Faculty Bibliography

Cancer patients without evidence of brain metastases often exhibit constitutional symptoms, cognitive dysfunction and mood changes at the time of clinical diagnosis, i.e. prior to surgical and/or chemotherapy treatment. At present however, there is limited information on brain metabolic and functional status in patients with systemic cancers such as lung cancer prior to initiation of treatment. Therefore, a prospective, observational study was conducted on patients with a clinical diagnosis of lung cancer to assess the cerebral metabolic status before treatment using proton magnetic resonance spectroscopy ((1)HMRS). Together with neurocognitive testing, (1)HMRS was performed in the parietal and occipital cortices of patients diagnosed with a lung mass (N=17) and an age-matched control group (N=15). Glutamate concentrations in the occipital cortex were found to be lower in the patients compared to controls and the concentrations of creatine and phosphocreatine were significantly lower in the parietal cortex of the patients. The lung cancer patients were also characterized by greater fatigue scores (but not depression) prior to treatment when compared to controls. In addition, the serum concentration of interleukin-6 (proinflammatory cytokine) was higher in patients compared to controls; and the concentration of tumor-necrosis factor alpha ([TNF-alpha]) was positively correlated to the metabolic activity of the lung tumor as defined by the 2-deoxy-2-((18)F)fluoro-D-glucose ((18)FDG) positron emission tomography (PET) derived maximal standardized uptake values (SUV(max)). Finally, multivariate statistical modeling revealed that the concentration of N-acetyl-aspartate [NAA] in the occipital cortex was negatively associated with [TNF-alpha]. In conclusion, our data demonstrate that the cerebral metabolic status of patients with lung cancer is changed even prior to treatment. In addition, the association between inflammatory cytokines, SUV(max) and [NAA] points towards interactions between the cancer's inherent metabolic activity, systemic subclinical inflammation and brain function.

The objective of this research was to determine the sensitivity and specificity of a commercially available computer-aided detection (CAD) system for detection of lung nodule on posterior-anterior (PA) chest radiograph in a varied patient population who are referred to computed tomographic angiogram (CTA) of the chest as a reference standard. Patients who had a PA chest radiograph with concomitant CTA of the chest were included in this retrospective study. The PA chest radiograph was analyzed by a CAD device, and results were recorded. A qualitative assessment of the CAD results was performed using a 5-point Likert scale. The CTA was then reviewed to determine if there were correlative nodules. The presence of a correlative nodule between 0.5 cm and 1.5 cm was considered a positive result. The baseline sensitivity of the system was determined to be 0.707 (95% CI = 0.52-0.86), with a specificity of 0.50 (95% CI = 0.38-0.76). Positive predictive value was 0.30 (95% CI = 0.24-0.49), with a negative predictive value of 0.858 (95% CI = 0.82-0.95), and accuracy of 0.555 (95% CI = 0.40-0.66). When excluding nodules that were qualitatively determined by a thoracic radiologist to be false positives, the specificity was 0.781 (95% CI = 0.764-0.839), the positive predictive value was 0.564 (95% CI = 0.491-0.654), the negative predictive value was 0.829 (95% CI = 0.819-0.878), and the accuracy was 0.737 (95% CI = 0.721-0.801). The use of CAD for lung nodule detection on chest radiograph, when used in conjunction with an experienced radiologist, has a very good sensitivity, specificity, and accuracy.

Lung cancer is the most common cause of death in adults. The treatment of choice is surgical resection with lobectomy, but a significant number of patients are non-surgical candidates due to comorbidities or limited pulmonary reserve. Patients may also have recurrent disease after resection or radiotherapy. Image ablation has recently been introduced as a safe, alternative treatment for localized disease in carefully selected patients. This article discusses the principles, technique, and follow-up of the 2 main ablative therapies currently used in the lung, radiofrequency ablation and cryoablation.

Rationale and Objectives. The aim of this study is to determine the effect of needle size on the diagnostic yield and complication rate of lung nodule biopsy. Materials and Methods. A total of 209 patients are included in a retrospective study. All patients underwent a needle lung biopsy under computer-tomography-guided guidance. Multiple different needle gauges are used in this study. Results. We found no correlation between the gauge of the needle and the incidence of complications or diagnostic yield associated with lung nodule biopsy. However, there was a statistically significant difference in the number of needle passes and the gauge of the needle (P < .01). Conclusion. Using a larger gauge needle does not correlate with an increase in complication rate. However, there is a statically significant decrease in the number of needle passes using a larger gauge needle. While the diagnostic yield comparing small gauge needle and large gauge needle was not statistically different, this lack of difference in yield could be related to the difference in number of passes. The use of larger needle is likely to decrease number of passes, thereby resulting in decreased procedure times