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      The value of chest computed tomography in evaluating lung cancer in a lobe affected by stable pulmonary tuberculosis in middle-aged and elderly patients: A preliminary study

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          Abstract

          Introduction

          Lung cancer can be masked by coexisting stable tuberculosis lesions, which may result in delayed lung cancer diagnosis and treatment. Information about pulmonary tuberculosis patients who are at high-risk of developing lung cancer is scarce. We aimed to examine the value of chest computed tomography (CT) in evaluating lung cancer in a lobe affected by stable pulmonary tuberculosis in middle-aged and elderly patients.

          Methods

          In this single-centered, retrospective, observational study, we enrolled 41 middle-aged and elderly patients with pulmonary tuberculosis who developed lung cancer in the same lobe from January 30, 2011 to December 30, 2020. Comparisons of the clinical and chest CT data were made with age-matched and sex-matched control groups of patients with stable pulmonary tuberculosis but no lung cancer diagnosis (n = 38).

          Results

          Seventeen patients in the lung cancer group (41%) were initially misdiagnosed. Compared to lesions in the control group, lesions in the lung cancer group were significantly more likely to demonstrate the following CT features: large size, vessel convergence, lobulation, spiculation, spinous protuberance, bronchial obstruction or stenosis, vacuolation, ground-glass opacification, heterogeneous or homogeneous enhancement, and gradual increase in size. Nodular enlargement showed the best diagnostic performance in the diagnosis of lung cancer in a lobe affected by tuberculosis (area under the receiver operating characteristic curve = 0.974; P <0.001; accuracy = 98.2%; sensitivity =94.7%; specificity = 100%).

          Conclusion

          Chest CT might play an important role in early diagnosis of lung cancer in a lobe affected by tuberculosis. Regular CT re-examination is necessary in continuous controls monitoring of patients with stable pulmonary tuberculosis. The study indicates necessity of prospective study in this field.

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          Most cited references31

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          Tracking the Evolution of Non–Small-Cell Lung Cancer

          Among patients with non-small-cell lung cancer (NSCLC), data on intratumor heterogeneity and cancer genome evolution have been limited to small retrospective cohorts. We wanted to prospectively investigate intratumor heterogeneity in relation to clinical outcome and to determine the clonal nature of driver events and evolutionary processes in early-stage NSCLC.
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            Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017.

            The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. © RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on March 13, 2017.
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              Epidemiology of lung cancer in China

              The incidence and mortality rates of lung cancer, the leading cause of cancer death in China, have significantly increased in recent years, and present geographic and gender differences as a result of diversity in lifestyles and socioeconomic development. A series of attribute risk analyses have shown that factors such as smoking, air pollution, and occupational factors are all related to lung cancer. Behavioral intervention, such as smoking cessation and screening, could effectively reduce lung cancer incidence and mortality.
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                Author and article information

                Contributors
                Journal
                Front Oncol
                Front Oncol
                Front. Oncol.
                Frontiers in Oncology
                Frontiers Media S.A.
                2234-943X
                06 October 2022
                2022
                : 12
                : 868107
                Affiliations
                [1] 1 Department of Radiology, Xiangya Hospital, Central South University , Changsha, China
                [2] 2 Department of Radiology, Xiangya Changde Hospital , Changde, China
                [3] 3 National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University , Changsha, China
                [4] 4 Department of Radiology, Qingyuan people’s Hospital , Qingyuan, China
                Author notes

                Edited by: John Varlotto, Marshall University, United States

                Reviewed by: Kenta Nakahashi, Yamagata Prefectural Central Hospital, Japan; Piotr Yablonskii, St. Petersburg Research Institute of Phthisiopulmonology, Russia

                *Correspondence: Hui Zhou, huistanzhou@ 123456csu.edu.cn

                This article was submitted to Cancer Imaging and Image-directed Interventions, a section of the journal Frontiers in Oncology

                Article
                10.3389/fonc.2022.868107
                9582123
                36276086
                e1e7787a-30c5-406d-8f45-bd64517bed7d
                Copyright © 2022 Long, Zhou, Li, Liu and Cai

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 02 February 2022
                : 16 September 2022
                Page count
                Figures: 2, Tables: 3, Equations: 0, References: 34, Pages: 9, Words: 4391
                Funding
                Funded by: Natural Science Foundation of Hunan Province , doi 10.13039/501100004735;
                Categories
                Oncology
                Original Research

                Oncology & Radiotherapy
                lung cancer,pulmonary tuberculosis,computed tomography,follow-up,misdiagnosis

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