Клініко-морфологічна діагностика доброякісних одиночних вогнищевих уражень легень без некротичних змін
Bibliographic record
Abstract
Цитуйте українською у Ванкувер стилі: Ліскіна ІВ, Мельник ОО, Загаба ЛМ, Кузовкова СД, Гренчук АФ. Клініко-морфологічна діагностика доброякісних одиночних вогнищевих уражень легень без некротичних змін. Медицина сьогодні і завтра. 2023;92(4):17-29. https://doi.org/10.35339/msz.2023.92.4.lmz Архівовано: https://doi.org/10.5281/zenodo.14824878 Резюме В останні роки при рентгенологічному дослідженні або комп’ютерній томографії легень нерідко виявляють одиночні, невеликого розміру, вогнища, етіологія яких зазвичай невідома. Метою роботи було провести аналіз діагностичної значущості клініко-рентгенологічних даних та морфологічних ознак за гістологічним дослідженням доброякісних одиночних вогнищевих уражень легень без некротичних змін із урахуванням заключного клінічного діагнозу. Проаналізовано клініко-рентгенологічні дані 42 пацієнтів, гістологічні висновки за матеріалом видалених легеневих вогнищ та заключні клінічні діагнози. Тканину вогнищевого утвору отримували як за допомогою мініінвазивних процедур, так і при звичайних оперативних втручаннях. Встановлено, що рентгенологічно частіше діагностували солітарне легеневе вогнище (34 випадки або 81,0 %); а за етіологією переважали обмежений хронічний запальний процес або післязапальні фіброзні зміни, загалом у 29 (69,0 %) пацієнтів. Результати показали, що за основними радіографічними показниками – локалізацією, розміром, формою, характеристикою внутрішнього вмісту, чітко визначити доброякісний характер не некротизованих вогнищевих уражень легень у переважній більшості випадків неможливо. Саме морфологічне дослідження тканини таких утворень забезпечує встановлення діагнозу в більшості випадків, у нашому дослідженні – в 83,3 % пацієнтів. Ключові слова: доброякісні не некротизовані вогнищеві ураження легень, рентгенологічні показники, гістологічна діагностика. Cite in English in Vancouver style: Liskina I, Melnyk O, Zagaba L, Kuzovkova S, Grenchuk A. Clinical and morphological diagnostics of bening single focal lung lesions without necrotic changes. Medicine Today and Tomorrow. 2023;92(4):17-29. https://doi.org/10.35339/msz.2023.92.4.lmz [in Ukrainian]. Archived: https://doi.org/10.5281/zenodo.14824878 Abstract In recent decades, the problem of accidental detection by radiography or chest computer tomography of solitary focal formations smaller than 3 cm has become relevant. Although the primary task is to find out its benign or malignant nature as soon as possible, the clarification of the etiology of benign formations with non-neoplastic genesis retains an important clinical significance, in particular in cases of their infectious nature. The purpose of the study was to analyze the diagnostic significance of clinical and radiological data and morphological features of benign single focal lung lesions without necrotic changes, taking into account the final clinical diagnosis. The study group consisted of 42 patients with single benign focal lung lesions without necrosis. Among them there were 29 (69.0%) women and 13 (31.0%) men. Average age of the patients was (50.5±2.2) years. The total number of focal formations was 52. According to the number of focal formations, one patient was diagnosed with 1 formation in 34 cases, 2 formations in 6, and 3 formations in 2 cases. The dimensions of each of the formations did not exceed 30 mm. The most common diagnostic measures were direct biopsy at FBS, 10 (23.8%) cases; and transbronchial biopsy of lung under radiological control, 16 (38.1%) cases respectively. Among the operative interventions, lobe resection of the lung with a focus was mainly performed, in 16 (84.2%) cases. According to the results of the histological examination and taking into account the clinical and laboratory data, the following diagnoses were obtained, which corresponded to the final clinical diagnosis of the patients. A lung abscess was established in 4 (9.5%) cases; a chronic inflammatory process of a non-specific nature was diagnosed in 14 (33.3%) cases. Predominantly post-inflammatory changes and local pneumofibrosis were determined in 15 (35.7%) cases. Vascular malformation and pulmonary sarcoidosis were diagnosed once. In another 7 (16.7%) cases, the final clinical diagnosis was based on clinical and laboratory data and patient supervision - in 2 observations, the final diagnosis of chronic non-specific pulmonary disease was made; and in 5 cases, the nature of single focal pulmonary formations was not established. The most numerous subgroups were cases with a chronic nonspecific inflammatory process and with limited post-inflammatory changes (in total, they amounted to 69.0%), so the clinical and radiological indicators of these subgroups were analyzed more detail. Overall clinical data did not differ significantly between both subgroups. Females predominated in the group with post-inflammatory changes. The number of focal lesions in both lungs was equal; the upper lobes were more often affected. The average size of foci was significantly larger in patients with a chronic inflammatory process and was 22.2 mm compared to 16.3 mm in the subgroup with post-inflammatory changes (p<0.05). Single foci with minimal destructive changes were observed only in the subgroup with a chronic inflammatory process. As a result of the research, such findings were obtained. Among benign single non-necrotized focal pulmonary lesions chronic non-specific inflammatory process and post-inflammatory fibrotic changes, including focal pneumofibrosis, predominate in etiology. In our study, they accounted for 69% of all cases. According to the main radiological indicators (localization, size, shape, characteristics of the internal contents) it is impossible correct determination of the benign nature of non-necrotized focal lung lesions in the vast majority of cases. Histological examination of tissue of focal lesions not only determines benign or malignant nature of the formations, but also, in the case of their benign nature, allows clarify their etiology in most cases (83.3%). Keywords: benign non-necrotized focal lung lesions, X-ray indicators, histological diagnostics.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.004 |
| Science and technology studies | 0.005 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.058 | 0.226 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".