低剂量螺旋CT扫描联合血清p16基因甲基化检测在肺癌早期诊断中的应用

目的研究在无症状的肺癌高危人群中利用低剂量CT（LDCT）联合血清p16基因甲基化检测进行肺癌早期诊断的可行性。方法肺癌高危人群入组标准：男性，年龄55～75岁；吸烟指数≥400支／年，目前仍在吸烟或戒烟不超过10年。共893例受检者被随机分为两组。一组为447例（LDCT—p16组），平均年龄66岁，进行LDCT联合血清p16基因甲基化检测；另一组为446例（CXR组），平均年龄67岁，接受后前位胸片检查。两组检查阳性病例将接受进一步组织病理学检查。并分别统计两组阳性结节检出率及肺癌检出率，并行X2检验。结果LDCT—p16组与CXR组分别有96．8％和92．8％的受检者完成了检查。LDCT—p16组中1113％病人可疑肺癌，明显高于CXR组的6．5％（P〈0．05）。其中LDCT—p16组中有7例，CXR组中有2例确诊为肺癌。LDCT—p16组肺癌检出率高于CXR组，但无统计学意义（P〉0．05）。结论低剂量CT联合血清p16基因甲基化检测是一种敏感、安全、可行的筛查早期肺癌的方法，能够取代胸片筛查早期肺癌。     

胸腔镜下肺磨玻璃结节定位的研究进展

随着高分辨率计算机断层扫描（high-resolution computed tomography,HRCT）普及于健康体检及早期肺癌筛查,肺部磨玻璃结节影（ground glass opacity,GGO）的检出率也逐年提高,其恶性倾向很高,虽然目前已提出很多鉴别其性质的方法,但准确判断仍依赖于病理检查。电视胸腔镜下肺局部切除术是目前早期诊断及治疗肺磨玻璃结节（ground-glass nodule,GGN）的主要手段,但常因结节体积小、位置处于肺实质深部、质地较软使术者在术中难以对其精确定位。胸腔镜下如何精准、快速定位肺GGN已成为近年来研究热点。     

MSCT多平面重建技术诊断磨玻璃密度结节样肺癌的影像学表现分析

目的分析多排螺旋CT(MSCT)多平面重建技术(MPR)诊断磨玻璃密度结节(GGN)样肺癌的影像学表现。方法选取我院2015年5月～2018年9月收治的126例GGN患者(共154个病灶),其中经手术或病理学确诊为GGN样肺癌患者共48例(51个病灶),所有患者均接受MSCT检查,回顾性对比MSCT、MSCT并MPR诊断GGN样肺癌的灵敏度、特异度、准确率及病灶征象显示情况,并分析GGN样肺癌病灶MSCT的影像学表现。结果MSCT并MPR诊断GGN样肺癌的灵敏度(92.16%)、特异度(92.23%)、准确率(92.21%)均高于MSCT的诊断结果(分别为75.55%、70.87%、71.43%),MSCT并MPR诊断支气管充气症显示率明显高于MSCT诊断(68.63%vs 41.18%,P0.05)。结论 MSCT联合MPR诊断GGN样肺癌的准确率高,能清晰反映肺部病灶情况,对术前诊断及后续治疗具有重要意义。     

宁波市鄞州区2009年-20124年新生儿疾病筛查结果的分析与回顾

目的通过对2009年～2012年间鄞州区新生儿疾病的筛查结果的分析,了解新生儿患甲状腺功能减低症（cH）、苯丙酮尿症（PKU）及高TsH血症的情况,以探索有效的预防措施。方法采新生儿足跟血3滴于专用纸片上,自然晾干,送市筛查中心,通过时间分辨荧光免疫分析法（DELFIA）测定标本中促甲状腺素（TSH）水平,用化学荧光法测定被检标本中苯丙氨酸（Phe）水平,并对结果进行统计分析。结果4年间,参与筛查的新生儿共52875人,总的筛查率为98．50％,召回率为95．02％,确诊cH患儿44例,发病率为1／1202,未发现PKU患儿,发现高TsH血症17例,发病率为1／3110。结论新生儿筛查是早期发现CH、PKU及高TSH血症,并使患儿能够得到及时治疗的有效手段,对于提高本区人口素质有重要的意义。     

基于深度学习的低剂量CT图像去噪

目的:提出一种基于深度学习的方法用于低剂量CT（LDCT）图像的噪声去除。方法:首先进行滤波反投影重建,然后利用多尺度并行残差U-net（MPR U-net）的深度学习模型对重建后的LDCT图像进行去噪。实验数据采用LoDoPaB-CT挑战赛的医学CT数据集,其中训练集35 820张图像,验证集3 522张图像,测试集3 553张图像,并采用峰值信噪比（PSNR）与结构相似性系数（SSIM）来评估模型的去噪效果。结果:LDCT图像处理前后PSNR分别为28.80、38.22 dB,SSIM分别为0.786、0.966,平均处理时间为0.03 s。结论:MPR U-net深度学习模型能较好地去除LDCT图像噪声,提升PSNR,保留更多图像细节。     

基于CT影像的早期肺腺癌病理类型预测方法研究进展

肺腺癌是非小细胞肺癌中最常见的类型。由于肺腺癌发生早期并没有明显的临床症状,多数患者发现时已处于晚期,晚期肺腺癌患者的预后情况极其不理想。早发现、早诊断和早治疗是提升患者生存率最有效的措施。根据癌细胞对周围组织浸润程度的不同,可将早期肺腺癌分为微浸润性腺癌和浸润性腺癌,同时腺体前驱病变也需长期观察随访,以防进一步发展恶化。不同病理类型的早期肺腺癌术后五年无病生存率存在很大差异,准确预测肺腺癌病理类型能够辅助医师更好地制定治疗方案,进一步改善病患的预后。早期肺腺癌与磨玻璃肺结节(ground-glass nodule, GGN)密切相关,CT凭借无创和高分辨率的优势成为了观察GGN最主要的影像方法。现有的早期肺腺癌病理类型预测研究主要围绕人工智能技术开展：传统影像组学基于计算机高通量提取和筛选GGN的定量特征来构建分类模型;而深度学习方法则自动提取GGN的深层特征并学习其与类别之间的隐含关系,以完成类别预测任务。目前国内外研究者基于GGN的CT影像以及影像组学和深度学习模型已发表了大量的早期肺腺癌病理组织类型预测的文献。本文主要就GGN的CT影像学特征、影像组学特征及深度学习方法在预测早...     

2008年～2012年山西省新生儿疾病筛查结果分析

目的分析总结山西省2008年-2012年新生儿甲状腺功能减低症（CH）和苯丙酮尿症（PKU）的筛查率、发病率和治疗情况,对筛查中存在的问题提出相应的对策,促进山西省新生儿疾病筛查工作更好的开展,提高筛查率。方法依据《新生儿疾病筛查技术规范》,对2007年10月1日至2012年9月30日（3＋1模式）在山西省各医疗保健机构出生的活产新生儿,在出生后72h并充分哺乳6次以上,采集足跟血并滴于专用滤纸上,进行CH和PKU筛查。结果2008年—2012年5牟间,共筛查新生儿649075例,筛查率逐年上升。确诊CH患儿267例,发病率为1／2431。确诊PKU患儿120例,发病率为1／5409,患儿均得到及时的早期的治疗,坚持规范治疗的患儿治疗效果得到肯定。结论新生儿疾病筛查可以早期发现CH和PKU患儿并及时治疗,是降低出生缺陷的有效预防措施,对提高出生人口素质具有重大意义。     

癌症筛查P扫描

正乳腺癌的早期诊断、早治疗可以延长病人的生命,很为重要。虽然钼靶乳房X光检查是早期发现的癌症筛查技术之一,可以发现小于0.5厘米的肿块,并判断其性质。但也存在一定的局限性,病人要受到X线的伤害,过小的癌肿无法做到早发现。因而寻找更简单,低成本癌症早期癌症筛查方法是人们研究方向。     

宁波地区141例新生儿先天性甲低患者的筛查与临床诊断分析

目的探讨先天性甲低早期筛查与诊断的方法和效果。方法时间分辨免疫分析法（DELFIA法）测定标本中促甲状腺素（TSH）水平,TSH≥20 uIU/ml即为阳性,再对阳性患儿采用放射免疫方法测定血清中的TSH、T3、T4水平确诊。结果筛查458 857人,平均筛查率99.8%,确诊并治疗141例,阳性率达3.1/万,患者按时随访并持续治疗,智力及身体发育未见明显异常,取得满意的疗效。结论加强筛查,达到早发现、早诊断、早治疗的目的,提高出生人口的素质。     

全身骨显像联合血清CYFRA21-1、CEA检测对肺癌骨转移的诊断价值

判断肺癌有无骨转移,对制订治疗方案、判断预后有重要意义。全身骨显像是诊断骨转移的方法,通过放射性核素异常分布发现转移灶[1]。可溶性细胞角蛋白19片段（CYFRA21-1）、癌胚抗原（CEA）是肺癌诊断中常用的血清肿瘤标志物[2]。本文探讨全身骨显像联合血清CYFRA21-1、CEA检测,诊断肺癌骨转移的价值,现报道如下。     

Lung cancer screening with low-dose helical CT in Korea: experiences at the Samsung Medical Center

To determine overall detection rates of lung cancer by low-dose CT (LDCT) screening and to compare histopathologic and imaging differences of detected cancers between high- and low-risk groups, this study included 6,406 asymptomatic Korean adults with >or=45 yr of age who underwent LDCT for lung cancer screening. All were classified into high- (>or=20 pack-year smoking; 3,353) and low-risk (3,053; <20 pack-yr smoking and non-smokers) groups. We compared CT findings of detected cancers and detection rates between high- and low-risk. At initial CT, 35% (2,255 of 6,406) had at least one or more non-calcified nodule. Lung cancer detection rates were 0.36% (23 of 6,406). Twenty-one non-small cell lung cancers appeared as solid (n=14) or ground-glass opacity (GGO) (n=7) nodules. Cancer likelihood was higher in GGO nodules than in solid nodules (p<0.01). Fifteen of 23 cancers occurred in high-risk group and 8 in low-risk group (p=0.215). Therefore, LDCT screening help detect early stage of lung cancer in asymptomatic Korean population with detection rate of 0.36% on a population basis and may be useful for discovering early lung cancer in low-risk group as well as in high-risk group.     

Lung cancer screening: history,current perspectives,and future directions

Lung cancer has remained the leading cause of death worldwide among all cancers. The dismal 5-year survival rate of 16% is in part due to the lack of symptoms during early stages and lack of an effective screening test until recently. Chest X-ray and sputum cytology were studied extensively as potential screening tests for lung cancer and were conclusively proven to be of no value. Subsequently, a number of studies compared computed tomography (CT) with the chest X-ray. These studies did identify lung cancer in earlier stages. However, they were not designed to prove a reduction in mortality. Later trials have focused on low-dose CT (LDCT) as a screening tool. The largest US trial – the National Lung Screening Trial (NLST) – enrolled approximately 54,000 patients and revealed a 20% reduction in mortality. While a role for LDCT in lung cancer screening has been established, the issues of high false positive rates, radiation risk, and cost effectiveness still need to be addressed. The guidelines of the international organizations that now include LDCT in lung cancer screening are reviewed. Other methods that may improve earlier detection such as positron emission tomography, autofluorescence bronchoscopy, and molecular biomarkers are also discussed.     

The BUILT study: a single-center 5-year experience of Lung Cancer screening in Taiwan

Background: There are no uniform guidelines on low-dose computed tomography (LDCT) follow-up in lung cancer screening. Few studies have analyzed the incidental abnormalities and role of tumor markers in lung cancer screening. The purpose of this study was to investigate the diagnostic performance of LDCT, optimal follow-up duration, incidental findings, and role of tumor markers in diagnosing lung cancer.Methods: We retrospectively analyzed subjects who underwent their first LDCT in Taipei Tzu Chi Hospital between September 1, 2015, and August 31, 2016. All chest CT scans until August 31, 2020, were recorded. A non-calcified nodule with a diameter ≥2 mm on LDCT was defined as a positive result. We extracted the data, including possible risk factors of lung cancer and follow-up outcomes.Results: A total of 1502 subjects were recruited. Of the 38 subjects who underwent biopsy, 31 had confirmed lung cancer. Lung cancer in all patients was diagnosed within 4 years. Univariate logistic regression analysis revealed that a family history of lung cancer in first-degree relatives and abnormal serum carcinoembryonic antigen (CEA) levels were the significant risk factors for lung cancer. A cumulative lung cancer incidence of 54.7 patients per 1000 person-years was determined solely via radiological follow-up. In total, 271 (18%) subjects exhibited incidental findings on baseline LDCT.Conclusion: The overall lung cancer detection rate in this study was 2.1% in the 5-year study period. A family history of lung cancer and abnormal serum CEA levels are important risk factors for lung cancer. A minimum of 4-year follow-up is required to track suspicious nodules. A purely radiological follow-up detects a high incidence of lung cancer.     

Low-dose computed tomography screening reduces lung cancer mortality

Lung cancer causes an estimated 1.6 million deaths each year, being the leading cause of cancer-related deaths in the world. Late diagnosis and, in some cases, the high aggressiveness of the tumour result in low overall five-year survival rates of 12% among men and 7% among women. The cure is most likely in early-stage disease. The poor outcomes of treatment in lung cancer resulting from the fact that most cases are diagnosed in the advanced stage of the disease justify the implementation of an optimal lung cancer prevention in the form of smoking cessation and screening programmes that would offer a chance to detect early stages of the disease, while fitting within specific economic constraints. The National Lung Screening Trial (NLST) – the largest and most expensive randomised, clinical trial in the USA demonstrated a 20% mortality rate reduction in patients who had undergone chest low-dose computed tomography (LDCT) screening, as compared to patients screened with a conventional chest X-ray. Results of the NLST enabled the implementation of lung cancer screening programme among highrisk patients in the USA and parts of China. In 2017, recommendations of the European Society of Thoracic Surgeons also strongly recommend an implementation of a screening programme in the EU. Further studies of improved lung cancer risk assessment scores and of effective molecular markers should intensify in order to reduce all potential harms to the high-risk group and to increase cost-effectiveness of the screening.     

AI-Driven Model for Automatic Emphysema Detection in Low-Dose Computed Tomography Using Disease-Specific Augmentation

The objective of this study is to evaluate the feasibility of a disease-specific deep learning (DL) model based on minimum intensity projection (minIP) for automated emphysema detection in low-dose computed tomography (LDCT) scans. LDCT scans of 240 individuals from a population-based cohort in the Netherlands (ImaLife study, mean age ± SD = 57 ± 6 years) were retrospectively chosen for training and internal validation of the DL model. For independent testing, LDCT scans of 125 individuals from a lung cancer screening cohort in the USA (NLST study, mean age ± SD = 64 ± 5 years) were used. Dichotomous emphysema diagnosis based on radiologists’ annotation was used to develop the model. The automated model included minIP processing (slab thickness range: 1 mm to 11 mm), classification, and detection maps generation. The data-split for the pipeline evaluation involved class-balanced and imbalanced settings. The proposed DL pipeline showed the highest performance (area under receiver operating characteristics curve) for 11 mm slab thickness in both the balanced (ImaLife = 0.90 ± 0.05) and the imbalanced dataset (NLST = 0.77 ± 0.06). For ImaLife subcohort, the variation in minIP slab thickness from 1 to 11 mm increased the DL model’s sensitivity from 75 to 88% and decreased the number of false-negative predictions from 10 to 5. The minIP-based DL model can automatically detect emphysema in LDCTs. The performance of thicker minIP slabs was better than that of thinner slabs. LDCT can be leveraged for emphysema detection by applying disease specific augmentation.

     

Investigation of new psychophysical measures for evaluation of similar images on thoracic computed tomography for distinction between benign and malignant nodules

We have been developing a computerized scheme to assist radiologists in improving the diagnostic accuracy for lung cancers on low-dose computed tomography (LDCT) scans by use of similar images for malignant nodules and benign nodules. A database of 415 LDCT scans including 73 cases with 76 confirmed cancers and 342 cases with 413 confirmed benign nodules was first collected in an LDCT screening program for early detection of lung cancers in Nagano, Japan. An observer study by use of receiver operating characteristics analysis was first conducted with five radiologists to demonstrate that presenting similar images for malignant nodules and benign nodules can significantly improve radiologists' performance in the diagnosis of unknown nodules. Another observer study was then conducted for obtaining reliable data on subjective similarity ratings by 10 radiologists. Based on the subjective similarity ratings, three important features were selected from a number of nodule features, and four different techniques for the determination of similarity measures, namely, a feature-based technique, a pixel-value-difference based technique, a cross-correlation-based technique, and a neural-network-based technique, were investigated and evaluated in terms of the correlation coefficient with the subjective similarity ratings. The experimental results in this study indicated that the neural-network-based technique can provide a reliable psychophysical similarity measure which is comparable to the subjective similarity ratings for a single radiologist when evaluated by use of correlation with the average similarity ratings for the other nine radiologists.     

The role of screening expectations in modifying short–term psychological responses to low-dose computed tomography lung cancer screening among high-risk individuals

ObjectiveThis study aimed to examine the relationship between pre-screening expectations and psychological responses to low-dose computerised tomography (LDCT) screening among high-risk individuals in the United Kingdom Lung Cancer Screening (UKLS) pilot trial.MethodsPrior to screening, high-risk individuals randomised into the intervention arm of the UKLS were asked about their expected screening test result. Their actual LDCT scan result was compared with their baseline screening expectation to determine the level of congruence. Levels of concern about and perceived accuracy of the result were assessed in a questionnaire two weeks following receipt of their test result.ResultsThe sample included 1589 participants. Regardless of their expected results, patients who required follow-up investigations after their initial LDCT scan were the most concerned about their result (p < 0.001). Participants who expected to require follow-up, but did not need it, perceived the test to be least accurate (p = 0.006).ConclusionsLung cancer screening participants who require follow-up or who have unexpected negative results can be identified for supportive interventions.Practical Implications: These findings can be used to ensure that any future LDCT lung cancer screening programme is tailored to identify and support those high-risk individuals who may benefit from additional help.     

非小细胞肺癌EGFR突变检测技术的研究进展

针对表皮生长因子受体(epidermal growth factor receptor,EGFR)突变基因的检测是肺癌靶向治疗的重要基石.目前临床中主要针对肺癌组织、脱落细胞以及液态活检标本开展检测工作,此外尿液标本近期也展现出良好的检测效率.针对上述标本,临床中开展多种检测技术,如以特定靶点为目的的技术,包括数字PCR、楔形探针扩增阻滞突变系统等;以筛查为目的的检测技术,包括二代测序(next generation sequencing,NGS)、Sanger测序等,这些技术在特定的标本类型和检测目的中具有独特的优势.一些新兴的技术,如拉曼光谱,也在临床检测中展现出良好的应用前景.