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A hybrid network integrating convolution and transformer for thymoma segmentation

Intelligent Medicine 2023年第3期3卷 164-172页

作者： Jingyuan Li Wenfang Sun Xiulong Feng Karen Mvon Deneen Wen Wang Guangbin Cui Yi Zhang Center for Brain Imaging School of Life Science and TechnologyXidian UniversityXi'anShaanxi 710126China International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment&Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information School of Life Science and TechnologyXidian UniversityXi'anShaanxi 710126China School of Aerospace Science and Technology Xidian UniversityXi'anShaanxi 710126China Department of Radiology Tangdu HospitalFourth Military Medical UniversityNo.4 Xinsi RoadXi'anShaanxi 710038China

Background Manual segmentation of thymoma is an onerous,labor-intensive,and subjective task for radiologists.Accordingly,the development of an automatic and efficient method for thymoma segmentation can be valuable for the early detection and diagnosis of this malignancy.Methods Three hundred and ten subjects were enrolled in this retrospective study and all underwent CECT scans.All the scans were manually labeled by four experienced radiologists.The successful application of convolution neural networks(CNNs)and Transformer in computer vision led us to propose a hybrid CNN–Transformer architecture,named transformer attention Net(TA-Net),that would allow the utilization of both local information from CNN features and the global information encoded by Transformers.U-Net was used as the basic structure and Transformers were inserted into convolution blocks in the encoder.In addition,attention gates were embedded in skip connections to highlight salient features.Comparison of the accuracy,intersection over Union(IoU),Dice score,and Boundary F1 contour matching score(BFScore)between the predicted segmentation and the manual labels were utilized to evaluate segmentation performance.Results For thymoma segmentation using TA-Net,the accuracy,Dice score,IoU,and BFScore were 92.49%,89.92%,83.80%,and 0.8945,respectively,and no significant differences were detected among tumor types and enhanced phases.Our proposed method achieved the best performance when compared with state-of-the-art methods.Conclusion The proposed method,which combines CNNs with Transformer,achives outstanding performance in thymoma segmentation compared with previous methods.TA-Net may provide consistent and reproducible delineation,thereby assisting radiologists in clinical applications.

关键词： Semantic segmentation Convolution neural network Transformer Attention mechanism thymoma

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thymoma： current diagnosis and treatment

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Chinese Medical Journal 2013年第11期126卷 2186-2191页

作者： Frank C. Detterbeck Ahmad Zeeshan Section of Thoracic Surgery Yale School of Medicine Yale University New Haven CT USA Section of Cardiothoracic Surgery Yale School of Medicine Yale University New Haven CT USA

Objective To review the presentation, diagnosis, staging and treatment of thymoma. Data sources Data were obtained from papers on thymoma published in English within the last 30 years. No formal systematic review was conducted, but an effort was made to be comprehensive. Study selection Studies were selected if they contained data relevant to the topic addressed in the particular section. In particular, standards adopted by the International Thymic Malignancies Interest Group through a formal process of achieving worldwide consensus are featured. Because of the limited length of this article, we have frequently referenced recent reviews that contain a comprehensive amalgamation of literature rather than the actual source papers. Results thymomas are rare malignant tumors. They account for about half （47%） of anterior mediastinal tumors. About one third of these are associated with myasthenia gravis. Computed tomography with intravenous contrast is the standard diagnostic modality. thymomas appear as round or oval masses in early stages but irregular shapes with calcifications occurring in later stages. They can invade surrounding structures including mediastinal fat, pleura, major blood vessels and nerves. Fine needle aspiration, core needle biopsy or open biopsy is used to obtain tissue diagnosis. Masaoka-Koga classification is currently used to stage thymomas. All thymomas should be considered for resection due to their malignant potential. A complete resection is a major prognostic factor and every effort should be made to achieve this even if this means resection and reconstruction of a major thoracic structure. Median sternotomy is the standard approach for thymoma resection. A number of minimally invasive techniques are used in selective centers. While stage I and II tumors undergo primary surgery, preoperative chemotherapy appears to increase the chances of complete resection for stage III and IVa tumors. Postoperative radiation could be considered for patients with residual disease. Excellent 5 and 10-yea

关键词： thymoma myasthenia gravis mediastinum Masaoka-Koga classification

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thymoma and autoimmunity

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Cellular & Molecular Immunology 2011年第3期8卷 199-202页

作者： Shahar Shelly Nancy Agmon-Levin Arie Altman Yehuda Shoenfeld The Zabludovicz Center for Autoimmune Diseases Sheba Medical CenterTel-Hashomeraffiliated with Sackler Faculty of MedicineTel Aviv UniversityIsrael Department of Medicine‘B’ Sheba Medical CenterTel-HashomerIsrael Sackler Faculty of Medicine Incumbent of the Laura Schwarz-Kip Chair for Research of Zabludowitz Center for Autoimmune DiseasesTel-Aviv UniversityTel-AvivIsrael

The thymus is a central lymphatic organ that is responsible for many immunological functions,including the production of mature,functional T cells and the induction of self-tolerance.Benign or malignant tumors may originate from the thymus gland,with thymoma being the most common and accounting for 50% of anterior mediastinal tumors.Malignancies linked to thymoma include the loss of self-tolerance and the presence of autoimmunity.In this review,we compiled the current scientific evidence detailing the various interactions between thymoma and autoimmune diseases,including myasthenia gravis,systemic lupus erythematosus,inappropriate antidiuretic hormone secretion,pure red cell aplasia,pernicious anemia,pemphigus and autoimmune thyroid diseases.In recent years,several mechanisms have been proposed to explain these interactions.Most are based on the assumption that the‘sick’thymus,like the‘normal’thymus,can generate mature T cells;however,the T cells generated by the sick thymus are impaired and thus may exert cellular autoreactivity.Here,we present several theories that may shed light on the loss of self-tolerance associated with this epithelial tumor of the thymus.

关键词： autoimmune diseases autoimmunity self-tolerance thymoma thymus

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thymoma associated with severe diarrhoea and anaemia

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Chinese Medical Journal 2006年第6期119卷 526-528页

作者： GE Feng LI Ze-jian CAO Zhi-li Department of Thoracic Surgery Peking Union Medical CollegeHospital Chinese Academy of Medical Sciences Beijing 100730China

About 40% of patients with thymoma have one or ,more paraneoplastic syndromes, including myasthenia gravis, pure red cell aplasia （PRCA） or hypogammaglobulinaemia, but Good syndrome occurs in only 5% of these conditions. To our knowledge, only 11 patients （including our cases） of thymoma accompanied with PRCA and Good syndrome have been reported, however, no such case was reported in China before 2000.

关键词： thymoma Good syndrome hypogammaglobulinaemia

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Long.term outcomes of 307 patients after complete thymoma resection

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Chinese Journal of Cancer 2017年第10期36卷 488-496页

作者： Zu-Yang Yuan Shu-Geng Gao Ju-Wei Mu Qi Xue You-Sheng Mao Da-Li Wang Jun Zhao Yu-Shun Gao Jin-Feng Huang Jie He Department of Thoracic Surgery National Cancer Center/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100021 P. R. China

Background: thymoma is an uncommon tumor without a widely accepted standard care to date. We aimed to investigate the clinicopathologic variables of patients with thymoma and identify possible predictors of survival and recurrence after initial resection.Methods: We retrospectively selected 307 patients with thymoma who underwent complete resection at the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College(Beijing, China) between January 2003 and December 2014. The associations of patients' clinical characteristics with prognosis were estimated using Cox regression and Kaplan–Meier survival analyses.Results: During follow?up(median, 86 months; range, 24–160 months), the 5? and 10?year disease?free survival(DFS) rates were 84.0% and 73.0%, respectively, and the 5? and 10?year overall survival(OS) rates were 91.0% and 74.0%, respectively. Masaoka stage(P thymoma who underwent repeated resec?tion had increased post?recurrence survival rates compared with those who underwent therapies other than surgery(P = 0.017).Conclusions: Masaoka stage and WHO histological classification were independent prognostic factors of thymoma after initial complete resection. The recurrence pattern was an independent predictor of post?recurrence survival. Locoregional recurrence and repeated resection of the recurrent tumor were associated with favorable prognosis.

关键词： thymoma Complete resection Recurrent thymoma Prognosis

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Value of Adjuvant Radiotherapy for thymoma with Myasthenia Gravis after Extended Thymectomy

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Chinese Medical Journal 2018年第8期131卷 927-932页

作者： Chang-Feng Lu Lei YU Yun Jing Yun-Feng Zhang Ji Ke Department of Neurology Beijing Tongren Hospital Capital Medical University Beijing 100730 China Department of Thoracic Surgery Beijing Tongren Hospital Capital Medical University Beijing 100730 China

Background：The co-existence of myasthenia gravis （MG） and thymoma makes the surgical treatment more complicated and adjuvant radiation more controversial. The aim of this study was to investigate adjuvant radiotherapy for thymoma with MG after extended thymectomy.Methods：A total of 181 patients with both MG and thymoma were recruited between 2003 and 2014 at Tongren Hospital, China. Among all the patients, 157 patients received radiation therapy after surgery （Group A）; whereas the other 24 patients did not receive radiation therapy （Group B）. According to the time that patients started mediastinal radiation therapy, we subdivided the 157 patients in Group A into subgroups （1-month subgroup, n = 98; 2-month subgroup, n = 7; and 3-month subgroup, n = 52）. We then compared the effect of the mediastinal radiation therapy across these different groups using the survival rate, the rate of postoperative myasthenic crisis, and the complete stable remission （CSR） rate as the primary endpoints.Results：There was a significant difference in the occurrence of postoperative myasthenic crisis between 1-month subgroup and Group B （χ2 = 4.631, P = 0.031）. The rates of reaching CSR were 32.6% in 1-month subgroup, 25% in 3-month subgroup, and 22.7% in Group B, respectively. The overall survival rates of 1-month subgroup, 3-month subgroup, and Group B were 88.8%, 83.3%, and 77.3%, respectively. Analysis on the Kaplan-Meier survival curves demonstrated that within 8 years after surgery, there was no significant difference in aspects of overall survival and disease-free survival between 1-month subgroup and Group B, and between 3-month subgroup and Group B; over 8 years after surgery, the disease-free survival rates in 1-month subgroup, 3-month subgroup and Group B were 79.4%, 70.6%, and 55.3%, respectively.Conclusions：Adjuvant radiation within 1 month after extended thymectomy may be helpful in controlling postoperative MG, such as decreasing the possibility of postoperative myasthenic crisis, and raising cumulative probabilities of

关键词： Myasthenia Gravis Prognosis Radiotherapy Thymectomy thymoma

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Spontaneous rupture of hepatic metastasis from a thymoma: A case report

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World Journal of Gastroenterology 2016年第44期22卷 9860-9864页

作者： Ho Jae Kim Yong Eun Park Min Seo Ki Se Ju Lee Seung Hun Beom Dai Hoon Han Young Nyun Park Jun Yong Park Department of Internal Medicine Yonsei University College of Medicine Department of Surgery Yonsei University College of Medicine Department of Pathology Yonsei University College of Medicine

Bleeding resulting from spontaneous rupture of the liver is an infrequent but potentially life threatening complication that may be associated with an underlying liver disease. A hepatocellular carcinoma or hepatic adenoma is frequently reported is such cases. However, hemoperitoneum resulting from a hepatic metastatic thymoma is extremely rare. Here, we present a case of a 62-year-old man with hypovolemic shock induced by ruptured hepatic metastasis from a thymoma. At the first hospital admission, the patient had a 45-mm anterior mediastinal mass that was eventually diagnosed as a type A thymoma. The mass was excised, and the patient was disease-free for 6 years. He experienced sudden-onset right upper quadrant pain and was again admitted to our hospital. We noted large hemoperitoneum with a 10-cm encapsulated mass in S5/8 and a 2.3-cm nodular lesion in the right upper quadrant of the abdomen. He was diagnosed with hepatic metastasis from the thymoma, and he underwent chemotherapy and surgical excision.

关键词： Spontaneous rupture Hemoperitoneum Transarterial chemoembolization Hepatic metastasis thymoma

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Surgical approaches for stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis:feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy in comparison with trans-sternal resection

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The Journal of Biomedical Research 2013年第1期27卷 62-70页

作者： Zhicheng He Quan Zhu Wei Wen Liang Chen Hai Xu Hai Li Department of Thoracic Surgery the First Affiliated HospitalNanjing Medical University Department of Radiology the First Affiliated HospitalNanjing Medical University Department of Pathology the First Affiliated HospitalNanjing Medical University

Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage I and II thymoma us- ing the trans-sternal technique. Whether this is appropriate for minimally invasive approach is not yet clear. We evalu- ated the feasibility of complete video-assisted thoracoscopic surgery （VATS） thymectomy for the treatment of Ma- saoka stage I and Ⅱ thymoma-associated myasthenia gravis, compared to conventional trans-sternal thymectomy. We summarized 33 patients with Masaoka stage I and II thymoma-associated myasthenia gravis between April 2006 and September 2011. Of these, 15 patients underwent right-sided complete VATS （the VATS group） by us- ing adjuvant pneuomomediastinum, comparing with 18 patients using the trans-sternal approach （the T3b group）. No intraoperative death was found and no VATS case required conversion to median sternotomy. Significant differences between the two groups regarding duration of surgery and volume of intraoperative blood loss （P = 0.001 and P 〈 0.001, respectively） were observed. Postoperative morbidities were 26.7% and 33.3% for the VATS and T3b groups, respectively. All 33 patients were followed up for 12 to 61 months in the study. The cumulative probabilities of reaching complete stable remission and effective rate were 26.7% （4/15） and 93.3% （14/15） in the VATS group, which had a significantly higher complete stable remission and effective rate than those in the T3b group （P = 0.026 and P = 0.000, respectively）. We conclude that VATS thymectomy utilizing adjuvant pneuomo- mediastinum for the treatment of stage I and II thymoma-associated myasthenia gravis is technically feasible but deserves further investigation in a large series with long-term follow-up.

关键词： video-assisted thoracoscopic surgery （VATS） thymoma thymectomy myasthenia gravis adjuvantpneuomomediastinum

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Effect of Age on the Clinicopathological Characteristics and Survival Outcomes of thymoma Patients

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Health 2022年第6期14卷 650-659页

作者： Zirong Wang Yuan Chen Yu Shi Ruiyu Zhang Xuesong Zhang Lingchen Meng Weibo Cao Tianjin Medical University General Hospital Tianjin China

Background: Age is an important prognostic factor for thymoma;however, few studies have specifically focused on age-related survival outcomes in thymoma patients. This study explored the effect of age on the clinicopathological features and survival outcomes of thymoma patients. Methods: We reviewed the clinical data of 1984 chest thymoma patients from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. In accordance with the World Health Organization age brackets, the patients were divided into young (group A, 0 - 44-year-old);middle-aged (group B, 45 - 59-year-old);old (group C, 60 - 74-year-old);and seniors (group D 75 - 84-year-old). Single-factor and multivariate analysis were performed using the Kaplan-Meier method, and a multivariate Cox regression model was generated to assess patient prognosis. Results: In total, 1984 patients were included. The median follow-up time was 156.0 months (range: 0 - 492 months). Group C (60 - 74-year-old) had the most patients (35.1%), and Group D had the fewest patients (12.3%). Among all age groups, the proportion of white people and men with thymoma increased with age, while the proportion of black people and women showed a downward trend. Univariate and multivariate analyses showed that the overall survival rate of thymoma patients was negatively correlated with age. The overall survival times of the four groups were significantly different (p Conclusion: Age is an important prognostic factor for survival in thymoma patients, and younger patients have a survival advantage over older patients.

关键词： Age Group thymoma SEER Survival

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EXPRESSION OF β-CATENIN AND C-MYC IN thymoma AND THE ASSOCIATION WITH BIOLOGICAL FEATURES

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Chinese Journal of Cancer Research 2006年第2期18卷 142-148页

作者：谭胜张其刚刘宏旭李玉张林刘楠谢成耀 Department of Thoracic Surgery The First Hospital China Medical University Shenyang 110001 Department of Pathology China Medical University Shenyang 110001

Objective： β-catenin is closely associated with proliferation, differentiation, invasion and metastasis of tumor cells. C-myc is proved to be abnormally expressed in various kinds of malignant neoplasmas. This study is aimed to investigate the features of β-catenin and C-myc expressions in thymoma and the corresponding clinical significance. Method： Immunochemistry was used to detect the features of expressions of β-catenin and C-myc in thymoma and normal thymus. Of the 105 samples, according to Beratz classification, there were： epithelial type 34; lymphocyte type 35; mixed type 31 and shuttle cell type 5. According to Masaoka classification, there were： stage 1： 38; stage 2： 32; stage 3：20 and stage 4： 15. According to WHO classification, there were： type A 20; type AB 19; type B1 21; type B2 17; type B3 13 and type C 15. Results： Different ways of expression was revealed in different stages of thymomas. With the progress of thymoma, the expression of β-catenin on cell membrane decreased, while increased in cytoplasma and nucleus, even with nucleus shift. The expression of C-myc increased in invasive thymoma. Abnormal expression of β-catenin and C-myc increased, with significant difference（P〈0.05）. Conclusion： The different ways of expression and diversity of expression level may indicate the biological characters of thymoma, and could be used as an objective index for invasive thymoma.

关键词： β-catenin C-myc thymoma

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