CT Signs and Differential Diagnosis of Peripheral Lung Cancer and Inflammatory Pseudotumor: A Meta-Analysis

We aimed to systematically evaluate the imaging features of peripheral lung cancer and inflammatory pseudotumor. PubMed, Embase, Cochrane Library, Chinese Knowledge Infrastructure (CNKI), Wanfang database (Wanfang), and Chinese Biomedical Network (CBM) were searched to collect relevant studies on CT image comparison of peripheral lung cancer and inflammatory pseudotumor. The search time was from database establishment to July 15, 2021. The search language was limited to Chinese and English. Data from the literature were screened and extracted, and meta-analysis was performed using Stata 16.0 software. A total of 8 cohort studies were included in this meta-analysis, including 675 patients. Meta-analysis showed that the lesion size of inflammatory pseudotumor was greater than that of peripheral lung cancer, and the difference had statistical significance [SMD = 0.29, 95% CI (0.01, 0.58), P < 0.05 ]. The difference in HU value between inflammatory pseudotumor and peripheral lung cancer CT had no statistical significance [SMD = −0.09, 95% CI (−0.79, 0.60), P > 0.05 ]. The HU value of enhanced CT of inflammatory pseudotumor was higher than that of peripheral lung cancer, and the difference had statistical significance [SMD = 0.75, 95% CI (0.15, 1.34), P < 0.05 ]. The incidence of calcification of inflammatory pseudotumor was significantly higher than that of peripheral lung cancer, and the difference had statistical significance [RR = 2.85, 95% CI (1.33, 6.11), P < 0.05 ]. The incidence of long hair puncture sign of inflammatory pseudotumor was lower than that of peripheral lung cancer, and the difference had statistical significance [RR = 0.49, 95% CI (0.24, 0.97), P < 0.05 ]. There was no significant difference between inflammatory pseudotumor and peripheral lung cancer in terms of cavity incidence, vacuole sign, pleural indentation, and bronchial inflation sign ( P > 0.05 ). Based on the available literature evidence, it can be found that there are differences in the CT signs between peripheral lung cancer and inflammatory pseudotumor, and the lesion size, HU value on enhanced CT, incidence of calcification, and incidence of burr sign may be important indicators for differentiating peripheral lung cancer from inflammatory pseudotumor.

Quantitative Parameters of Contrast-Enhanced Ultrasound Combined with Lung Biopsy Were Used to Evaluate the Benign and Malignant Lesions around the Lungs

In recent years, due to the influence of living habits and smoking, the number of lung cancer patients worldwide has increased year by year, and it has gradually developed into one of the common diseases endangering human life. CEUS can observe the lesion and realize the rapid identification of the location of the active area of the lesion. CEUS is the abbreviation of contrast-enhanced ultrasound technology. Contrast-enhanced ultrasound technology is to inject ultrasound contrast agent through a peripheral vein to perform ultrasound exploration to observe the enhancement of the internal nodules. Compared with color ultrasound, it can diagnose more accurately and improve the inspection effect. At present, this technology is used for the diagnosis of many types of space-occupying lesions, but it is rarely used for the diagnosis of lung lesions. The purpose of this study is to explore the role of CEUS quantitative parameters combined with lung biopsy in the assessment of benign and malignant peripheral lung diseases. Based on the relevant theoretical basis of CEUS and lung biopsy, 158 patients with peripheral lung disease were selected as experimental subjects, and they were divided into experimental group and control group for comparative experiments. Experiments proved the effectiveness of CEUS quantitative parameters combined with lung biopsy methods. The experimental results showed that, compared with the benign group, the time-intensity curve, the rise time, and the peak time of the malignant lesions were significantly prolonged. In addition, CEUS combined with the quantitative parameters of lung biopsy can effectively distinguish the activity of lung lesions and the site of necrosis and promote the effective increase of the positive rate of lung biopsy.

Safety and Diagnostic Yield of Radial Probe Endobronchial Ultrasound-Guided Biopsy for Peripheral Lung Lesions in Patients with Idiopathic Pulmonary Fibrosis: A Multicenter Cross-Sectional Study

<b><i>Background:</i></b> Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) is widely used for diagnosis of peripheral lung lesions (PLLs). To date, there have been no reports regarding the clinical outcomes of RP-EBUS-TBLB for PLLs in patients with idiopathic pulmonary fibrosis (IPF). <b><i>Objectives:</i></b> This study was performed between October 2017 and December 2019 to identify the safety and diagnostic performance of RP-EBUS-TBLB in IPF patients. <b><i>Methods:</i></b> Patients were divided into the usual interstitial pneumonia (UIP) group (<i>n</i> = 39, 4%), the probable UIP group (<i>n</i> = 12, 1%), and the noninterstitial lung disease (non-ILD) group (<i>n</i> = 903, 95%). <b><i>Results:</i></b> The diagnostic yield was significantly lower in the UIP group than in the non-ILD group (62% vs. 76%; <i>p</i> = 0.042), but there were no significant differences between the UIP and probable UIP groups (62% vs. 83%; <i>p</i> = 0.293) or the probable UIP and non-ILD groups (83% vs. 76%; <i>p</i> = 0.741). Multivariate logistic analysis showed that the mean diameter of PLLs, positive bronchus sign on CT, and “within the lesion” status on EBUS were independently associated with success of the procedure. Especially, the presence of the UIP pattern on CT (OR, 0.385; 95% CI: 0.172–0.863; <i>p</i> = 0.020) was independently associated with failed diagnosis. Among patients with UIP, “within the lesion” status on EBUS (OR, 25.432; 95% CI: 2.321–278.666; <i>p</i> = 0.008) was shown to be a factor contributing to a successful diagnosis. Overall, there were no significant differences in complication rates among the 3 study groups. <b><i>Conclusion:</i></b> RP-EBUS-TBLB can be performed safely with an acceptable diagnostic yield, even in patients with IPF.

A diagnostic conundrum in the context of a pandemic of Coronavirus Disease 2019 (COVID-19)

ABSTRACT A 52-year-old with lung cancer and brain metastases, on a 3-month weaning regime of dexamethasone, had a coincidental finding of bilateral, patchy ground-glass opacifications of both central and peripheral lung fields on computed tomography (CT). This was reported to be a sign of Coronavirus Disease 2019 (COVID-19). On Day 13, due to poor clinical progression and multiple negative reverse transcriptase-polymerase chain reaction tests for COVID-19, an alternative diagnosis was sought. Subsequently, this led to a diagnosis of Pneumocystis jirovecii pneumonia. This case demonstrates complicating factors in the diagnosis of COVID-19 and the presence of cognitive bias during a pandemic, which may lead clinicians to overlook a diagnosis, which may otherwise be addressed earlier.

Yield of tumor samples with a large guide-sheath in endobronchial ultrasound transbronchial biopsy for non-small cell lung cancer: A prospective study

Background Adequate tumor tissue is required to make the best treatment choice for non-small cell lung cancer (NSCLC). Transbronchial biopsy (TBB) by endobronchial ultrasonography with a guide sheath (EBUS-GS) is useful to diagnose peripheral lung lesions. The data of tumor cell numbers obtained by two different sizes of GSs is limited. We conducted this study to investigate the utility of a large GS kit to obtain many tumor cells in patients with NSCLC. Methods Patients with a peripheral lung lesion and suspected of NSCLC were prospectively enrolled. They underwent TBB with a 5.9-mm diameter bronchoscope with a large GS. When the lesion was invisible in EBUS, we changed to a thinner bronchoscope and TBB was performed with a small GS. We compared the tumor cell number prospectively obtained with a large GS (prospective large GS group) and those previously obtained with a small GS (small GS cohort). The primary endpoint was the tumor cell number per sample, and we assessed characteristics of lesions that could be obtained by TBB with large GS. Results Biopsy with large GS was performed in 55 of 87 patients (63.2%), and 37 were diagnosed with NSCLC based on histological samples. The number of tumor cells per sample was not different between two groups (658±553 vs. 532±526, estimated difference between two groups with 95% confidence interval (CI); 125 (-125–376), p = 0.32). The sample size of the large GS group was significantly larger than that of the small GS cohort (1.75 mm2 vs. 0.83 mm2, estimated difference with 95% CI; 0.92 (0.60–1.23) mm2, p = 0.00000019). The lesion involving a third or less bronchus generation was predictive factors using large GS. Conclusions The sample size obtained with large GS was significantly larger compared to that obtained with small GS, but there was no significant difference in tumor cell number. The 5.9-mm diameter bronchoscope with large GS can be used for lesions involving a third or less bronchus generation.