Publications
283 results found
Khiroya R, Macaluso C, Montero MA, et al., 2017, Pleuroparenchymal Fibroelastosis: A Review of Histopathologic Features and the Relationship Between Histologic Parameters and Survival., American Journal of Surgical Pathology, Vol: 41, Pages: 1683-1689, ISSN: 0147-5185
Pleuroparenchymal fibroelastosis (PPFE) is now a defined clinicopathologic entity in the updated 2013 ATS/ERS classification of idiopathic interstitial pneumonias (IIPs), which has led to a significant increase in cases being diagnosed at our institution. We have therefore reviewed 43 PPFE cases (58 biopsies in total) to assess whether any clinical or histopathologic features provide prognostic information. A semiquantatitive grading system was used to assess extent of fibroblastic foci, intra-alveolar fibroelastosis, visceral pleural fibrosis, chronic inflammation in areas of fibrosis, vascular fibrointimal thickening, and presence of granulomas. Other patterns of interstitial lung disease were also noted, if present. All biopsies showed intra-alveolar fibroelastosis, fibroblastic foci at the leading edge of fibrosis and chronic inflammation within areas of fibrosis, 91% showed vascular fibrointimal thickening of vessels, 73% showed pleural fibrosis, and 35% showed granulomas. Ten cases showed a coexistent IIP (5 usual IIP, 5 showed features of hypersensitivity pneumonitis). There was no significant correlation with mortality and severity of histologic parameters, other than a significant decrease in mortality in PPFE with coexistent granulomas, after adjusting for age and gender (hazard ratio, 0.27; P=0.049). Male gender was also associated with an increased risk of mortality, after adjusting for age (hazard ratio, 4.8; P=0.045). PPFE is more common than previously thought, not infrequently showing coexistent pathology, specifically usual interstitial pneumonia and granulomatous lung disease, our data suggesting the latter may have prognostic significance.
Robbie H, Wells A, Jacob J, et al., 2017, Novel CT markers of volume loss in idiopathic pulmonary fibrosis (IPF) predict mortality, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
- Author Web Link
- Cite
- Citations: 1
Bax S, Bredy C, Dimopoulos K, et al., 2017, Right ventricular dimensions on CTPA predict pulmonary hypertension and prognosis in interstitial lung disease (ILD), European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Bax S, Bredy C, Dimopoulos K, et al., 2017, Rate of change in main pulmonary artery diameter predicts mortality in interstitial lung disease, European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Bax S, Bredy C, Dimopoulos K, et al., 2017, The composite physiological index strongly predicts mortality in interstitial lung disease (ILD) associated pulmonary hypertension (PH-ILD), European-Respiratory-Society (ERS) International Congress, Publisher: EUROPEAN RESPIRATORY SOC JOURNALS LTD, ISSN: 0903-1936
Devaraj A, van Ginneken B, Nair A, et al., 2017, Use of Volumetry for Lung Nodule Management: Theory and Practice, RADIOLOGY, Vol: 284, Pages: 630-644, ISSN: 0033-8419
- Author Web Link
- Cite
- Citations: 81
Charlton TG, Devaraj A, Wells A, et al., 2017, A rigid solution to a relapsing problem, LANCET RESPIRATORY MEDICINE, Vol: 5, Pages: 760-760, ISSN: 2213-2600
Moser JB, Mak SM, McNulty WH, et al., 2017, The influence of inspiratory effort and emphysema on pulmonary nodule volumetry reproducibility, Clinical Radiology, Vol: 72, Pages: 925-929, ISSN: 0009-9260
AimTo evaluate the impact of inspiratory effort and emphysema on reproducibility of pulmonary nodule volumetry.Materials and methodsEighty-eight nodules in 24 patients with emphysema were studied retrospectively. All patients had undergone volumetric inspiratory and end-expiratory thoracic computed tomography (CT) for consideration of bronchoscopic lung volume reduction. Inspiratory and expiratory nodule volumes were measured using commercially available software. Local emphysema extent was established by analysing a segmentation area extended circumferentially around each nodule (quantified as percent of lung with density of –950 HU or less). Lung volumes were established using the same software. Differences in inspiratory and expiratory nodule volumes were illustrated using the Bland–Altman test. The influences of percentage reduction in lung volume at expiration, local emphysema extent, and nodule size on nodule volume variability were tested with multiple linear regression.ResultsThe majority of nodules (59/88 [67%]) showed an increased volume at expiration. Mean difference in nodule volume between expiration and inspiration was +7.5% (95% confidence interval: –24.1, 39.1%). No relationships were demonstrated between nodule volume variability and emphysema extent, degree of expiration, or nodule size.ConclusionExpiration causes a modest increase in volumetry-derived nodule volumes; however, the effect is unpredictable. Local emphysema extent had no significant effect on volume variability in the present cohort.
Abbosh C, Birkbak NJ, Wilson GA, et al., 2017, Phylogenetic ctDNA analysis depicts early-stage lung cancer evolution, NATURE, Vol: 545, Pages: 446-451, ISSN: 0028-0836
The early detection of relapse following primary surgery for non-small-cell lung cancer and the characterization of emerging subclones, which seed metastatic sites, might offer new therapeutic approaches for limiting tumour recurrence. The ability to track the evolutionary dynamics of early-stage lung cancer non-invasively in circulating tumour DNA (ctDNA) has not yet been demonstrated. Here we use a tumour-specific phylogenetic approach to profile the ctDNA of the first 100 TRACERx (Tracking Non-Small-Cell Lung Cancer Evolution Through Therapy (Rx)) study participants, including one patient who was also recruited to the PEACE (Posthumous Evaluation of Advanced Cancer Environment) post-mortem study. We identify independent predictors of ctDNA release and analyse the tumour-volume detection limit. Through blinded profiling of postoperative plasma, we observe evidence of adjuvant chemotherapy resistance and identify patients who are very likely to experience recurrence of their lung cancer. Finally, we show that phylogenetic ctDNA profiling tracks the subclonal nature of lung cancer relapse and metastasis, providing a new approach for ctDNA-driven therapeutic studies.
Veiga C, Landau D, Devaraj A, et al., 2017, Quantification of radiotherapy-induced mediastinum changes using serial CT imaging, Publisher: ELSEVIER IRELAND LTD, Pages: S938-S939, ISSN: 0167-8140
- Author Web Link
- Cite
- Citations: 1
Devaraj A, 2017, Special issue on thoracic imaging, CLINICAL RADIOLOGY, Vol: 72, Pages: 341-342, ISSN: 0009-9260
Shah A, Donovan J, Marino P, et al., 2017, A lesson in plasticity: a 74-year-old man with plastic bronchitis., Thorax, Vol: 72, Pages: 1055-1057, ISSN: 0040-6376
Wilson R, Devaraj A, 2017, Radiomics of pulmonary nodules and lung cancer, TRANSLATIONAL LUNG CANCER RESEARCH, Vol: 6, Pages: 86-91, ISSN: 2218-6751
- Author Web Link
- Cite
- Citations: 130
Javed M, Sheard S, Robbie H, et al., 2017, Two year audit of CT-guided biopsy for lung cancer in emphysema and fibrotic interstitial lung disease patients, LUNG CANCER, Vol: 103, Pages: S16-S17, ISSN: 0169-5002
Baldwin DR, Duffy SW, Devaraj A, et al., 2017, Optimum low dose CT screening interval for lung cancer: the answer from NELSON?, THORAX, Vol: 72, Pages: 6-7, ISSN: 0040-6376
- Author Web Link
- Cite
- Citations: 8
Skevington-Postles L, Akers S, George P, et al., 2016, THE EMERGING ROLE OF AIRWAY CLEARANCE TECHNIQUES IN THE TREATMENT OF INTERSTITIAL LUNG DISEASE, THORAX, Vol: 71, Pages: A174-A174, ISSN: 0040-6376
George PM, Devaraj A, Nicholson AG, et al., 2016, Interactive grand round at The Royal Brompton Hospital: Emerging Interstitial Lung Disease, Publisher: Elsevier: Lancet
George PM, Devaraj A, Nicholson AG, et al., 2016, An emerging interstitial lung disease., Lancet Respiratory Medicine, Vol: 4, Pages: 762-762, ISSN: 2213-2619
Field JK, Duffy SW, Devaraj A, et al., 2016, Implementation planning for lung cancer screening: five major challenges, LANCET RESPIRATORY MEDICINE, Vol: 4, Pages: 685-687, ISSN: 2213-2600
- Author Web Link
- Cite
- Citations: 12
Nair A, Gartland N, Barton B, et al., 2016, Comparing the performance of trained radiographers against experienced radiologists in the UK lung cancer screening (UKLS) trial., British Journal of Radiology, Vol: 89, ISSN: 1748-880X
OBJECTIVE: To compare the performance of radiographers against that of radiologists for CT lung nodule detection in the UK Lung Cancer Screening (UKLS) pilot trial. METHODS: Four radiographers, trained in CT nodule detection, and three radiologists were prospectively evaluated. 290 CTs performed for the UKLS were independently read by 2 radiologists and 2 radiographers. The reference standard comprised all radiologist-identified positive nodules after arbitration of discrepancies. For each radiographer and radiologist, relative sensitivity and average false positives (FPs) per case were compared for all cases read, as well as for subsets of cases read by each radiographer-radiologist combination (10 combinations). RESULTS: 599 nodules in 209/290 (72.1%) CT studies comprised the reference standard. The relative mean (±standard deviation) sensitivity of the four radiographers was 71.6 ± 8.5% compared with 83.3 ± 8.1% for the three radiologists. Radiographers were less sensitive and detected more FPs per case than radiologists in 7/10 and 8/10 radiographer-radiologist combinations, respectively (ranges of difference 11.2-33.8% and 0.4-2.6; p < 0.05). In 3/10 and 2/10 combinations, there was no difference in sensitivity and FPs per case between radiographers and radiologists. For nodules ≥100 mm(3) in volume or ≥5 mm in maximum diameter, radiographers were relatively less sensitive than radiologists in only 5/10 radiographer-radiologist combinations (range of difference 16.1-30.6%; p < 0.05) and not significantly different in the remaining 5/10 combinations. CONCLUSION: Although overall radiographer performance was lower than that of experienced radiologists in this study, some radiographer performances were comparable with that of radiologists. ADVANCES IN KNOWLEDGE: Overall, radiographers were less sensitive than radiologists reading the same CTs and also displayed h
Brain K, Lifford KJ, Carter B, et al., 2016, Long-term psychosocial outcomes of low-dose CT screening: results of the UK Lung Cancer Screening randomised controlled trial., Thorax, Vol: 71, Pages: 996-1005, ISSN: 0040-6376
BACKGROUND: The UK Lung Cancer Screening (UKLS) trial is a randomised pilot trial of low-dose CT (LDCT) screening for individuals at high risk of lung cancer. We assessed the long-term psychosocial impact on individuals participating in the UKLS trial. METHODS: A random sample of individuals aged 50-75 years was contacted via primary care. High-risk individuals who completed T0 questionnaires (baseline) were randomised to LDCT screening (intervention) or usual care (no screening control). T1 questionnaires were sent 2 weeks after baseline scan results or control assignment. T2 questionnaires were sent up to 2 years after recruitment. Measures included cancer distress, anxiety, depression and decision satisfaction. RESULTS: A total of 4037 high-risk individuals were randomised and they completed T0 questionnaires (n=2018 intervention, n=2019 control). Cancer distress was higher at T1 in intervention arm participants who received positive screening results (p≤0.001), but not at T2 (p=0.04). T2 anxiety (p≤0.001) and depression (p≤0.01) were higher in the control arm, but the absolute differences were small and not clinically relevant. At both time points, fewer control than screened participants were satisfied with their decision to participate in UKLS (p≤0.001). Regardless of trial allocation, cancer distress was higher in women (p≤0.01), participants aged ≤65 years (p≤0.001), current smokers (p≤0.001), those with lung cancer experience (p≤0.001) and those recruited from the Liverpool area (p≤0.001). CONCLUSION: Lung cancer screening using LDCT appears to have no clinically significant long-term psychosocial impact on high-risk participants. Strategies for engaging and supporting underserved groups are the key to implement routine lung cancer screening in the UK. TRIAL REGISTRATION NUMBER: ISRCTN 78513845; results.
Viola P, Vroobel KM, Devaraj A, et al., 2016, Follicular dendritic cell tumour/sarcoma: a commonly misdiagnosed tumour in the thorax, Histopathology, Vol: 69, Pages: 752-761, ISSN: 1365-2559
AIMS: Follicular dendritic cell sarcoma is a rare tumour reported to occur occasionally in association with the hyaline-vascular type of Castleman's disease (HVCD). Most cases arise in lymph nodes, although extranodal presentation is described. METHODS AND RESULTS: Clinical, radiological and histological characteristics, including diagnosis on pre-resection material, were assessed in seven intrathoracic cases from five males and two females with a median age of 38 years. Clinical symptoms were related to mass location, six cases presenting within central and/or posterior mediastinal compartments and one within the lungs. Positron emission tomography-computed tomography demonstrated marked fluoro-deoxy-glucose avidity and the prominent vessels traversing the lesions. Four of six cases (67%) were misdiagnosed initially. HVCD was present in three cases. Two cases with high mitotic rates recurred after resection. All were positive for at least one of the follicular dendritic cell markers (CD21, CD35 and CD23). Six of seven cases (86%) show cyclin D1 expression ranging from 5% to 90%. CONCLUSIONS: Follicular dendritic cell sarcoma is often misdiagnosed on biopsy and pathologists need to be aware of the tumour to request the relevant immunohistochemistry, especially in masses presenting in the central/posterior mediastinum with high vascularity and standardized uptake values. Background HVCD appears more common than previously thought.
Chakrabarti AM, Jacobs J, Molyneaux PL, et al., 2016, Smoking-related interstitial lung disease, Clinical Pulmonary Medicine, Vol: 23, Pages: 151-156, ISSN: 1068-0640
Chronic or heavy smoking can lead to different forms of pathologic remodeling in the airways and distal lung. There is an 8% to 19% prevalence of interstitial lung disease (ILD) in chronic smokers who were unaware that they had a lung disorder. Descriptive pathologic and radiologic analyses have enabled a number of clinical diseases to be identified and grouped within a range of smoking-related ILDs. We review the radiology, pathology, and clinical management of pulmonary Langerhans cell histiocytosis, respiratory bronchiolitis-associated ILD, and desquamative interstitial pneumonia. We discuss the difficulties of classification and also where the new entity of airspace enlargement with fibrosis fits into the current grouping. The prognosis for these conditions is variable depending on the intrinsic behavior of each condition. Smoking cessation is the first-line therapy of choice for any smoking-related ILD, whereas treatment with corticosteroids and other agents forms an important, but occasionally futile, intervention.
Baldwin DR, Devaraj A, 2016, Lung cancer risk in new pulmonary nodules: implications for CT screening and nodule management, LANCET ONCOLOGY, Vol: 17, Pages: 849-850, ISSN: 1470-2045
- Author Web Link
- Cite
- Citations: 8
Field JK, Duffy SW, Baldwin DR, et al., 2016, The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer., Health Technology Assessment, Vol: 20, Pages: 1-146, ISSN: 1366-5278
BACKGROUND: Lung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects. OBJECTIVES: To (1) analyse LDCT lung cancer screening in a high-risk UK population, determine optimum recruitment, screening, reading and care pathway strategies; and (2) assess the psychological consequences and the health-economic implications of screening. DESIGN: A pilot randomised controlled trial comparing intervention with usual care. A population-based risk questionnaire identified individuals who were at high risk of developing lung cancer (≥ 5% over 5 years). SETTING: Thoracic centres with expertise in lung cancer imaging, respiratory medicine, pathology and surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire. PARTICIPANTS: Individuals aged 50-75 years, at high risk of lung cancer, in the primary care trusts adjacent to the centres. INTERVENTIONS: A thoracic LDCT scan. Follow-up computed tomography (CT) scans as per protocol. Referral to multidisciplinary team clinics was determined by nodule size criteria. MAIN OUTCOME MEASURES: Population-based recruitment based on risk stratification; management of the trial through web-based database; optimal characteristics of CT scan readers (radiologists vs. radiographers); characterisation of CT-detected nodules utilising volumetric analysis; prevalence of lung cancer at baseline; sociodemographic factors affecting participation; psychosocial measures (cancer distress, anxiety, depression, decision satisfaction); and cost-effectiveness modelling. RESULTS: A total of 247,354 individuals were approached to take part in the trial; 30.7% responded positively to the screening invitation. Recruitment of participants resulted in 2028 in
Molyneaux PL, Jacob J, Chakrabarti A, et al., 2016, Hypersensitivity Pneumonitis, Clinical Pulmonary Medicine, Vol: 23, Pages: 136-141, ISSN: 1068-0640
Hypersensitivity pneumonitis (HP) is a syndrome caused by an exaggerated immune response to the inhalation and subsequent sensitization to a variety of environmental antigenic particles. The pathogenesis remains unclear; however, a "two-hit hypothesis" implicating a pathologic interaction between an environmental antigen and the immune system of a susceptible host seems likely as only a minority of the exposed individuals develop HP. The presentation may be acute, as in bird fancier's lung, the classical form of HP, or more insidiously as the subacute form of chronic HP caused by repeated lowlevel antigenic exposure. Despite these categorizations, there is frequently an overlap between the clinical entities and no guaranteed linear progression through the different pathologic stages. Prompt diagnosis is crucial, and is based on an exposure history, precipitating antibodies to the offending antigen, and a combination of clinical, radiologic, and physiological findings. The mainstay of treatment is allergen avoidance, but systemic steroids are of value for both the subacute and the chronic forms, although they do not alter the longterm outcome. This review summarizes the current knowledge of the pathophysiology of HP and the main entities in the differential diagnosis.
Price LC, Devaraj A, Wort SJ, 2016, Central pulmonary arteries in idiopathic pulmonary fibrosis: size really matters, European Respiratory Journal, Vol: 47, Pages: 1318-1320, ISSN: 1399-3003
Despite the uncertainties of why, when it comes to PH risk in IPF, pulmonary artery size clearly matters http://ow.ly/YlKVy
Devaraj A, Sayer C, Field J, 2016, Computed Tomography Characterisation of Lung Nodules and Management of Incidentally Detected Nodules, MULTIDETECTOR-ROW CT OF THE THORAX, 2ND EDITION, Editors: Schoepf, Meinel, Publisher: SPRINGER INTERNATIONAL PUBLISHING AG, Pages: 183-193, ISBN: 978-3-319-30353-6
Field JK, Duffy SW, Baldwin DR, et al., 2015, UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening, Thorax, Vol: 71, Pages: 161-170, ISSN: 1468-3296
Field JK, Devaraj A, Duffy SW, et al., 2015, CT screening for lung cancer: Is the evidence strong enough?, Lung Cancer, Vol: 91, Pages: 29-35, ISSN: 1872-8332
The prevailing questions at this time in both the public mind and the clinical establishment is, do we have sufficient evidence to implement lung cancer Computed Tomography (CT) screening in Europe? If not, what is outstanding?This review addresses the twelve major areas, which are critical to any decision to implement CT screening and where we need to assess whether we have sufficient evidence to proceed to a recommendation for implementation in Europe. The readiness level of these twelve categories in 2015 have been with colour coded, where green indicates we have sufficient evidence, amber is borderline evidence and red requires further evidence. Recruitment from the ‘Hard to Reach’ community still remains at red, while mortality data, cost effectiveness and screening interval are all categorised as amber. The integration of smoking cessation into CT screening programmes is still considered to be category amber.The US Preventive Services Task Force have recommended that CT screening is implemented in the USA utilising the NLST criteria, apart from continuing screening to 80 years of age. The cost effectiveness of the NLST was calculated to be $81,000/QALY, however, its well recognised that the costs of medical care in the USA, is far higher than that of Europe. Medicare have agreed to cover the cost of screening but have stipulated a number of stringent requirements for inclusion.To date we do not have good CT screening mortality data available in Europe and eagerly await the publication of the NELSON trial data in 2016 and then the pooled UKLS and NELSON data thereafter. However in the meantime we should start planning for implementation in Europe, especially in the areas of the radiological service provision and accreditation, as well as identifying novel mechanisms to recruit from the hardest to reach communities.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.