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Diagnostics
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Lung Cancer: Screening, Diagnosis and Management
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Lung Cancer: Screening, Diagnosis and Management

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: 30 August 2024 | Viewed by 7404

Special Issue Editor

Dr. Fu-Zong Wu

E-Mail Website
Guest Editor
1. Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
2. School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
Interests: lung cancer; diagnosis; prognosis; radiomics; texture analysis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

With the huge growing usage and popularization of low-dose computed tomography (LDCT) for lung cancer screening, there has been an increasing number of smoking- and non-smoking-related lung cancer patients worldwide manifesting with subsolid nodules, especially in Asian populations. This will raise and improve the survival rate a lot for lung cancer populations. However, there are still some dilemmas in the clinical application, screening, diagnosis and management of subsolid nodules.

Screening

With the rising utilization of low-dose pulmonary computed tomography in Asian non-smoking populations, the diagnosis of early lung cancer is facing two problems: overdiagnosis and delayed diagnosis. Therefore, how to optimize the screening process and efficiency of lung cancer screening by using clinical decision sharing, public health education, follow-up guidelines with adherence rate, and artificial intelligence assistance is an important issue in early lung cancer screening.

Diagnosis

In recent years, due to the rapid development of artificial intelligence technology, the clinical use of computer artificial intelligence software to assist radiologists in diagnosis has become a very important clinical issue. Due to the rapid increase in the number of imaging examinations, radiologists are faced with overwork/burnout and the risk of clinical misdiagnosis is increased. Computer-assisted software may reduce the workload of radiologists. However, the impact of artificial intelligence software on the clinical lung cancer diagnosis process still needs clinical verification in the real world. In addition, the use of radiomics to assist the pre-operative diagnosis and growth trend assessment of early lung cancer has also become the focus of current international research.

Management

In recent years, due to the advancement of thoracoscopic surgery technology, there are more alternative surgical options for early lung cancer treatment/management. Therefore, how to apply radiologic imaging criteria to select appropriate lung cancer surgical methods such as wedge resection, lobectomy or segmentectomy will reduce the harm caused by surgery in lung cancer patients without affecting the survival rate of lung cancer. In addition, how to apply robotic surgery in the treatment of early lung cancer is also a major focus of future early lung cancer research.

Paper recruitment

Therefore, the improvement of the early diagnosis of lung cancer is an important clinical challenge. Papers submitted to this Special Issue can be focused on lung cancer screening, diagnosis, clinical management, and artificial intelligence application of lung cancer with prognostic outcomes. In this Special Issue, research on clinical and translational aspects, as well as original articles, review articles and case reports, should help to gain better insights into the current knowledge and further perspectives of research in the early diagnosis of lung cancer with its management.

Dr. Fu-Zong Wu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • lung cancer
  • LDCT
  • overdiagnosis
  • artificial intelligence
  • deep learning
  • prognosis
  • radiomics
  • texture analysis
  • thoracic surgery

Published Papers (6 papers)

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Research

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10 pages, 539 KiB  
Article
A Retrospective Analysis: Investigating Factors Linked to High Lung-RADS Scores in a Nonsmoking, Non-Family History Population
by Chi-Shen Chen, Hsien-Chung Yu, Chun-Hao Yin, Jin-Shuen Chen, Yao-Shen Chen and I-Shu Chen
Diagnostics 2024, 14(8), 784; https://doi.org/10.3390/diagnostics14080784 - 09 Apr 2024
Viewed by 361
Abstract
Low-dose computed tomography screening for lung cancer is currently targeted at heavy smokers or those with a family history of lung cancer. This study aimed to identify risk factors for lung cancer in individuals who do not meet the current lung cancer screening [...] Read more.
Low-dose computed tomography screening for lung cancer is currently targeted at heavy smokers or those with a family history of lung cancer. This study aimed to identify risk factors for lung cancer in individuals who do not meet the current lung cancer screening criteria as stipulated by the Taiwan Health Promotion Agency’s low-dose computed tomography (LDCT) screening policy. A cohort analysis was conducted on 12,542 asymptomatic healthy subjects aged 20–80 years old who voluntarily underwent LDCT scans from January 2016 to December 2021. Logistic regression demonstrated that several factors, including age over 55 years, female gender, a body mass index (BMI) less than 23, a previous history of respiratory diseases such as tuberculosis or obstructive respiratory diseases (chronic obstructive pulmonary disease [COPD], asthma), and previous respiratory symptoms such as cough or dyspnea, were associated with high-risk lung radiology scores according to LDCT scans. These findings indicate that risk-based assessments using primary data and questionnaires to identify risk factors other than heavy smoking and a family history of lung cancer may improve the efficiency of lung cancer screening. Full article
(This article belongs to the Special Issue Lung Cancer: Screening, Diagnosis and Management)
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11 pages, 3768 KiB  
Article
Usefulness of Saline Sealing in Preventing Pneumothorax after CT-Guided Biopsies of the Lung
by Andrei Roman, Andreea Brozba, Alexandru Necula, Delia Doris Muntean, Paul Kubelac, Zsolt Fekete, Ciprian Tomuleasa, Csaba Csutak, Diana Feier, Roxana Pintican and Catalin Vlad
Diagnostics 2023, 13(23), 3546; https://doi.org/10.3390/diagnostics13233546 - 28 Nov 2023
Viewed by 1348
Abstract
This study aimed to assess the effectiveness of saline sealing in reducing the incidence of pneumothorax after a CT-guided lung biopsy. This was a retrospective case-control study of patients who underwent CT-guided biopsies for lung tumors using 18 G semiautomatic core needles in [...] Read more.
This study aimed to assess the effectiveness of saline sealing in reducing the incidence of pneumothorax after a CT-guided lung biopsy. This was a retrospective case-control study of patients who underwent CT-guided biopsies for lung tumors using 18 G semiautomatic core needles in conjunction with 17 G coaxial needles. The patients were divided into two consecutive groups: a historical Group A (n = 111), who did not receive saline sealing, and Group B (n = 87), who received saline sealing. In Group B, NaCl 0.9% was injected through the coaxial needle upon its removal. The incidence of pneumothorax and chest tube insertion was compared between the two groups. Multivariate logistic regression was performed to verify the contribution of other pneumothorax risk factors. The study included 198 patients, with 111 in Group A and 87 in Group B. There was a significantly (p = 0.02) higher pneumothorax rate in Group A (35.1%, n = 39) compared to Group B (20.7%, n = 18). The difference regarding chest tube insertion was not significant (p = 0.1), despite a tendency towards more insertions in Group A (5.4%, n = 6), compared to Group B (1.1%, n = 1). Among the risk factors for pneumothorax, only the presence of emphysema (OR = 3.5, p = 0.0007) and belonging to Group A (OR = 2.2, p = 0.02) were significant. Saline sealing of the needle tract after a CT-guided lung biopsy can significantly reduce the incidence of pneumothorax. This technique is safe, readily available, and inexpensive, and should be considered as a routine preventive measure during this procedure. Full article
(This article belongs to the Special Issue Lung Cancer: Screening, Diagnosis and Management)
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12 pages, 2751 KiB  
Article
Predictive Value of Clinicopathological Factors to Guide Post-Operative Radiotherapy in Completely Resected pN2-Stage III Non-Small Cell Lung Cancer
by Ju-Chun Chien, Yu-Chang Hu, Yi-Ju Tsai, Yu-Ting Chien, I-Jung Feng and Yow-Ling Shiue
Diagnostics 2023, 13(19), 3095; https://doi.org/10.3390/diagnostics13193095 - 29 Sep 2023
Cited by 1 | Viewed by 908
Abstract
Introduction: With the evolution of radiotherapy techniques and a better understanding of clinicopathological factors, we aimed to evaluate the treatment effect of post-operative radiotherapy (PORT) and associated predictive factors in patients with completely resected pN2 stage III non-small cell lung cancer (R0 pN2-stage [...] Read more.
Introduction: With the evolution of radiotherapy techniques and a better understanding of clinicopathological factors, we aimed to evaluate the treatment effect of post-operative radiotherapy (PORT) and associated predictive factors in patients with completely resected pN2 stage III non-small cell lung cancer (R0 pN2-stage III NSCLC). Material and Method: The cancer registration database of a single medical center was searched for R0 pN2-stage III NSCLC. Clinicopathological factors and information about post-operative therapies, including PORT and adjuvant systemic treatment, were retrospectively collected and analyzed. The Kaplan-Meier method and a Cox regression model were applied for time-to-event analysis, with disease-free survival (DFS) being the primary outcome. Results: From 2010 to 2021, 82 R0 pN2-stage III NSCLC patients were evaluated, with 70.1% of tumors harboring epidermal growth factor receptor mutations (EGFR mut.). PORT was performed in 73.2% of cases, and the median dose was 54 Gy. After a median follow-up of 42 months, the 3-year DFS and overall survival (OS) rates were 40.6% and 77.3%, respectively. Distant metastasis (DM) was the main failure pattern. In the overall cohort, DFS was improved with PORT (3-year DFS: 44.9% vs. 29.8%; HR: 0.552, p = 0.045). Positive predictive factors for PORT benefit, including EGFR mut., negative extranodal extension, positive lymphovascular invasion, 1–3 positive lymph nodes, and a positive-to-dissected lymph node ratio ≤0.22, were recognized. OS improvement was also observed in subgroups with less lymph node burden. Conclusions: For R0 pN2-stage III NSCLC, PORT prolongs DFS and OS in selected patients. Further studies on predictive factors and the development of nomograms guiding the application of PORT are highly warranted, aiming to enhance the personalization of lung cancer treatment. Full article
(This article belongs to the Special Issue Lung Cancer: Screening, Diagnosis and Management)
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14 pages, 3491 KiB  
Article
Comparison of the Outcomes between Systematic Lymph Node Dissection and Lobe-Specific Lymph Node Dissection for Stage I Non-small Cell Lung Cancer
by Ching-Chun Huang, En-Kuei Tang, Chih-Wen Shu, Yi-Ping Chou, Yih-Gang Goan and Yen-Chiang Tseng
Diagnostics 2023, 13(8), 1399; https://doi.org/10.3390/diagnostics13081399 - 12 Apr 2023
Cited by 2 | Viewed by 1471
Abstract
Background: This study compares the surgical and long-term outcomes, including disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS), between lobe-specific lymph node dissection (L-SND) and systematic lymph node dissection (SND) among patients with stage I non-small cell lung cancer (NSCLC).Methods: In [...] Read more.
Background: This study compares the surgical and long-term outcomes, including disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS), between lobe-specific lymph node dissection (L-SND) and systematic lymph node dissection (SND) among patients with stage I non-small cell lung cancer (NSCLC).Methods: In this retrospective study, 107 patients diagnosed with clinical stage I NSCLC undergoing video-assisted thoracic surgery lobectomy (exclusion of the right middle lobe) from January 2011 to December 2018 were enrolled. The patients were assigned to the L-SND (n = 28) and SND (n = 79) groups according to the procedure performed on them. Demographics, perioperative data, and surgical and long-term oncological outcomes were collected and compared between the L-SND and SND groups. Results: The mean follow-duration was 60.6 months. The demographic data and surgical outcomes and long-term oncological outcomes were not significantly different between the two groups. The 5-year OS of the L-SND and SND groups was 82% and 84%, respectively. The 5-year DFS of the L-SND and SND groups was 70% and 65%, respectively. The 5-year CSS of the L-SND and SND groups was 80% and 86%, respectively. All the surgical and long-term outcomes were not statistically different between the two groups. Conclusion: L-SND showed comparable surgical and oncologic outcomes with SND for clinical stage I NSCLC. L-SND could be a treatment choice for stage I NSCLC. Full article
(This article belongs to the Special Issue Lung Cancer: Screening, Diagnosis and Management)
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Review

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17 pages, 2743 KiB  
Review
Managing Persistent Subsolid Nodules in Lung Cancer: Education, Decision Making, and Impact of Interval Growth Patterns
by Yung-Chi Liu, Chia-Hao Liang, Yun-Ju Wu, Chi-Shen Chen, En-Kuei Tang and Fu-Zong Wu
Diagnostics 2023, 13(16), 2674; https://doi.org/10.3390/diagnostics13162674 - 14 Aug 2023
Cited by 2 | Viewed by 1757
Abstract
With the popularization of lung cancer screening, many persistent subsolid nodules (SSNs) have been identified clinically, especially in Asian non-smokers. However, many studies have found that SSNs exhibit heterogeneous growth trends during long-term follow ups. This article adopted a narrative approach to extensively [...] Read more.
With the popularization of lung cancer screening, many persistent subsolid nodules (SSNs) have been identified clinically, especially in Asian non-smokers. However, many studies have found that SSNs exhibit heterogeneous growth trends during long-term follow ups. This article adopted a narrative approach to extensively review the available literature on the topic to explore the definitions, rationale, and clinical application of different interval growths of subsolid pulmonary nodule management and follow-up strategies. The development of SSN growth thresholds with different growth patterns could support clinical decision making with follow-up guidelines to reduce over- and delayed diagnoses. In conclusion, using different SSN growth thresholds could optimize the follow-up management and clinical decision making of SSNs in lung cancer screening programs. This could further reduce the lung cancer mortality rate and potential harm from overdiagnosis and over management. Full article
(This article belongs to the Special Issue Lung Cancer: Screening, Diagnosis and Management)
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Other

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13 pages, 1583 KiB  
Systematic Review
Predicting the Invasiveness of Pulmonary Adenocarcinomas in Pure Ground-Glass Nodules Using the Nodule Diameter: A Systematic Review, Meta-Analysis, and Validation in an Independent Cohort
by Jieke Liu, Xi Yang, Yong Li, Hao Xu, Changjiu He, Peng Zhou and Haomiao Qing
Diagnostics 2024, 14(2), 147; https://doi.org/10.3390/diagnostics14020147 - 08 Jan 2024
Viewed by 817
Abstract
The nodule diameter was commonly used to predict the invasiveness of pulmonary adenocarcinomas in pure ground-glass nodules (pGGNs). However, the diagnostic performance and optimal cut-off values were inconsistent. We conducted a meta-analysis to evaluate the diagnostic performance of the nodule diameter for predicting [...] Read more.
The nodule diameter was commonly used to predict the invasiveness of pulmonary adenocarcinomas in pure ground-glass nodules (pGGNs). However, the diagnostic performance and optimal cut-off values were inconsistent. We conducted a meta-analysis to evaluate the diagnostic performance of the nodule diameter for predicting the invasiveness of pulmonary adenocarcinomas in pGGNs and validated the cut-off value of the diameter in an independent cohort. Relevant studies were searched through PubMed, MEDLINE, Embase, and the Cochrane Library, from inception until December 2022. The inclusion criteria comprised studies that evaluated the diagnostic accuracy of the nodule diameter to differentiate invasive adenocarcinomas (IAs) from non-invasive adenocarcinomas (non-IAs) in pGGNs. A bivariate mixed-effects regression model was used to obtain the diagnostic performance. Meta-regression analysis was performed to explore the heterogeneity. An independent sample of 220 pGGNs (82 IAs and 128 non-IAs) was enrolled as the validation cohort to evaluate the performance of the cut-off values. This meta-analysis finally included 16 studies and 2564 pGGNs (761 IAs and 1803 non-IAs). The pooled area under the curve, the sensitivity, and the specificity were 0.85 (95% confidence interval (CI), 0.82–0.88), 0.82 (95% CI, 0.78–0.86), and 0.73 (95% CI, 0.67–0.78). The diagnostic performance was affected by the measure of the diameter, the reconstruction matrix, and patient selection bias. Using the prespecified cut-off value of 10.4 mm for the mean diameter and 13.2 mm for the maximal diameter, the mean diameter showed higher sensitivity than the maximal diameter in the validation cohort (0.85 vs. 0.72, p < 0.01), while there was no significant difference in specificity (0.83 vs. 0.86, p = 0.13). The nodule diameter had adequate diagnostic performance in differentiating IAs from non-IAs in pGGNs and could be replicated in a validation cohort. The mean diameter with a cut-off value of 10.4 mm was recommended. Full article
(This article belongs to the Special Issue Lung Cancer: Screening, Diagnosis and Management)
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