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Ren Yuan



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    MA03 - Lung Cancer Screening - Next Step (ID 896)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 10:30 - 12:00, Room 206 AC
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      MA03.02 - Prospective Evaluation of the Clinical Utility of the International Lung Screen Trial Lung Nodule Management Protocol (ID 14043)

      10:35 - 10:40  |  Author(s): Ren Yuan

      • Abstract
      • Presentation
      • Slides

      Background

      Several protocols are available to guide management of lung nodules identified by low-dose screening CT. It is important to objectively assess their clinical utility in order to weigh the potential harm versus potential beneficial impacts of the following: early recall imaging studies/biopsy and health care resource utilization. We aimed to prospectively evaluate clinical utility of the PanCan lung nodule management protocol in the International Lung Screen Trial (ILST).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Ever smokers age 55 to 80 years were enrolled into ILST if they has a ≥30 pack-years smoking history and smoked within 15 years or if their PLCO m2012 6 year lung cancer risk was ≥1.51%. Figure 1 shows the ILST lung nodule management protocol based on the PanCan nodule malignancy risk calculator (NEJM 2013;369:908 & BMJ 2014;348:g2253).

      4c3880bb027f159e801041b1021e88e8 Result

      Since July 2016, 757 ever smokers (mean age 65 years, 44% female, 15% non-Caucasian) had been enrolled. The distribution of malignancy risk categories (CAT) were: CAT1 70%, CAT2 15%, CAT3 11%, CAT4 3.5%, CAT5 0.4%. CT biopsy or bronchoscopic biopsy for diagnosis/staging was done in 16/26 CAT 4 (62%) and 7/84 CAT 3 (8%) participants. Lung cancer was confirmed in 15/757 (2%). Thus far, surgery was performed in 9 CAT 4 and 2 CAT 3 participants, with one benign resection (9%) for a growing FDG avid nodule. Of the 3 CAT5 participants, one was found to have granulomatous changes in an enlarged paratracheal lymph node and two had segmental atelectasis due to mucoid impaction.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The ILST protocol triaged 70% of the screening cohort with low malignancy risk to biennial screening instead of annual repeat screening. Participants with high malignancy risk (CAT 4+5) were triaged to a diagnostic pathway (4%). Our preliminary results suggest the ILST protocol may decrease resource utilization and potentially minimize risk of screening for participants.

      figure1 ilst lung nodule management protocol.jpg

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P1.11 - Screening and Early Detection (Not CME Accredited Session) (ID 943)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.11-10 - Optimizing Radiomics Features by Minimizing Boundary Effects and Normalizing with Opposite Lung Tissue Characteristics (ID 14062)

      16:45 - 18:00  |  Author(s): Ren Yuan

      • Abstract
      • Slides

      Background

      For wide adoption of LDCT screening it is thought that CAD will likely by necessary. We hypothesize that CAD features that minimizes perimeter effects and normalizes nodule CT features using the lung parenchyma from the opposite lung will improve the ability to determine nodule malignancy.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We have developed a CAD system that includes lung tissue segmentation, nodule detection and feature extraction from the segmented nodule, the segmented nodule minus the perimeter transition pixels (Core), and the opposite lung parenchymal tissue. (See Figure 1).

      We use the Mann-Whitney U test to compare teh discriminating ability of individual features and combinations of features) extracted from the nodule, nodule core and nodule normalized by mirror region features.

      figure-1 (1).jpg

      4c3880bb027f159e801041b1021e88e8 Result

      In total, 34 early small suspect baseline nodules detected as part of the PanCan screening trial were used, these include 17 nodules proven to be cancer and 17 nodules that resolved on follow-up scans. The comparison of classification ability of features from nodules without edge vs. nodules with edge pixels reveals that the core features show better classification ability for 76 out of the 136 calculated features.

      Performing a leave-one-out LDA classifier cross-validation approach in using core features, gives an accuracy of 76% with only 1 feature through 3 features, and 82% with 4 features. However, repeating the same experiment for core plus edge features, shows accuracy of 67% with only 1 feature, 73% with 3 features, 79% with 4 features. Normalizing the core texture features by the texture features of the mirrored region in the opposite lung shows an improved classification ability for 52 out of the 89 texture features.

      8eea62084ca7e541d918e823422bd82e Conclusion

      In this study, the results suggest using the nodule core improves feature classification as does normalizing of the nodule by the mirrored region in opposite lung.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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