Publications
283 results found
Verghese P, Horst C, Dickson J, et al., 2021, THE SUMMIT STUDY: RESULTS PROCESSING TIME, Publisher: BMJ PUBLISHING GROUP, Pages: A94-A94, ISSN: 0040-6376
Bartlett EC, Devaraj A, 2021, Imaging Techniques in Lung Cancer, Encyclopedia of Respiratory Medicine, Second Edition, Pages: 722-728, ISBN: 9780081027233
The TNM (tumor, node, metastasis) system, currently in its 8th edition, is used worldwide to stage lung cancers. Staging gives an indication of prognosis and determines eligibility for treatment. Multimodality imaging is recommended by international guidelines to accurately stage lung cancers to guide diagnostic tests and to determine suitability for treatment. Various imaging modalities and their limitations are discussed, as well as ongoing conundrums in lung cancer staging.
Barnett J, Pulzato I, Javed M, et al., 2021, Radiological-pathological correlation of negative CT biopsy results enables high negative predictive value for thoracic malignancy, CLINICAL RADIOLOGY, Vol: 76, ISSN: 0009-9260
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- Citations: 2
Dafydd DAP, O'Mahony M, Jhanji S, et al., 2021, The role of CT chest in screening for asymptomatic COVID-19 infection in self-isolating patients prior to elective oncological surgery: findings from a UK Cancer Hub, BRITISH JOURNAL OF RADIOLOGY, Vol: 94, ISSN: 0007-1285
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- Citations: 8
Wright J, Kokosi M, Renzoni E, et al., 2020, Plastic bronchitis: expanding clinical associations and identifying specific histologic characteristics compared to other intraluminal casts, Publisher: SPRINGER, Pages: S127-S127, ISSN: 0945-6317
George PM, Hida T, Putman RK, et al., 2020, Hiatus hernia and interstitial lung abnormalities, EUROPEAN RESPIRATORY JOURNAL, Vol: 56, ISSN: 0903-1936
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- Citations: 5
Arachchillage DJ, Desai SR, Devaraj A, et al., 2020, Reply to: Sanfilippo et al Caviedes et al., American Journal of Respiratory and Critical Care Medicine, Vol: 203, Pages: 261-263, ISSN: 1073-449X
George PM, Barratt SL, Condliffe R, et al., 2020, Respiratory follow-up of patients with COVID-19 pneumonia, Thorax, Vol: 75, Pages: 1009-1016, ISSN: 0040-6376
The COVID-19 pandemic has led to an unprecedented surge in hospitalised patients with viral pneumonia. The most severely affected patients are older men, individuals of black and Asian minority ethnicity and those with comorbidities. COVID-19 is also associated with an increased risk of hypercoagulability and venous thromboembolism. The overwhelming majority of patients admitted to hospital have respiratory failure and while most are managed on general wards, a sizeable proportion require intensive care support. The long-term complications of COVID-19 pneumonia are starting to emerge but data from previous coronavirus outbreaks such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) suggest that some patients will experience long-term respiratory complications of the infection. With the pattern of thoracic imaging abnormalities and growing clinical experience, it is envisaged that interstitial lung disease and pulmonary vascular disease are likely to be the most important respiratory complications. There is a need for a unified pathway for the respiratory follow-up of patients with COVID-19 balancing the delivery of high-quality clinical care with stretched National Health Service (NHS) resources. In this guidance document, we provide a suggested structure for the respiratory follow-up of patients with clinicoradiological confirmation of COVID-19 pneumonia. We define two separate algorithms integrating disease severity, likelihood of long-term respiratory complications and functional capacity on discharge. To mitigate NHS pressures, virtual solutions have been embedded within the pathway as has safety netting of patients whose clinical trajectory deviates from the pathway. For all patients, we suggest a holistic package of care to address breathlessness, anxiety, oxygen requirement, palliative care and rehabilitation.
Ridge CA, Desai SR, Jeyin N, et al., 2020, Dual-energy CT pulmonary angiography (DECTPA) quantifies vasculopathy in severe COVID-19 pneumonia, Radiology: Cardiothoracic Imaging, Vol: 2, ISSN: 2638-6135
BackgroundThe role of dual energy computed tomographic pulmonary angiography (DECTPA) in revealing vasculopathy in coronavirus disease 2019 (COVID-19) has not been fully explored.PurposeTo evaluate the relationship between DECTPA and disease duration, right ventricular dysfunction (RVD), lung compliance, D-dimer and obstruction index in COVID-19 pneumonia.Materials and MethodsThis institutional review board approved this retrospective study, and waived the informed consent requirement. Between March-May 2020, 27 consecutive ventilated patients with severe COVID-19 pneumonia underwent DECTPA to diagnose pulmonary thrombus (PT); 11 underwent surveillance DECTPA 14 ±11.6 days later. Qualitative and quantitative analysis of perfused blood volume (PBV) maps recorded: i) perfusion defect ‘pattern’ (wedge-shaped, mottled or amorphous), ii) presence of PT and CT obstruction index (CTOI) and iii) PBV relative to pulmonary artery enhancement (PBV/PAenh); PBV/PAenh was also compared with seven healthy volunteers and correlated with D-Dimer and CTOI.ResultsAmorphous (n=21), mottled (n=4), and wedge-shaped (n=2) perfusion defects were observed (M=20; mean age=56 ±8.7 years). Mean extent of perfusion defects=36.1%±17.2. Acute PT was present in 11/27(40.7%) patients. Only wedge-shaped defects corresponded with PT (2/27, 7.4%). Mean CTOI was 2.6±5.4 out of 40. PBV/PAenh (18.2 ±4.2%) was lower than in healthy volunteers (27 ±13.9%, p = 0.002). PBV/PAenh correlated with disease duration (β = 0.13, p = 0.04), and inversely correlated with RVD (β = -7.2, p = 0.001), persisting after controlling for confounders. There were no linkages between PBV/PAenh and D-dimer or CTOI.ConclusionPerfusion defects and decreased PBV/PAenh are prevalent in severe COVID-19 pneumonia. PBV/PAenh correlates with disease duration and inversely correlates with RVD. PBV/PAenh may be an important marker of vasculopathy in severe COVID-19 pneumonia
Horst C, Dickson JL, Tisi S, et al., 2020, Delivering low-dose CT screening for lung cancer: a pragmatic approach, THORAX, Vol: 75, Pages: 831-832, ISSN: 0040-6376
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- Citations: 16
Bartlett EC, Kemp S, Ridge CA, et al., 2020, Baseline Results of the West London lung cancer screening pilot study - Impact of mobile scanners and dual risk model utilisation, LUNG CANCER, Vol: 148, Pages: 12-19, ISSN: 0169-5002
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- Citations: 25
Ruparel M, Quaife SL, Dickson JL, et al., 2020, Lung Screen Uptake Trial: results from a single lung cancer screening round, THORAX, Vol: 75, Pages: 908-912, ISSN: 0040-6376
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- Citations: 12
Feary J, Parfrey H, Burge S, et al., 2020, Interstitial Lung Disease (ILD) in aluminium welders, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
George P, Hida T, Putman R, et al., 2020, Hiatus hernia and interstitial lung abnormalities, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Flaherty KR, Wells AU, Cottin V, et al., 2020, Effects of nintedanib on progression of ILD in patients with fibrosing ILDs and a progressive phenotype: further analyses of the INBUILD trial, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Nicholson AG, Osborn M, Devaraj A, et al., 2020, COVID-19 related lung pathology: old patterns in new clothing?, Histopathology, Vol: 77, Pages: 169-172, ISSN: 0309-0167
Nair A, Rodrigues JCL, Hare SS, et al., 2020, A British Society of Thoracic Imaging statement: considerations in designing local imaging diagnostic algorithms for the COVID-19 pandemic. A reply, CLINICAL RADIOLOGY, Vol: 75, Pages: 637-637, ISSN: 0009-9260
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- Citations: 1
Patel BV, Arachchillage DJ, Ridge CA, et al., 2020, Pulmonary angiopathy in severe COVID-19: physiologic, imaging and hematologic observations, American Journal of Respiratory and Critical Care Medicine, Vol: 202, Pages: 690-699, ISSN: 1073-449X
Rationale: Clinical and epidemiologic data in coronavirus disease 2019 (Covid-19) have accrued rapidly since the outbreak but few address the underlying pathophysiology. Objectives: To ascertain the physiologic, hematologic and imaging basis of lung injury in severe Covid-19 pneumonia. Methods: Clinical, physiologic and laboratory data were collated. Radiologic (computed tomography pulmonary angiography [CTPA, n=39] and dual-energy CT [DECT, n=20]) studies were evaluated: observers quantified CT patterns (including the extent of abnormal lung and the presence/extent of dilated peripheral vessels) and perfusion defects on DECT. Coagulation status was assessed using thromboelastography (TEG). Measurements and Results: In 39 consecutive patients (M:F 32:7; mean age, 53±10 years [range 29-79 years]; black and ethnic minority, n=25 [64%]), there was a significant vascular perfusion abnormality and increased physiologic dead-space (dynamic compliance, 33.7±14.7 mls/cmH2O; Murray Lung Injury Score, 3.14±0.53; mean ventilatory ratios, 2.6±0.8) with evidence of hypercoagulability and fibrinolytic ‘shutdown’. The mean CT extent (±SD) of normally-aerated lung, ground-glass opacification and dense parenchymal opacification were 23.5±16.7%, 36.3±24.7% and 42.7±27.1%, respectively. Dilated peripheral vessels were present in 21/33 (63.6%) patients with at least two assessable lobes (including 10/21 [47.6%] with no evidence of acute pulmonary emboli). Perfusion defects on DECT (assessable in 18/20 [90%]), were present in all patients (wedge-shaped, n=3; mottled, n= 9; mixed pattern, n=6). Conclusions: Physiologic, hematologic and imaging data show not only the presence of a hypercoagulable phenotype in severe Covid-19 pneumonia but also markedly impaired pulmonary perfusion likely caused by pulmonary angiopathy and thrombosis.
AbdulJabbar K, Raza SEA, Rosenthal R, et al., 2020, Geospatial immune variability illuminates differential evolution of lung adenocarcinoma., Nat Med, Vol: 26, Pages: 1054-1062
Remarkable progress in molecular analyses has improved our understanding of the evolution of cancer cells toward immune escape1-5. However, the spatial configurations of immune and stromal cells, which may shed light on the evolution of immune escape across tumor geographical locations, remain unaddressed. We integrated multiregion exome and RNA-sequencing (RNA-seq) data with spatial histology mapped by deep learning in 100 patients with non-small cell lung cancer from the TRACERx cohort6. Cancer subclones derived from immune cold regions were more closely related in mutation space, diversifying more recently than subclones from immune hot regions. In TRACERx and in an independent multisample cohort of 970 patients with lung adenocarcinoma, tumors with more than one immune cold region had a higher risk of relapse, independently of tumor size, stage and number of samples per patient. In lung adenocarcinoma, but not lung squamous cell carcinoma, geometrical irregularity and complexity of the cancer-stromal cell interface significantly increased in tumor regions without disruption of antigen presentation. Decreased lymphocyte accumulation in adjacent stroma was observed in tumors with low clonal neoantigen burden. Collectively, immune geospatial variability elucidates tumor ecological constraints that may shape the emergence of immune-evading subclones and aggressive clinical phenotypes.
Devaraj A, 2020, Important lessons for infection control in radiology departments during the COVID-19 pandemic, EUROPEAN RADIOLOGY, Vol: 30, Pages: 3599-3599, ISSN: 0938-7994
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- Citations: 4
Ruparel M, Quaife SL, Dickson JL, et al., 2020, Prevalence, Symptom Burden, and Underdiagnosis of Chronic Obstructive Pulmonary Disease in a Lung Cancer Screening Cohort, ANNALS OF THE AMERICAN THORACIC SOCIETY, Vol: 17, Pages: 869-878, ISSN: 1546-3222
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- Citations: 36
Biswas D, Birkbak NJ, Rosenthal R, et al., 2020, Publisher Correction: A clonal expression biomarker associates with lung cancer mortality., Nat Med, Vol: 26
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Joshi K, de Massy MR, Ismail M, et al., 2020, Publisher Correction: Spatial heterogeneity of the T cell receptor repertoire reflects the mutational landscape in lung cancer., Nat Med, Vol: 26
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Chemi F, Rothwell DG, McGranahan N, et al., 2020, Publisher Correction: Pulmonary venous circulating tumor cell dissemination before tumor resection and disease relapse., Nat Med, Vol: 26
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
Folgoc LL, Baltatzis V, Alansary A, et al., 2020, Bayesian sampling bias correction: training with the right loss function, Publisher: arXiv
We derive a family of loss functions to train models in the presence ofsampling bias. Examples are when the prevalence of a pathology differs from itssampling rate in the training dataset, or when a machine learning practionerrebalances their training dataset. Sampling bias causes large discrepanciesbetween model performance in the lab and in more realistic settings. It isomnipresent in medical imaging applications, yet is often overlooked attraining time or addressed on an ad-hoc basis. Our approach is based onBayesian risk minimization. For arbitrary likelihood models we derive theassociated bias corrected loss for training, exhibiting a direct connection toinformation gain. The approach integrates seamlessly in the current paradigm of(deep) learning using stochastic backpropagation and naturally with Bayesianmodels. We illustrate the methodology on case studies of lung nodule malignancygrading.
Kouranos V, Ward S, Kokosi MA, et al., 2020, Mixed ventilatory defects in pulmonary sarcoidosis: prevalence and clinical features., Chest, Vol: 158, Pages: 2007-2014, ISSN: 0012-3692
BACKGROUND: In cohort studies of pulmonary sarcoidosis, abnormal ventilatory patterns have generally been sub-divided into restrictive and obstructive defects. Mixed ventilatory defects have been largely overlooked in pulmonary sarcoidosis as total lung capacity (TLC) has seldom been taken into account in historical series. RESEARCH QUESTION: We evaluated the prevalence of mixed disease in pulmonary sarcoidosis and its clinical associations. STUDY DESIGN: and Methods: In patients with pulmonary sarcoidosis (n=1110), mixed defects were defined using ATS/ERS criteria. Clinical data, pulmonary function variables and vital status were abstracted from clinical records. Chest radiographs were evaluated independently by two experienced radiologists. RESULTS: The prevalence of a mixed ventilatory defect was 10.4% in the whole cohort, rising to 25.9% in patients with airflow obstruction. When compared to isolated airflow obstruction, mixed defects were associated with lower DLco levels (50.7 ± 16.3 versus 70.8 ± 18.1, p<0.0001), a higher prevalence of chest radiographic stage IV disease (63.5% versus 38.3%, p<0.0001), and higher mortality (HR 2.36; 95% CI 1.34, 4.15; p=0.003). These findings were reproduced in all patient sub-group analyses, including patients with a histologic diagnosis, a clinical diagnosis, incident disease and prevalent disease. INTERPRETATION: Mixed disease is present in approximately 25% of pulmonary sarcoidosis patients with airflow obstruction and is associated with lower DLco levels, a higher prevalence of stage IV disease and higher mortality than seen in a pure obstructive defect. These observations identify a distinct phenotype associated with a mixed ventilatory defect, justifying future studies of its clinical and pathogenetic significance.
Veronesi G, Baldwin DR, Henschke CI, et al., 2020, Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe, CANCERS, Vol: 12
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- Citations: 35
Kauczor H-U, Baird A-M, Blum TG, et al., 2020, ESR/ERS statement paper on lung cancer screening., Eur Radiol, Vol: 30, Pages: 3277-3294
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• R
Chua F, Armstrong-James D, Desai SR, et al., 2020, The role of CT in case ascertainment and management of COVID-19 pneumonia in the UK: insights from high-incidence regions, The Lancet Respiratory Medicine, Vol: 8, Pages: 438-440, ISSN: 2213-2600
Wells AU, Flaherty KR, Brown KK, et al., 2020, Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial, LANCET RESPIRATORY MEDICINE, Vol: 8, Pages: 453-460, ISSN: 2213-2600
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- Citations: 257
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