastasis to death. Cox proportional hazards models stratified for these transitions were performed with the risk factors; transition probabilities for each patient were predicted.A total of 949 patients were identified [median age: 67 years, male: 614 (64.6%)]. Recurrence occurred in 194 (20.4%) patients (locoregional recurrence: 7.3%, distant metastasis: 13.1%). Hazard ratios for distant metastasis after surgery were higher for older age (hazard ratio: 1.03, 95% confidence interval: 1.01-1.06) and adenocarcinoma (hazard ratio: 1.67, 95% confidence interval: 1.06-2.61). Lower lobe location exhibited a higher hazard ratio for death after surgery without recurrence (hazard ratio: 1.59, 95% confidence interval: 1.00-2.53). Stage IIB lung cancer showed a higher probability of transition to distant metastasis after surgery than other stages. Cumulative transition hazards rapidly increased in both recurrence patterns until approximately two years after surgery (locoregional recurrence: 0.052; distant metastasis: 0.104). Patients with distant metastasis were more likely to die within 5 years of surgery than those with locoregional recurrence (6.8% and 2.6%, respectively).With the multi-state model, risk factors and post-relapse survival probabilities differed between locoregional recurrence and distant metastasis. These findings may enable clinicians to establish personalized follow-up strategies for patients undergoing curative resection for early stage non-small cell lung cancer.

Background Few reports have evaluated the effect of the SARS-CoV-2 variant and vaccination on the clinical and imaging features of COVID-19. Purpose To evaluate and compare the effect of vaccination and variant prevalence on the clinical and imaging features of infections by the SARS-CoV-2. Materials and Methods Consecutive adults hospitalized for confirmed COVID-19 at three centers (two academic medical centers and one community hospital) and registered in a nationwide open data repository for COVID-19 between August 2021 and March 2022 were retrospectively included. All patients had available chest radiographs or CT. Patients were divided into two groups according to predominant variant type over the study period. Differences between clinical and imaging features were analyzed using Pearson χ

Background The association between interstitial lung abnormalities (ILAs) and long-term outcomes has not been reported in Asian health screening populations. Purpose To investigate ILA prevalence in an Asian health screening cohort and determine rates and risks for ILA progression, lung cancer development, and mortality within the 10-year follow-up. Materials and Methods This observational, retrospective multicenter study included patients aged 50 years or older who underwent chest CT at three health screening centers over a 4-year period (2007-2010). ILA status was classified as none, equivocal ILA, and ILA (nonfibrotic or fibrotic). Progression was evaluated from baseline to the last follow-up CT examination, when available. The log-rank test was performed to compare mortality rates over time between ILA statuses. Multivariable Cox proportional hazards models were used to assess factors associated with hazards of ILA progression, lung cancer development, and mortality. Results Of the 2765 included patients (mean age, 59 years ± 7 [SD]; 2068 men), 94 (3%) had a finding of ILA (35 nonfibrotic and 59 fibrotic ILA) and 119 (4%) had equivocal ILA. The median time for CT follow-up and the entire observation was 8 and 12 years, respectively. ILA progression was observed in 80% (48 of 60) of patients with ILA over 8 years. Those with fibrotic and nonfibrotic ILA had a higher mortality rate than those without ILA (

Air embolism is a rare, fatal complication of computed tomography (CT)‐guided transthoracic needle biopsy (TTNB) of the lung. Here, we report a patient who developed an air embolism after CT‐guided TTNB, which led to ST‐elevation myocardial infarction and acute cerebral ischemia. The patient recovered completely without critical sequelae and was diagnosed with adenocarcinoma harboring activating epidermal growth factor receptor (EGFR) mutation. The patient responded to subsequent treatment with gefitinib. Key points Signficant findings of the study Air embolism is a rare, fatal complication of CT‐guided transthoracic lung biopsy. Only a few cases have been previously reported where myocardial and cerebral infarction occurred after TTNB, demonstrated not only on CT scan, but also electrocardiogram and electroencephalogram. What this study adds Detection of driver gene mutation is crucial for planning lung cancer treatment. Despite the need for tissue biopsy, air embolism propagation to vital organs could result in severe end‐organ damage and multidisciplinary approaches are needed to improve initial outcomes., Systemic air embolism developed after CT‐guided TTNB, leading to ST‐elevation, myocardial infarction and acute ischemic stroke. The patient recovered completely without sequelae and was diagnosed with adenocarcinoma harboring activating EGFR mutation. Treatment with gefitinib showed a response.

Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed tomography and radiography can be differentiated on MRI. Using a three-compartment model to localize the mass and employing a basic knowledge of MRI, radiologists can easily diagnose mediastinal masses. Here, we review the use of MRI in evaluating mediastinal masses and present the images of various mediastinal masses categorized using the International Thymic Malignancy Interest Group's three-compartment classification system. These masses include thymic hyperplasia, thymic cyst, pericardial cyst, thymoma, mediastinal hemangioma, lymphoma, mature teratoma, bronchogenic cyst, esophageal duplication cyst, mediastinal thyroid carcinoma originating from ectopic thyroid tissue, mediastinal liposarcoma, mediastinal pancreatic pseudocyst, neurogenic tumor, meningocele, and plasmacytoma.

The aim of this study was to assess the potential of a prone chest CT for the evaluation of esophageal cancer, as compared with a routine supine chest CT. 69 patients (67±18 years old) with pathologically confirmed esophageal cancers underwent MDCT in the supine and prone positions. The supine CT was performed first, followed by the prone position. Localization and staging of individual esophageal lesions on both the prone and supine CTs were assessed by two thoracic radiologists, using a scoring system that consisted of three confidence scales, and the results were correlated with the endoscopic and surgical findings. The mean confidence score for the detection of esophageal cancer was higher in the prone position (2.58±0.74) than that in the supine position (2.42±0.83) with statistical significance (p=0.002). The mean confidence score for predicting local invasion in the selected patients (n=18) who underwent esophagectomy was also higher in the prone position (2.39±0.85) than that in the supine position (2.06±0.73) with statistical significance (p=0.01). In 10 of 11 cases that showed definitive determination for periesophageal infiltration or adjacent organ invasion on the prone CT (score 3), the corresponding findings were also observed in the post-operative evaluations. In conclusion, prone chest CT for evaluating esophageal cancer could have advantages in regards to the localization of esophageal cancer and predicting local invasion compared to that of routine supine CT and can improve the diagnostic accuracy of chest CTs.

We analyzed the differences between clinical characteristics and computed tomography (CT) findings in patients with coronavirus disease 2019 (COVID-19) to establish potential relationships with mediastinal lymphadenopathy and clinical outcomes.We compared the clinical characteristics and CT findings of COVID-19 patients from a nationwide multicenter cohort who were grouped based on the presence or absence of mediastinal lymphadenopathy. Differences between clinical characteristics and CT findings in these groups were analyzed. Univariate and multivariate analyses were performed to determine the impact of mediastinal lymphadenopathy on clinical outcomes.Of the 344 patients included in this study, 53 (15.4%) presented with mediastinal lymphadenopathy. The rate of diffuse alveolar damage pattern pneumonia and the visual CT scores were significantly higher in patients with mediastinal lymphadenopathy than in those without (COVID-19 patients with mediastinal lymphadenopathy had a larger extent of pneumonia than those without. Multivariate analysis adjusted for clinical characteristics and CT findings revealed that the presence of mediastinal lymphadenopathy was significantly associated with ICU admission.

The mediastinum is the most prevalent site of extragonadal teratomas. Patients with mediastinal mature teratomas are usually young adults, and the condition does not show significant sexual differences. Mediastinal teratomas are mostly located in the anterior mediastinum. Patients are usually asymptomatic, although they can have several complications when the teratomas become large or rupture. Most mediastinal teratomas can be diagnosed using CT. Diagnosing ruptured or malignant teratomas is challenging because of their atypical clinical and radiological presentations. In this article, we describe various manifestations of mediastinal teratomas, with an emphasis on radiologic features.

Purpose: This study utilized a radiomics approach combined with a machine learning algorithm to distinguish primary lung cancer (LC) from solitary lung metastasis (LM) in colorectal cancer (CRC) patients with a solitary pulmonary nodule (SPN). Materials and Methods: In a retrospective study, 239 patients who underwent chest computerized tomography (CT) at three different institutions between 2011 and 2019 and were diagnosed as primary LC or solitary LM were included. The data from the first institution were divided into training and internal testing datasets. The data from the second and third institutions were used as an external testing dataset. Radiomic features were extracted from the intra and perinodular regions of interest (ROI). After a feature selection process, Support vector machine (SVM) was used to train models for classifying between LC and LM. The performances of the SVM classifiers were evaluated with both the internal and external testing datasets. The performances of the model were compared to those of two radiologists who reviewed the CT images of the testing datasets for the binary prediction of LC versus LM. Results: The SVM classifier trained with the radiomic features from the intranodular ROI and achieved the sensitivity/specificity of 0.545/0.828 in the internal test dataset, and 0.833/0.964 in the external test dataset, respectively. The SVM classifier trained with the combined radiomic features from the intra- and perinodular ROIs achieved the sensitivity/specificity of 0.545/0.966 in the internal test dataset, and 0.833/1.000 in the external test data set, respectively. Two radiologists demonstrated the sensitivity/specificity of 0.545/0.966 and 0.636/0.828 in the internal test dataset, and 0.917/0.929 and 0.833/0.929 in the external test dataset, which were comparable to the performance of the model trained with the combined radiomics features. Conclusion: Our results suggested that the machine learning classifiers trained using radiomics features of SPN in CRC patients can be used to distinguish the primary LC and the solitary LM with a similar level of performance to radiologists.

PurposeIdentifying pretreatment interstitial lung abnormalities (ILAs) is important because of their predictive value for complications after lung cancer treatment. This study aimed to assess the predictive value of ILAs for postoperative pulmonary complications (PPCs) in elderly patients undergoing curative resection for early-stage non-small cell lung cancer (NSCLC).Materials and MethodsElderly patients (age ≥ 70 years) who underwent curative resection for pathologic stage I or II NSCLC with normal preoperative spirometry results (pre-bronchodilator forced expiratory volume in 1 s to forced vital capacity [FVC] ratio > 0.70 and FVC ≥ 80% of the predicted value) between January 2012 and December 2019 were retrospectively identified. Univariable and multivariable regression analyses were performed to assess risk factors for PPCs. The Kaplan–Meier method and log-rank test were used to analyze the relationship between ILAs and postoperative mortality. One-way analysis of variance was performed to assess the correlation between ILAs and hospital stay duration.ResultsA total of 262 patients (median age, 73 [interquartile range, 71–76] years; 132 male) were evaluated. A multivariable logistic regression model revealed that, among several relevant risk factors, fibrotic ILAs independently predicted both overall PPCs (adjusted odds ratio [OR], 4.84; 95% confidence interval [CI], 1.35–17.38; p=0.016) and major PPCs (adjusted OR, 8.72; 95% CI, 1.71–44.38; p=0.009). Fibrotic ILAs were significantly associated with higher postoperative mortality and longer hospital stay (F=5.21, p=0.006).ConclusionPretreatment fibrotic ILAs are associated with PPCs, higher postoperative mortality, and longer hospital stay.

Background This study aimed to evaluate the computed tomography (CT) features of solitary pulmonary nodule (SPN), which can be a non-invasive diagnostic tool to differentiate between primary lung cancer (LC) and solitary lung metastasis (LM) in patients with colorectal cancer (CRC). Methods This retrospective study included SPNs resected in CRC patients between January 2011 and December 2019. The diagnosis of primary LC or solitary LM was based on histopathologic report by thoracoscopic wedge resection. Chest CT images were assessed by two thoracic radiologists, and CT features were identified by consensus. Predictive parameters for the discrimination of primary LC from solitary LM were evaluated using multivariate logistic regression analysis. Results We analyzed CT data of 199 patients (mean age, 65.95 years; 131 men and 68 women). The clinical characteristic of SPNs suggestive of primary LC rather than solitary LM was clinical stages I–II CRC (P < 0.001, odds ratio [OR] 21.70). The CT features of SPNs indicative of primary LC rather than solitary LM were spiculated margin (quantitative) (P = 0.020, OR 8.34), sub-solid density (quantitative) (P < 0.001, OR 115.56), and presence of an air bronchogram (quantitative) (P = 0.032, OR 5.32). Conclusions Quantitative CT features and clinical characteristics of SPNs in patients with CRC could help differentiate between primary LC and solitary LM.

Fusarium is a large genus of filamentous fungi that are rarely associated with disease in humans. In the clinical setting, Fusarium species are often difficult to distinguish from other fungal organisms, particularly Aspergillus species. Invasive fungal pneumonia caused by Fusarium species has rarely been reported, especially in immunocompetent patients. In this study, we reported a case of invasive Fusarium pneumonia in a previously healthy 68-year-old woman. The disease was initially misdiagnosed as invasive Aspergillus pneumonia because of the similarity in radiologic and histopathologic findings between these conditions. After Fusarium was identified via microbiological analysis, the antifungal agent was changed, and the patient recovered fully.

Purpose: To evaluate the features of solitary pulmonary nodule (SPN) that can be used to differentiate between primary lung cancer (LC) and solitary lung metastasis (LM) in patients with colorectal cancer (CRC).Materials and Methods: This retrospective study included SPNs resected in CRC patients between 2011 and 2019. The diagnosis of primary LC or solitary LM was based on histopathologic report by thoracoscopic wedge resection. Chest computed tomography (CT) images were assessed by two thoracic radiologists, and features were identified by consensus. Predictive parameters for the discrimination of primary LC from solitary LM were evaluated using multivariate logistic regression analysis.Results: We analyzed 199 patients (mean age, 65.95 years; 131 men). The clinical characteristics suggestive of primary LC rather than solitary LM was clinical stage I-II CRC (P < 0.001, odds ratio (OR): 21.70). The CT features of SPNs indicative of primary LC rather than solitary LM were a spiculated margin (P = 0.020, OR: 8.34), a sub-solid density (P < 0.001, OR: 115.56), and presence of an air-bronchogram (OR: 5.32; P = 0.032).Conclusions: CT features and clinical characteristics of SPNs in patients with CRC could help differentiate between primary LC and solitary LM.

BACKGROUND: IBM Watson for Oncology (WFO) is a cognitive computing system helping physicians quickly identify key information in a patient’s medical record, surface relevant evidence, and explore treatment options. This study assessed the possibility of using WFO for clinical treatment in lung cancer patients. METHODS: We evaluated the level of agreement between WFO and multidisciplinary team (MDT) for lung cancer. From January to December 2018, newly diagnosed lung cancer cases in Chonnam National University Hwasun Hospital were retrospectively examined using WFO version 18.4 according to four treatment categories (surgery, radiotherapy, chemoradiotherapy, and palliative care). Treatment recommendations were considered concordant if the MDT recommendations were designated ‘recommended’ by WFO. Concordance between MDT and WFO was analyzed by Cohen’s kappa value. RESULTS: In total, 405 (male 340, female 65) cases with different histology (adenocarcinoma 157, squamous cell carcinoma 132, small cell carcinoma 94, others 22 cases) were enrolled. Concordance between MDT and WFO occurred in 92.4% (k=0.881, P

The apocrine morphology of the breast is observed in a broad pathological spectrum, ranging from benign cysts to invasive carcinomas. However, the number of clinical research investigating malignant apocrine lesions is limited. This study retrospectively reviewed the data of patients with malignant apocrine lesions admitted in a tertiary center between January 2004 and December 2021, based on the radiology-pathology correlation and the recent advances in their status to enhance the therapeutic implications of androgen receptor (AR). Among the 37 patients with lesions, 27 (73.0%) had triple-negative subtypes with predominant AR expression. The radiological features of malignant apocrine lesions did not differ from those of typical invasive ductal carcinoma or ductal carcinoma in situ. This study demonstrated that knowledge on the imaging features of malignant apocrine lesions and their histological basis could enhance the adoption of new targeted therapies in patients with this particular type of breast cancer.