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Shades of Gray: Subsolid Nodule Considerations and Management

Azour, Lea; Ko, Jane P; Naidich, David P; Moore, William H
Subsolid nodules are common on chest CT and may be either benign or malignant. Their varied features, and broad differential diagnoses present management challenges. While subsolid nodules often represent lung adenocarcinomas, other possibilities are common, and influence management. Practice guidelines exist for subsolid nodule management for both incidentally and screening-detected nodules, incorporating patient and nodule characteristics. This review will highlight similarities and differences amongst these algorithms, with the intent of providing a resource for comparison, and aid in choosing management options.
PMCID:7534873
PMID: 33031828
ISSN: 1931-3543
CID: 4627172

The Usefulness of Chest CT Imaging in Patients With Suspected or Diagnosed COVID-19: A Review of Literature

Machnicki, Stephen; Patel, Dhara; Singh, Anup; Talwar, Arunabh; Mina, Bushra; Oks, Margarita; Makkar, Priyanka; Naidich, David; Mehta, Atul; Hill, Nicholas; Brown, Kevin; Raoof, Suhail
The COVID-19 pandemic has had devastating medical and economic consequences globally. The severity of COVID-19 is related, in a large measure, to the extent of pulmonary involvement. The role of chest CT imaging in the management of patients with COVID-19 has evolved since the onset of the pandemic. Specifically, the description of CT scan findings, use of chest CT imaging in various acute and subacute settings, and its usefulness in predicting chronic disease have been defined better. We performed a review of published data on CT scans in patients with COVID-19. A summary of the range of imaging findings, from typical to less common abnormalities, is provided. Familiarity with these findings may facilitate the diagnosis and management of this disease. A comparison of sensitivity and specificity of chest CT imaging with reverse-transcriptase polymerase chain reaction testing highlights the potential role of CT imaging in difficult-to-diagnose cases of COVID-19. The usefulness of CT imaging to assess prognosis, to guide management, and to identify acute pulmonary complications associated with SARS-CoV-2 infection is highlighted. Beyond the acute stage, it is important for clinicians to recognize pulmonary parenchymal abnormalities, progressive fibrotic lung disease, and vascular changes that may be responsible for persistent respiratory symptoms. A large collection of multi-institutional images were included to elucidate the CT scan findings described.
PMCID:8056836
PMID: 33861993
ISSN: 1931-3543
CID: 4871522

CT features of electronic-cigarette or vaping-associated lung injury (EVALI); our experience during the recent outbreak [Case Report]

Girvin, Francis; Naidich, David
As an emerging clinical syndrome, our knowledge of the clinical, pathologic and radiologic features of electronic-cigarette or vaping-associated lung injury is evolving. CT appearances are described in six cases imaged at our institution (NYU Langone Health, New York) in the cluster of 2019.
PMCID:7465747
PMID: 32922848
ISSN: 2055-7159
CID: 4629822

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

Mazzone, Peter J; Gould, Michael K; Arenberg, Douglas A; Chen, Alexander C; Choi, Humberto K; Detterbeck, Frank C; Farjah, Farhood; Fong, Kwun M; Iaccarino, Jonathan M; Janes, Samuel M; Kanne, Jeffrey P; Kazerooni, Ella A; MacMahon, Heber; Naidich, David P; Powell, Charles A; Raoof, Suhail; Rivera, M Patricia; Tanner, Nichole T; Tanoue, Lynn K; Tremblay, Alain; Vachani, Anil; White, Charles S; Wiener, Renda Soylemez; Silvestri, Gerard A
BACKGROUND:The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. METHODS:An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. RESULTS:Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer. CONCLUSIONS:There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.
PMCID:7177099
PMID: 32485147
ISSN: 1558-349x
CID: 4498732

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

Mazzone, Peter J; Gould, Michael K; Arenberg, Douglas A; Chen, Alexander C; Choi, Humberto K; Detterbeck, Frank C; Farjah, Farhood; Fong, Kwun M; Iaccarino, Jonathan M; Janes, Samuel M; Kanne, Jeffrey P; Kazerooni, Ella A; MacMahon, Heber; Naidich, David P; Powell, Charles A; Raoof, Suhail; Rivera, M Patricia; Tanner, Nichole T; Tanoue, Lynn K; Tremblay, Alain; Vachani, Anil; White, Charles S; Wiener, Renda Soylemez; Silvestri, Gerard A
BACKGROUND:The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. METHODS:An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. RESULTS:Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer. CONCLUSIONS:There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.
PMCID:7177089
PMID: 32335067
ISSN: 1931-3543
CID: 4526752

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

Mazzone, Peter J; Gould, Michael K; Arenberg, Douglas A; Chen, Alexander C; Choi, Humberto K; Detterbeck, Frank C; Farjah, Farhood; Fong, Kwun M; Iaccarino, Jonathan M; Janes, Samuel M; Kanne, Jeffrey P; Kazerooni, Ella A; MacMahon, Heber; Naidich, David P; Powell, Charles A; Raoof, Suhail; Rivera, M Patricia; Tanner, Nichole T; Tanoue, Lynn K; Tremblay, Alain; Vachani, Anil; White, Charles S; Wiener, Renda Soylemez; Silvestri, Gerard A
Background:The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. Materials and Methods:An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. Results:Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer. Conclusion:There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.© 2020 RSNA; The American College of Chest Physicians, published by Elsevier Inc; and The American College of Radiology, published by Elsevier Inc.
PMCID:7233408
PMID: 33778716
ISSN: 2638-616x
CID: 4882362

Managing Stable Subsolid Lung Nodules: A Possible Approach [Comment]

Naidich, David P; Azour, Lea
PMID: 32186460
ISSN: 1527-1315
CID: 4352702

How I Do It: An Algorithmic Approach to the Interpretation of Diffuse Lung Disease on Chest CT Imaging

Gruden, James F; Naidich, David P; Machnicki, Stephen C; Cohen, Stuart L; Girvin, Francis; Raoof, Suhail
PMID: 31704148
ISSN: 1931-3543
CID: 4184552

Lung Hyperlucency - A Clinical-Radiologic Algorithmic Approach to Diagnosis

Cherian, Sujith V; Girvin, Francis; Naidich, David P; Machnicki, Stephen; Brown, Kevin K; Ryu, Jay H; Gupta, Nishant; Mehta, Vishisht; Estrada-Y-Martin, Rosa M; Narasimhan, Mangala; Oks, Margarita; Raoof, Suhail
Areas of diminished lung density are frequently identified both on routine chest radiographs and chest CT examinations. Colloquially referred to as "hyperlucent" foci of lung, a broad range of underlying pathophysiologic mechanisms and differential diagnoses account for these changes. Despite this, the spectrum of etiologies can be categorized into underlying parenchymal, airway and vascular related entities, respectively. The purpose of this review is to provide a practical diagnostic algorithmic approach to pulmonary hyperlucencies incorporating clinical history and characteristic imaging patterns to narrow the differential.
PMID: 31356811
ISSN: 1931-3543
CID: 4015192

Author Correction: End-to-end lung cancer screening with three-dimensional deep learning on low-dose chest computed tomography

Ardila, Diego; Kiraly, Atilla P; Bharadwaj, Sujeeth; Choi, Bokyung; Reicher, Joshua J; Peng, Lily; Tse, Daniel; Etemadi, Mozziyar; Ye, Wenxing; Corrado, Greg; Naidich, David P; Shetty, Shravya
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
PMID: 31253948
ISSN: 1546-170x
CID: 3964032