1101
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Jin SM, Choi SH, Yoo CG, Kim YW, Han SK, Shim YS, Lee SM. Small solid noncalcified pulmonary nodules detected by screening chest computed tomography. Respir Med 2007; 101:1880-4. [PMID: 17587561 DOI: 10.1016/j.rmed.2007.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 05/02/2007] [Accepted: 05/03/2007] [Indexed: 11/27/2022]
Abstract
We aimed to determine the outcome of small (<10 mm) solid noncalcified pulmonary nodules detected by chest computed tomography (CT) scans. Reports of low-dose chest CT scans performed from October 2003 to April 2005 at the Seoul National University Hospital Healthcare System Gangnam Center were reviewed to identify patients with solid noncalcified pulmonary nodules smaller than 10 mm. Partly solid and nonsolid nodules or nodules without follow-up imaging within 1 year were excluded. Records were studied to determine if the initial nodules had changed in size. A total of 3478 chest CT examinations were performed, with 232 patients having small noncalcified nodules (6.7%). One hundred and thirty-eight patients met the criteria (104 men and 34 women) and 213 nodules were identified. The median age was 54 years (range 32-80) and at least 86 patients (62%) were at low to intermediate risk for developing lung cancer. The largest nodule was less than 5 mm in diameter in 87 patients (63%) and 5 mm or more in 51 patients (37%). None of the nodules grew and 29 (14%) decreased in size at follow-up CT scans performed within 12 months. When those individuals at low to intermediate risk for lung cancer were included, solid noncalcified subcentimeter nodules were less frequently found in low-dose CT screening and were nearly unchanged in size when a follow-up CT scan was done within 12 months.
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Affiliation(s)
- Sang-Man Jin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea
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1102
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Gleeson FV. Screening for lung cancer with spiral CT is not justified. ACTA ACUST UNITED AC 2007; 4:442-3. [PMID: 17579599 DOI: 10.1038/ncponc0878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 05/08/2007] [Indexed: 11/08/2022]
Affiliation(s)
- Fergus V Gleeson
- Churchill Hospital, Oxford Radcliffe Hospitals, Headington, Oxford, UK.
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1103
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Bria E, Cuppone F, Cecere FL, Milella M, Nisticò C, Cognetti F, Terzoli E. Adjuvant chemotherapy for non-small cell lung cancer. J Thorac Oncol 2007; 2:S7-11. [PMID: 17457237 DOI: 10.1097/01.jto.0000268633.87529.75] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cisplatin must be considered the treatment standard for lung cancer chemotherapy, whatever the disease setting, at least in the Western world. After the seminal meta-analysis published in 1995, 12 randomized clinical trials (RCTs) exploring the benefits of adjuvant cisplatin-based chemotherapy have been completed, published, or presented. Although all these RCTs differ in patient features, two common suggestions emerge when the stage is taken into account: a significant benefit for chemotherapy is demonstrated for stage II and IIIA patients and none of these trials showed any significant benefit for adjuvant chemotherapy in stage IB patients. Ten years after this meta-analysis, a further individual patient data-pooled analysis exploring the eventual benefits of adjuvant cisplatin-based chemotherapy after surgery for early stage non-small cell lung cancer in the more recent RCTs has been presented. The 5-year overall survival benefit in favor of cisplatin-based chemotherapy was 5.3% (48.8% versus 43.3%, p = 0.004), with a relative risk reduction of 11%. These results confirm those reported by previous meta-analyses performed according to a literature-based approach. Advances are emerging in the selection of those patients who are likely to benefit more from such treatment. In this respect, the customized therapy based on molecular/genetic patient and disease features constitutes a new avenue to pursue.
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Affiliation(s)
- Emilio Bria
- Department of Medical Oncology, Regina Elena National Cancer Institute, Rome, Italy.
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1104
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Henschke CI. CT screening for lung cancer is justified. ACTA ACUST UNITED AC 2007; 4:440-1. [PMID: 17563776 DOI: 10.1038/ncponc0852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 05/01/2007] [Indexed: 11/08/2022]
Affiliation(s)
- Claudia I Henschke
- Department of Radiology (Box 586), The New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY 10021, USA.
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1105
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Affiliation(s)
- Sarita Dubey
- Division of Hematology and Oncology, University of California, San Francisco, CA, USA
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1106
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Yankelevitz DF. CT Screening for Lung Cancer: Editorials Can Be Deceiving. J Am Coll Radiol 2007; 4:429-30; author reply 430. [PMID: 17544148 DOI: 10.1016/j.jacr.2007.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Indexed: 11/24/2022]
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1107
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Hillman BJ. Author’s Reply. J Am Coll Radiol 2007. [DOI: 10.1016/j.jacr.2007.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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1108
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Fukui T, Sakakura N, Mori S, Hatooka S, Shinoda M, Yatabe Y, Mitsudomi T. Controversy about Small Peripheral Lung Adenocarcinomas: How Should We Manage Them? J Thorac Oncol 2007; 2:546-52. [PMID: 17545852 DOI: 10.1097/jto.0b013e318060d30d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In recent years, the clinical use of high-resolution computed tomography has greatly advanced the diagnosis of small lesions of the peripheral lung. Such small lesions are often associated with ground-glass opacity in computed tomography findings. The noninvasive bronchioloalveolar carcinoma component with a replacement growth pattern of alveolar lining cells manifests as ground-glass opacity. Bronchioloalveolar carcinoma is classified as a subset of lung adenocarcinoma, but has a distinct clinical presentation, tumor biology, and favorable prognosis. Most small peripheral lung lesions including bronchioloalveolar carcinoma putatively originate from the peripheral airway epithelium, in which the epidermal growth factor receptor gene is frequently mutated. As with other subsets of non-small cell lung cancer, surgical resection is a potentially curative treatment. For the ground-glass opacity type of tiny lesions, particularly those less than 1 cm in their greatest dimension, the question has been raised whether lobectomy is really needed. Although several authors in Japan suggest the suitability of limited resection including segmentectomy and wedge resection without any nodal dissections for these small lung adenocarcinomas, this procedure should be validated in future clinical trials.
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Affiliation(s)
- Takayuki Fukui
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
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1109
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Dowe DA. The case in favor of screening for coronary artery disease with coronary CT angiography. J Am Coll Radiol 2007; 4:289-94. [PMID: 17467610 DOI: 10.1016/j.jacr.2007.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Indexed: 12/21/2022]
Abstract
Coronary computed tomographic angiography is leading a technologic revolution in the field of cardiac imaging. For the first time, it is possible to image the wall of the coronary artery noninvasively to assess plaque burden, characterize plaque, and assess the degree of stenosis. This paper explores the possibility of using coronary computed tomographic angiography as a screening tool. Key screening examination elements, the pros and cons of screening, the limitations of current technology, and potential pitfalls are discussed.
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Affiliation(s)
- David A Dowe
- Atlantic Medical Imaging, Galloway, NJ 08205, USA.
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1110
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Miller YE, Keith RL. Inhaled corticosteroids and lung cancer chemoprevention. Am J Respir Crit Care Med 2007; 175:636-7. [PMID: 17384324 DOI: 10.1164/rccm.200701-087ed] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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1111
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Muss HB, Biganzoli L, Sargent DJ, Aapro M. Adjuvant Therapy in the Elderly: Making the Right Decision. J Clin Oncol 2007; 25:1870-5. [PMID: 17488985 DOI: 10.1200/jco.2006.10.3457] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Adjuvant chemotherapy has led to improvements in relapse-free and overall survival in patients with breast, colon, and non–small-cell lung cancer, yet many older patients are not offered these potentially life-saving treatments. Moreover, older patients have been either excluded or under-represented in most adjuvant trials, limiting the generalizability of these treatments to older populations. Limited data in elders suggest that older patients derive significant benefits from adjuvant therapies provided they have life expectancies exceeding 5 years. Making treatment decisions in elders is challenging. Many have major comorbidities that may substantially limit life expectancy and minimize or negate the benefits of adjuvant chemotherapy. In this review, we discuss the potential benefits of adjuvant treatment in older patients with solid tumors with a focus on general principles involved in the selection of adjuvant therapy for patients with breast, colon, and non–small-cell lung cancer. In addition, we discuss the role of comorbidity and how it factors in treatment decisions. Finally, we discuss future research directions and funding for elders with cancer.
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Affiliation(s)
- Hyman B Muss
- University of Vermont and Vermont Cancer Center, Burlington, VT 05401, USA.
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1112
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1113
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Affiliation(s)
- David F Yankelevitz
- Department of Radiology, Weill Medical College of Cornell University, The New York Presbyterian Hospital, New York, NY 10021, USA.
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1114
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CT Screening for lung cancer: diagnoses resulting from the New York Early Lung Cancer Action Project. Radiology 2007; 243:239-49. [PMID: 17392256 DOI: 10.1148/radiol.2431060467] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate prospectively the diagnostic performance of the New York Early Lung Cancer Action Project (NY-ELCAP) regimen in the diagnosis of early lung cancer at baseline and annual repeat computed tomographic (CT) screenings. MATERIALS AND METHODS Informed consent and institutional review board approval were obtained for this HIPAA-compliant study of baseline and annual repeat low-dose CT screening performed with a common regimen in asymptomatic individuals at 12 institutions in New York State. All 6295 participants were aged 60 years or older, had smoked for at least 10 pack-years, had no prior cancer, had not undergone chest CT in the previous 3 years, and were medically fit to undergo thoracic surgery. Median age was 66 years, and median smoking history was 40 pack-years. The proportion (and 95% exact confidence intervals [CIs]) of subjects with a positive result, as determined by using nodule size; the diagnoses of lung cancer resulting from subsequent work-up; and the distribution by cancer stage and cell type were determined. When relevant, 95% CIs for the proportions were calculated. RESULTS Initial CT imaging led to recommendations for further work-up in 14.4% (95% CI: 13.5%, 15.3%) of the 6295 baseline screenings and 6.0% (95% CI: 5.1%, 6.6%) of the 6014 annual repeat screenings. Of 101 patients in whom the diagnosis of lung cancer resulted from baseline screening and three in whom a diagnosis of lung cancer was prompted by symptoms prior to the first scheduled repeat screening, 95 (91.3%) had no clinical evidence of metastases. Of the 20 patients in whom the diagnosis of lung cancer resulted from annual repeat screening, 17 (85%) showed no evidence of metastases. Of the 134 recommended biopsies, 125 (93.3%) resulted in diagnosis of lung cancer or another malignancy, while none of the 24 biopsies performed outside of the recommendation of the regimen resulted in diagnosis of lung cancer. CONCLUSION The NY-ELCAP regimen of screening revealed that annual CT screening for lung cancer resulted in identification of a high proportion of patients with early-stage disease.
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1115
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Abstract
Molecular genetic studies of lung cancer have revealed that clinically evident lung cancers have multiple genetic and epigenetic abnormalities, including DNA sequence alterations, copy number changes, and aberrant promoter hypermethylation. Together, these abnormalities result in the activation of oncogenes and inactivation of tumor-suppressor genes. In many cases these abnormalities can be found in premalignant lesions and in histologically normal lung bronchial epithelial cells. Findings suggest that lung cancer develops through a stepwise process from normal lung epithelial cells towards frank malignancy, which usually occurs as a result of cigarette smoking. Lung cancer has a high morbidity because it is difficult to detect early and is frequently resistant to available chemotherapy and radiotherapy. New, rationally designed early detection, chemoprevention, and therapeutic strategies based on the growing understanding of the molecular changes important to lung cancer are under investigation. For example, methylated tumor DNA sequences in sputum or blood are being investigated for early detection screening, and new treatments that specifically target molecules such as vascular endothelial growth factor and the epidermal growth factor receptor are becoming available. Meanwhile, global gene expression signatures from individual tumors are showing potential as prognostic and therapeutic indicators, such that molecular typing of individual tumors for therapy selection is not far away. Finally, the recent development of a model system of immortalized human bronchial epithelial cells, along with a paradigm shift in the conception of cancer stem cells, promises to improve the situation for patients with lung cancer. These advances highlight the translation of molecular discoveries on lung cancer pathogenesis from the laboratory to the clinic.
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MESH Headings
- Carcinoma, Non-Small-Cell Lung/epidemiology
- Carcinoma, Non-Small-Cell Lung/etiology
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/physiopathology
- Carcinoma, Small Cell/epidemiology
- Carcinoma, Small Cell/etiology
- Carcinoma, Small Cell/genetics
- Carcinoma, Small Cell/physiopathology
- Cell Transformation, Neoplastic/genetics
- DNA Methylation
- DNA, Neoplasm
- Early Diagnosis
- ErbB Receptors/genetics
- ErbB Receptors/metabolism
- Female
- Genes, Tumor Suppressor
- Genetic Predisposition to Disease/epidemiology
- Genomics/methods
- Humans
- Lung Neoplasms/epidemiology
- Lung Neoplasms/etiology
- Lung Neoplasms/genetics
- Lung Neoplasms/physiopathology
- Male
- Mass Screening
- Molecular Biology
- Prevalence
- Prognosis
- Risk Factors
- Smoking/adverse effects
- Survival Analysis
- United States/epidemiology
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Affiliation(s)
- Mitsuo Sato
- Hamon Center for Therapeutic Oncology Research Simmons Cancer Center, The University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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1116
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Paci E. Observational, One-Arm Studies and Randomized Population-Based Trials for Evaluation of the Efficacy of Lung Cancer Screening. J Thorac Oncol 2007; 2:S45-6. [PMID: 17457234 DOI: 10.1097/01.jto.0000268644.78944.3f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Eugenio Paci
- Unit of Clinical and Descriptive Epidemiology, CSPO Scientific Institute for Oncological Prevention, Florence, Italy.
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1117
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Abstract
A person who is at high-risk for lung cancer and asymptomatic, and who is interested in potentially being screened should be fully apprized of the implications of screening and of the treatment that may result. In light of this, it is reasonable for the individual to choose to be screened by a multidisciplinary medical team with experience in performing such screenings, using a well-defined CT regimen of screening, and having appropriate quality assurance procedures in place.
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Affiliation(s)
- Claudia I Henschke
- Department of Radiology and Cardiothoracic Surgery, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA.
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1118
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Abstract
Over the past two decades, many surgical specialties have seen a dramatic shift from large, open operations with wide incisions towards more-minimal incisions and less-invasive procedures. Surgical techniques for lung cancer are no exception, and today, video-assisted thoracic surgical lobectomies are being performed with increasing frequency in large-volume thoracic practices. Despite these new surgical techniques, however, the most substantial innovations that have changed surgical outcomes occurred away from the operative theatre. In lung cancer, in particular, the last 20 years have witnessed the clinical debut of more sophisticated, more elegant and more accurate imaging modalities for improved screening, diagnostic and staging, such as the spiral CT scan, PET scan, PET/CT and the endobronchial ultrasound machine. This technology has been complimented by more targeted chemotherapeutic regimens, novel methods of administering more accurate and more concentrated doses of radiation therapy, and innovative local excisional methods, such as the Cyberknife and radiofrequency ablation. The result has been that surgical excision, although remaining the most effective local therapeutic modality in early-stage lung cancer, is no longer the 'lone ranger' treatment, but rather is part of a complex mosaic of multimodality therapy. As scientific advances continue to be translated into the clinic, this trend will inexorably continue with the advent of a molecular staging system using molecular markers and tumour profiling, which ultimately could enhance our ability to predict tumour chemosensitivity. In this brave new world, however, complete surgical resection of the lung cancer will continue to be critical.
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1119
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Yankelevitz DF, Cham MD, Farooqi AO, Henschke CI. CT-Directed Diagnosis of Peripheral Lung Lesions Suspicious for Cancer. Thorac Surg Clin 2007; 17:143-58. [PMID: 17626393 DOI: 10.1016/j.thorsurg.2007.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Small peripheral pulmonary nodules continue to be a diagnostic challenge and because of improved technology are also being identified with increased frequency. TNB, performed properly, is a highly accurate procedure and with careful attention to technical factors, nodules of any size in any location may undergo biopsy. A skilled cytologist is an essential part of the team. Continued advances in molecular diagnostics allow for an expanded role of the usefulness of this procedure.
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Affiliation(s)
- David F Yankelevitz
- Division of Chest Imaging, Department of Radiology, Weill Medical College of Cornell University, 525 East 68th Street, Box 586, New York, NY 10021, USA.
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1120
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Eberhardt R, Anantham D, Herth F, Feller-Kopman D, Ernst A. Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest 2007; 131:1800-5. [PMID: 17400670 DOI: 10.1378/chest.06-3016] [Citation(s) in RCA: 223] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Electromagnetic navigation bronchoscopy (ENB) with biopsy under fluoroscopic guidance has enhanced the yield of flexible bronchoscopy in the diagnosis of peripheral lung lesions. However, the accuracy of ENB navigation suggests that the addition of fluoroscopy is redundant. OBJECTIVES Data were prospectively collected to determine the yield of ENB without fluoroscopy in the diagnosis of peripheral lung lesions. METHOD ENB was performed via flexible bronchoscopy (superDimension/Bronchus system; superDimension Inc; Plymouth, MN). Biopsy specimens were obtained through the extended working channel after navigation. Fluoroscopy was not utilized, but post-transbronchial biopsy chest radiographs were obtained to exclude pneumothorax. The primary end point was diagnostic yield, and the secondary end points were navigation accuracy, procedure duration, and safety. Analysis by lobar distribution was also performed to assess performance in different lobes of the lung. RESULTS Ninety-two peripheral lung lesions were biopsied in the 89 subjects. The diagnostic yield of ENB was 67%, which was independent of lesion size. Total procedure time ranged from 16.3 to 45.0 min (mean [+/- SD] procedure time, 26.9 +/- 6.5 min). The mean navigation error was 9 +/- 6 mm (range, 1 to 31 mm). There were two incidences of pneumothorax for which no intervention was required. When analyzed by lobar distribution, there was a trend toward a higher ENB yield in diagnosing lesions in the right middle lobe (88%). CONCLUSIONS ENB can be used as a stand-alone bronchoscopic technique without compromising diagnostic yield or increasing the risk of pneumothorax. This may result in sizable timesaving and avoids radiation exposure.
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Affiliation(s)
- Ralf Eberhardt
- Department of Pneumology and Critical Care Medicine, Thoraxklinik University of Heidelberg, Germany
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1121
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Flahault A, Costagliola D. Le dépistage du cancer du poumon par le scanner hélicoïdal est-il justifié ? Med Sci (Paris) 2007; 23:333-4. [PMID: 17349299 DOI: 10.1051/medsci/2007233333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Antoine Flahault
- Santé Publique, Faculté de Médecine Pierre et Marie Curie, Inserm U707, 27, rue de Chaligny, 75571 Paris Cedex 12, France
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1122
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Holley JL. Screening, diagnosis, and treatment of cancer in long-term dialysis patients. Clin J Am Soc Nephrol 2007; 2:604-10. [PMID: 17699470 DOI: 10.2215/cjn.03931106] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Some have suggested that the American Cancer Society guidelines for cancer screening be applied to patients who are on long-term dialysis and have used cancer screening as a means of assessing delivered preventive health care to patients with ESRD. However, cancer screening is effective only when it leads to survival benefit (usually expressed as days of life saved) without incurring high financial costs. Certain cancers such as human papillomavirus-associated cervical and tongue cancer and urologic malignancies are more common among dialysis patients, yet because the expected remaining lifetime of most dialysis patients is shorter than the time lived to develop malignancy, cancer screening in dialysis patients as applied to the general population is ineffective from the perspective of both cost and survival benefit. Cancer screening in dialysis patients is therefore best provided in an individual patient-focused manner. The occurrence, diagnosis, and treatment of cancer as well as issues related to cancer screening in dialysis patients are discussed.
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Affiliation(s)
- Jean L Holley
- University of Virginia Health System, Nephrology Division, Charlottesville, VA 22908, USA.
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1123
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Rumberger JA. Reply. J Am Coll Cardiol 2007. [DOI: 10.1016/j.jacc.2006.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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1124
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Callol L, Roig F, Cuevas A, de Granda JI, Villegas F, Jareño J, Arias E, Albiach JM. Low-dose CT: a useful and accessible tool for the early diagnosis of lung cancer in selected populations. Lung Cancer 2007; 56:217-21. [PMID: 17316889 DOI: 10.1016/j.lungcan.2007.01.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Revised: 11/23/2006] [Accepted: 12/22/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE An evaluation is made of the effectiveness of low-dose computed tomography (LDCT) in diagnosing early stage lung cancer in the Autonomous Community of Madrid (Spain). METHODS The study comprised subjects over 50 years of age who were active smokers (or who had stopped smoking up to 6 months previously) who smoked more than 30 cigarettes daily for at least 15 years, or 20 cigarettes daily for 20 years, or more than 10packs/year and in contact with asbestos at work. The study group was evaluated using LDCT. For all participants in whom LDCT showed no pathological findings, or in those cases classified as benign, a new LDCT scan was performed 2 years after the first. In case of doubt regarding the benign nature of the findings, an assessment algorithm was applied. RESULTS Among the initial 482 candidates in the study group, 466 LDCT scans were performed at baseline, revealing 9 extrapulmonary lesions and 114 pulmonary lesions in 98 subjects. The latter raised diagnostic doubts in 32 cases; of these, 15 were confirmed as benign by high resolution computed tomography (HRCT). In the remaining 17 cases, stage IAp adenocarcinoma was diagnosed at baseline (0.2%). With LDCT after 2 years, an additional four adenocarcinomas were diagnosed-all in stage IAp (0.98%). The complete study, including prevalence cut-off and incidence calculation after 2 years, resulted in the diagnosis of five cancers (1.1%) and two false positive cases (28%). CONCLUSIONS The use of low-dose computed tomography in risk groups is valid for the early diagnosis of bronchogenic cancer. Nevertheless, significant problems remain, particularly those associated with false positive interpretations. The results of randomized studies on lung cancer mortality such as the US NLST trial and the Dutch-Belgian NELSON trial have to be awaited before any conclusion regarding the effectiveness of LDCT screening can be drawn.
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Affiliation(s)
- Luis Callol
- Servicio de Neumología, Hospital Central de la Defensa, Glorieta del Ejército s/n, 28047 Madrid, Spain
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1125
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1126
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Bangma CH, Roemeling S, Schröder FH. Overdiagnosis and overtreatment of early detected prostate cancer. World J Urol 2007; 25:3-9. [PMID: 17364211 PMCID: PMC1913182 DOI: 10.1007/s00345-007-0145-z] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 01/06/2007] [Indexed: 11/28/2022] Open
Abstract
Early detection of prostate cancer is associated with the diagnosis of a considerable proportion of cancers that are indolent, and that will hardly ever become symptomatic during lifetime. Such overdiagnosis should be avoided in all forms of screening because of potential adverse psychological and somatic side effects. The main threat of overdiagnosis is overtreatment of indolent disease. Men with prostate cancer that is likely to be indolent may be offered active surveillance. Evaluation of active surveillance studies and validation of new biological parameters for risk assessment are expected.
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Affiliation(s)
- C H Bangma
- Department of Urology, Erasmus University Medical Centre, PO Box 2040, 3000 DR Rotterdam, Netherlands.
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1127
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Abstract
Results of randomised trials are needed before recommending its adoption
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1128
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Lee CI, Forman HP. CT Screening for Lung Cancer: Implications on Social Responsibility. AJR Am J Roentgenol 2007; 188:297-8. [PMID: 17242233 DOI: 10.2214/ajr.07.5212] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Christoph I Lee
- Department of Diagnostic Radiology, Stanford University School of Medicine, Palo Alto, CA, USA
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1129
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Grenier P. [Does CT screening for pulmonary nodules decrease lung cancer mortality?]. JOURNAL DE RADIOLOGIE 2007; 88:296. [PMID: 17372561 DOI: 10.1016/s0221-0363(07)89820-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Ph Grenier
- Secrétaire Général de la Société Française de Radiologie, 20 av Rapp, 75007 Paris, France
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1130
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Hillman BJ. CT Screening for Lung Cancer: Appearances Can Be Deceiving. J Am Coll Radiol 2007; 4:83-5. [PMID: 17412234 DOI: 10.1016/j.jacr.2006.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Indexed: 11/29/2022]
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Ou SHI, Zell JA, Ziogas A, Anton-Culver H. Prognostic factors for survival of stage I nonsmall cell lung cancer patients. Cancer 2007; 110:1532-41. [PMID: 17702091 DOI: 10.1002/cncr.22938] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Platinum-based adjuvant chemotherapy in randomized trials has failed to provide a survival benefit in patients with resected stage I nonsmall cell lung cancer (NSCLC). Using data from the California Cancer Registry (CCR), we explored factors that had detrimental effects on survival in patients with stage I NSCLC to identify a subset of patients at high risk for disease recurrence and subsequent mortality. METHODS Between 1989 and 2003, 19,702 incident cases of stage I NSCLC in the CCR were identified and subgrouped into stage IA and IB disease. Patient demographic factors, tumor characteristics, and treatment delivered were examined. Kaplan-Meier survival curves were calculated to estimate survival rates. Cox proportional-hazards ratios were used to identify independent prognostic factors for survival. RESULTS Advanced age at diagnosis, male sex, low socioeconomic status (SES), nonsurgical treatment, and poor histologic grade (stage IA NSCLC: hazards ratio [HR], 1.13; 95% confidence interval [95% CI], 1.08-1.19; stage IB NSCLC: HR, 1.11; 95% CI, 1.07-1.16) were associated with increased mortality risk on multivariate analysis. Non-upper lobe tumor location (right middle lobe, right and left lower lobes) and tumor size > or =4 cm (vs <4 cm: HR, 1.23; 95% CI, 1.15-1.30) were additional factors that increased the risk of mortality among patients with stage IB disease. Bronchioloalveolar carcinoma and Asian ethnicity were associated with decreased mortality risk in stage I NSCLC. CONCLUSIONS Stage I NSCLC with poorly differentiated histology and stage IB NSCLC with non-upper lobar tumor location or tumor size > or =4 cm carried an increased mortality risk.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma, Bronchiolo-Alveolar/mortality
- Adenocarcinoma, Bronchiolo-Alveolar/pathology
- Adult
- Aged
- Asian/statistics & numerical data
- California/epidemiology
- Carcinoma, Large Cell/mortality
- Carcinoma, Large Cell/pathology
- Carcinoma, Non-Small-Cell Lung/enzymology
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Female
- Humans
- Kaplan-Meier Estimate
- Lung Neoplasms/ethnology
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Male
- Middle Aged
- Multivariate Analysis
- Neoplasm Staging
- Pneumonectomy/methods
- Predictive Value of Tests
- Prognosis
- Proportional Hazards Models
- Registries
- Risk Assessment
- Risk Factors
- Survival Rate
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Affiliation(s)
- S-H Ignatius Ou
- Division of Hematology/Oncology, Department of Medicine, Chao Family Comprehensive Cancer Center, Orange, California 92868, USA.
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Budoff MJ, Gopal A. Rebuttal: Reviewing large field of views on cardiac CT does not lead to improved outcomes. Catheter Cardiovasc Interv 2007. [DOI: 10.1002/ccd.21152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Leong SPL, Cady B, Jablons DM, Garcia-Aguilar J, Reintgen D, Werner JA, Kitagawa Y. Patterns of metastasis in human solid cancers. Cancer Treat Res 2007; 135:209-221. [PMID: 17953419 DOI: 10.1007/978-0-387-69219-7_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Stanley P L Leong
- Department of Surgery, University of California San Francisco, California, USA
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Kalra MK, Abbara S, Cury RC, Brady TJ. Interpretation of incidental findings on cardiac CT angiography. Catheter Cardiovasc Interv 2007; 70:324-5; author reply 326-8. [PMID: 17630679 DOI: 10.1002/ccd.21155] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Black WC. Computed tomography screening for lung cancer: Review of screening principles and update on current status. Cancer 2007; 110:2370-84. [DOI: 10.1002/cncr.23059] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
BACKGROUND While population based screening for lung cancer has not been adopted by most countries, it is not clear whether sputum examinations, chest radiography or newer methods such as computed tomography are effective in reducing mortality from lung cancer. OBJECTIVES To determine whether screening for lung cancer using regular sputum examinations or chest radiography or CT chest reduces lung cancer mortality. SEARCH STRATEGY Electronic databases (the Cochrane Central Register of Controlled Trials, MEDLINE, PREMEDLINE and EMBASE; 1966 to July 2000) ), bibliographies, hand searching of a journal and discussion with experts were used to identify published and unpublished trials. SELECTION CRITERIA Controlled trials of screening for lung cancer using sputum examinations, chest radiography or CT chest. DATA COLLECTION AND ANALYSIS Intention to screen analysis was performed. Where there was significant statistical heterogeneity relative risks were reported using the random effects model, but for other outcomes the fixed effect model was used. MAIN RESULTS Seven trials were included (6 randomised controlled studies and 1 non-randomised controlled trial) with a total of 245,610 subjects. There were no studies with an unscreened control group. Frequent screening with chest x-rays was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, CI: 1.00-1.23). A non statistically significant trend was observed to reduced mortality from lung cancer when screening with chest x-ray and sputum cytology was compared with chest x-ray alone (RR 0.88, CI:0.74-1.03). Several of the included studies had potential methodological weaknesses. There were no controlled studies of spiral CT. REVIEWER'S CONCLUSIONS The current evidence does not support screening for lung cancer with chest radiography or sputum cytology. Frequent chest x-ray screening might be harmful. Further, methodologically rigorous trials are required.
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Affiliation(s)
- R L Manser
- Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
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