Nantaka Kiranantawat

Objectives: To assess inter-rater agreement and diagnostic performance of six United States National Institute for Occupational Safety and Health-certified B readers (physicians certified in standardized chest X-ray (CXR) classification for pneumoconiosis) in diagnosing tuberculosis (TB) on CXR, with the goal of developing a reliable dataset to support external validation of artificial intelligence (AI) models for TB detection. Materials and methods: 1097 CXRs from five institutions were analyzed by six B readers. Patients aged ≥ 15 years were included, excluding those with HIV or opportunistic infections. CXRs were classified as unremarkable or abnormal. Abnormalities were categorized using a modified International Labor Organization classification and classified as consistent or inconsistent with TB. Microbiological references included sputum smears, cultures, or molecular tests. Descriptive statistics summarized the CXR and microbiological findings. Inter-rater agreement was assessed with Fleiss’ kappa. Diagnostic performance was evaluated by comparing CXR findings to microbiological references. Results: Of the 3117 readings, 69% of CXRs were abnormal, and 31% were unremarkable. Microbiological results confirmed that 87% of abnormal CXRs were TB cases, while 83% of unremarkable CXRs were non-TB. Inter-rater agreements were κ = 0.83 for all findings, κ = 0.67 for findings consistent with TB, and κ = 0.76 for active TB findings. For findings consistent with TB, the sensitivity, specificity, and accuracy ranged from 77.2% to 91.1%, 87.4% to 98.6%, and 84.1% to 90.1%, respectively. Conclusion: B readers exhibited strong agreement and high accuracy in diagnosing TB on CXR, providing a robust dataset that could be used for external validation of AI models in TB diagnosis. Critical relevance statement: With substantial inter-rater agreement and strong diagnostic performance, B readers’ interpretations of CXRs provide a reliable dataset to support external validation of AI models for TB diagnosis. Key Points: B readers can provide a reliable reference for validating AI models in TB diagnosis. Less variability and high accuracy were observed among B readers in CXR-based TB diagnosis.

Objective: Pleural procedure-related tumor seeding detected by computed tomography (CT) is common in lung cancer patients with malignant pleural effusion. This study aimed to identify the incidence of tumor seeding and the associated factors among lung cancer patients with malignant pleural effusions. Material and Methods: This retrospective cohort study was conducted on 146 lung cancer patients with malignant pleural effusions, diagnosed between 2010 and 2017, who underwent at least 1 pleural procedure and had at least 2 series of CT images. The potential factors were categorized into clinical characteristics, pleural characteristics, treatment factors, and pleural procedures. Incidence rate ratios (IRR) were analyzed by Poisson regression to identify factors that were independently associated with tumor seeding. Results: The incidence of procedure-related tumor seeding was 26%. Significantly increased IRRs of tumor seeding were found in relation to 1 time (IRR 5.653, 95% confidence interval [CI] 2.549 to 12.538) and ≥2 times of conventional intercostal chest drainage (ICD) insertion (IRR 5.837, 95% CI 1.768 to 19.266), 1 time (IRR 8.924, 95% CI 3.181 to 25.033) and ≥2 times of pleural biopsy (IRR 6.485, 95% CI 1.372 to 30.660), adenocarcinoma (IRR 8.329, 95% CI 2.804 to 24.747), and pleural thickening (IRR 12.458, 95% CI 1.360 to 114.152). Conclusion: Patients who had at least one pleural biopsy or ICD insertion, pleural fluid cytology positive or suspicious for malignancy, adenocarcinoma, or pleural thickening were found to be significantly at risk for tumor seeding.

The differential diagnosis of multiple lesions in the airway is mainly metastasis and multiple solitary plasmacytoma.

Teaching point: The probable mechanism of pseudoaneurysm formation related to metastatic neoplasm is a tumor embolus penetrating and destroying the vessel wall.

To investigate the predictive factors for a non-diagnostic result and the final diagnosis of pulmonary lesions with an initial non-diagnostic result on CT-guided percutaneous transthoracic needle biopsy. All percutaneous transthoracic needle biopsies performed over a 4-year period were retrospectively reviewed. The initial pathological results were classified into three categories-malignant, benign, and non-diagnostic. A non-diagnostic result was defined when no malignant cells were seen and a specific benign diagnosis could not be made. The demographic data of patients, lesions' characteristics, technique, complications, initial pathological results, and final diagnosis were reviewed. Statistical analysis was performed using binary logistic regression. Of 894 biopsies in 861 patients (male:female, 398:463; mean age 67, range 18-92 years), 690 (77.2%) were positive for malignancy, 55 (6.2%) were specific benign, and 149 (16.7%) were non-diagnostic. Of the 149 non-diagnostic biopsies, excluding 27 cases in which the final diagnosis could not be confirmed, 36% revealed malignant lesions and 64% revealed benign lesions. Predictive factors for a non-diagnostic biopsy included the size ≤ 15 mm, needle tract traversing emphysematous lung parenchyma, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Non-diagnostic biopsies with a history of malignancy or atypical cells on pathology were more likely to be malignant (p = 0.043 and p = 0.001). The predictive factors for a non-diagnostic biopsy were lesion size ≤ 15 mm, needle tract traversing emphysema, introducer needle outside the lesion, procedure time > 60 minutes, and presence of alveolar hemorrhage. Thirty-six percent of the non-diagnostic biopsies yielded a malignant diagnosis. In cases with a history of malignancy or the presence of atypical cells in the biopsy sample, a repeat biopsy or surgical intervention should be considered.

Introduction: Pleural procedures are performed to prove the diagnosis of pleural effusion. This study was to assess the incidence and outcome of pleural procedure‐related tumour seeding in lung cancer with malignant pleural effusion, and to review the characteristics of the implanted tumours on computed tomography (CT) images.Methods: From January 2008 to December 2010, 165 patients with the diagnosis of lung cancer with malignant pleural effusion, who underwent at least one pleural procedure and had follow‐up CT, were included. Two radiologists retrospectively reviewed the presence of implanted tumours and their manifestations on CT images. The incidence of tumour seeding, the time to tumour seeding, and hazard ratios for death associated with the procedures and presence of tumour seeding were evaluated. Multivariable logistic regression analysis was used to identify variables that were independently associated with procedure‐related tumour seeding.Results: The incidence of procedure‐related tumour seeding was 22.4%. Conventional intercostal drainage (ICD) was the independent predictor of tumour seeding. Patients with a history of ICD rapidly developed implanted tumours (P = 0.0319). The estimated mean time of tumour seeding was 2.9 months. There was an increased risk of death with the presence of tumour seeding (HR: 3.35, 95% CI: 1.87–6.01). The majority of CT features showed ill‐defined margins with heterogeneous enhancement.Conclusion: Pleural procedure‐related tumour seeding in lung cancer with malignant pleural effusion is common. There was a significantly increased risk of death with the presence of tumour seeding. The majority of the CT features in implanted tumours were ill‐defined margins with heterogeneous enhancement.

Explore the definitive diagnoses of imaging-guided transthoracic needle biopsies (TNB) with a pathological result of benign non-specific diagnosis in a tuberculosis-endemic area. The secondary goal was to characterize the initial CT imaging findings between malignancy and benign lesions. All TNB diagnoses considered to have benign non-specific features at the Radiology Department between January 2007 andDecember 2011 were retrospectively reviewedfor definitive diagnosis based on clinical impressions andfor CT imaging characteristics. Sixty-seven cases with TNB were given a benign non-specific diagnosis and had complete pathologic or radiologic follow-ups. Of these 67 cases, 16 (23.9%) were malignant and 51 were benign. Two main definitive diagnoses of benign cases were pulmonary tuberculosis (32.8%) and pneumonia/lung abscess (23.9%). On the CT images, most of lesions in the group of pulmonary tuberculosis (14/22, 63.6%) were not enhanced after contrast administration (p < 0.005), and necrotic mediastinal lymph nodes were significantly found more in final malignancy diagnoses (p < 0.005). The definitive diagnoses of benign non-specific diagnoses based on TNB in this tuberculosis-endemic area had a high rate of both malignancy and pulmonary tuberculosis. Hence, repeated biopsies or radiological follow-ups are advised.

To evaluate the outcome and safety of ultrasound-guided percutaneous catheter drainage of exudative pleural effusion. The present study was a retrospective analysis of 412 pleural effusions from 373 patients that underwent ultrasound-guided small-bore catheter drainage in exudative pleural effusions between 2004 and 2009. The two most common causes for drainage were parapneumonic effusion or empyema (52.2%) and malignant effusion (30.3%), while the remains were trauma, iatrogenic, and others. Overall clinical success rate was 76.5%. The success rate was lower among malignant pleural effusion (p = 0.003). Causes of effusion were the only independent predictors related to success. Only five (1.2%) patients developed complication during the procedure. Seventy-five of 412 effusions (15.8%) developed complication during the period of drainage; the majority were drain blockage (9%) and accidental dislodgment (4.1%). Ultrasound-guided small-bore catheter drainage was a safe and efficient procedure for exudative pleural effusions.