Wesley T Smith1, Kenneth T Shiao2, Elena Varotto2, Yinmei Zhou3, Mayuko Iijima2, Doralina L Anghelescu4, Cheng Cheng3, Sima Jeha5, Ching-Hon Pui6, Sue C Kaste7, Hiroto Inaba8. 1. Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN; Department of Pediatrics, Section of Hematology/Oncology, Baylor College of Medicine, Houston, TX. 2. Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN. 3. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN. 4. Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN. 5. Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN; Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN. 6. Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN; Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN. 7. Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN; Department of Radiology, University of Tennessee Health Science Center, Memphis, TN. 8. Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN. Electronic address: hiroto.inaba@stjude.org.
Abstract
OBJECTIVE: To evaluate the diagnostic yield of baseline chest radiographs (CXRs) of children with acute lymphoblastic leukemia (ALL). STUDY DESIGN: We reviewed the CXR findings at diagnosis for 990 patients aged 1-18 years with ALL treated during the Total XV and XVI studies at St. Jude Children's Research Hospital and evaluated the associations of these findings with clinical characteristics and initial management. RESULTS: Common findings were peribronchial/perihilar thickening (n = 187 [19.0%]), pulmonary opacity/infiltrate (n = 159 [16.1%]), pleural effusion/thickening (n = 109 [11.1%]), mediastinal mass (n = 107 [10.9%]), and cardiomegaly (n = 68 [6.9%]). Portable CXRs provided results comparable with those obtained with 2-view films. Forty of 107 patients with a mediastinal mass (37.4%) had tracheal deviation/compression. Mediastinal mass, pleural effusion/thickening, and tracheal deviation/compression were more often associated with T-cell ALL than with B-cell ALL (P < .001 for all). Pulmonary opacity/infiltrate was associated with younger age (P = .003) and was more common in T-cell ALL than in B-cell ALL (P = .001). Peribronchial/perihilar thickening was associated with younger age (P < .001) and with positive central nervous system disease (P = .012). Patients with cardiomegaly were younger (P = .031), more often black than white (P = .007), and more often categorized as low risk than standard/high risk (P = .017). Patients with a mediastinal mass, pleural effusion/thickening, tracheal deviation/compression, or pulmonary opacity/infiltrate were more likely to receive less invasive sedation and more intensive care unit admissions and respiratory support (P ≤ .001 for all). Cardiomegaly was associated with intensive care unit admission (P = .008). No patients died of cardiorespiratory events during the initial 7 days of management. CONCLUSIONS: The CXR can detect various intrathoracic lesions and is helpful in planning initial management.
OBJECTIVE: To evaluate the diagnostic yield of baseline chest radiographs (CXRs) of children with acute lymphoblastic leukemia (ALL). STUDY DESIGN: We reviewed the CXR findings at diagnosis for 990 patients aged 1-18 years with ALL treated during the Total XV and XVI studies at St. Jude Children's Research Hospital and evaluated the associations of these findings with clinical characteristics and initial management. RESULTS: Common findings were peribronchial/perihilar thickening (n = 187 [19.0%]), pulmonary opacity/infiltrate (n = 159 [16.1%]), pleural effusion/thickening (n = 109 [11.1%]), mediastinal mass (n = 107 [10.9%]), and cardiomegaly (n = 68 [6.9%]). Portable CXRs provided results comparable with those obtained with 2-view films. Forty of 107 patients with a mediastinal mass (37.4%) had tracheal deviation/compression. Mediastinal mass, pleural effusion/thickening, and tracheal deviation/compression were more often associated with T-cell ALL than with B-cell ALL (P < .001 for all). Pulmonary opacity/infiltrate was associated with younger age (P = .003) and was more common in T-cell ALL than in B-cell ALL (P = .001). Peribronchial/perihilar thickening was associated with younger age (P < .001) and with positive central nervous system disease (P = .012). Patients with cardiomegaly were younger (P = .031), more often black than white (P = .007), and more often categorized as low risk than standard/high risk (P = .017). Patients with a mediastinal mass, pleural effusion/thickening, tracheal deviation/compression, or pulmonary opacity/infiltrate were more likely to receive less invasive sedation and more intensive care unit admissions and respiratory support (P ≤ .001 for all). Cardiomegaly was associated with intensive care unit admission (P = .008). No patientsdied of cardiorespiratory events during the initial 7 days of management. CONCLUSIONS: The CXR can detect various intrathoracic lesions and is helpful in planning initial management.
Authors: Jinghui Zhang; Li Ding; Linda Holmfeldt; Gang Wu; Sue L Heatley; Debbie Payne-Turner; John Easton; Xiang Chen; Jianmin Wang; Michael Rusch; Charles Lu; Shann-Ching Chen; Lei Wei; J Racquel Collins-Underwood; Jing Ma; Kathryn G Roberts; Stanley B Pounds; Anatoly Ulyanov; Jared Becksfort; Pankaj Gupta; Robert Huether; Richard W Kriwacki; Matthew Parker; Daniel J McGoldrick; David Zhao; Daniel Alford; Stephen Espy; Kiran Chand Bobba; Guangchun Song; Deqing Pei; Cheng Cheng; Stefan Roberts; Michael I Barbato; Dario Campana; Elaine Coustan-Smith; Sheila A Shurtleff; Susana C Raimondi; Maria Kleppe; Jan Cools; Kristin A Shimano; Michelle L Hermiston; Sergei Doulatov; Kolja Eppert; Elisa Laurenti; Faiyaz Notta; John E Dick; Giuseppe Basso; Stephen P Hunger; Mignon L Loh; Meenakshi Devidas; Brent Wood; Stuart Winter; Kimberley P Dunsmore; Robert S Fulton; Lucinda L Fulton; Xin Hong; Christopher C Harris; David J Dooling; Kerri Ochoa; Kimberly J Johnson; John C Obenauer; William E Evans; Ching-Hon Pui; Clayton W Naeve; Timothy J Ley; Elaine R Mardis; Richard K Wilson; James R Downing; Charles G Mullighan Journal: Nature Date: 2012-01-11 Impact factor: 49.962
Authors: Ching-Hon Pui; John T Sandlund; Deqing Pei; Gaston K Rivera; Scott C Howard; Raul C Ribeiro; Jeffrey E Rubnitz; Bassem I Razzouk; Melissa M Hudson; Cheng Cheng; Susana C Raimondi; Frederick G Behm; James R Downing; Mary V Relling; William E Evans Journal: JAMA Date: 2003-10-15 Impact factor: 56.272
Authors: H T Winer-Muram; S A Rubin; B D Fletcher; W M Kauffman; S G Jennings; K L Arheart; P M Bozeman Journal: Radiology Date: 1994-10 Impact factor: 11.105
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