101
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Yang D, Zhang X, Powell CA, Ni J, Wang B, Zhang J, Zhang Y, Wang L, Xu Z, Zhang L, Wu G, Song Y, Tian W, Hu JA, Zhang Y, Hu J, Hong Q, Song Y, Zhou J, Bai C. Probability of cancer in high-risk patients predicted by the protein-based lung cancer biomarker panel in China: LCBP study. Cancer 2017; 124:262-270. [PMID: 28940455 DOI: 10.1002/cncr.31020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND The authors built a model for lung cancer diagnosis previously based on the blood biomarkers progastrin-releasing peptide (ProGRP), carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), and cytokeratin 19 fragment (CYFRA21-1). In the current study, they examined whether modification of the model to include relevant clinical information, risk factors, and low-dose chest computed tomography screening would improve the performance of the biomarker panel in large cohorts of Chinese adults. METHODS The current study was a large-scale multicenter study (ClinicalTrials.gov identifier NCT01928836) performed in a Chinese population. A total of 715 participants were enrolled from 5 regional centers in Beijing, Henan, Nanjing, Shanghai, and Chongqing between October 2012 and February 2014. Serum biomarkers ProGRP, CEA, SCC, and CYFRA21-1 were analyzed on the ARCHITECT i2000SR. Relevant clinical information was collected and used to develop a patient risk model and a nodule risk model. RESULTS The resulting patient risk model had an area under the receiver operating characteristic (ROC) curve of 0.7037 in the training data set and 0.7190 in the validation data set. The resulting nodule risk model had an area under the ROC curve of 0.9151 in the training data set and 0.5836 in the validation data set. Moreover, the nodule risk model had a relatively higher area under the ROC curve (0.9151 vs 0.8360; P = 0.001) compared with the American College of Chest Physician model in patients with lung nodules. CONCLUSIONS Both the patient risk model and the nodule risk model, developed for the early diagnosis of lung cancer, demonstrated excellent discrimination, allowing for the stratification of patients with different levels of lung cancer risk. These new models are applicable in high-risk Chinese populations. Cancer 2018;124:262-70. © 2017 American Cancer Society.
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Affiliation(s)
- Dawei Yang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Chinese Alliance Against Lung Cancer, China.,Shanghai Respiratory Research Institution, Shanghai, China
| | - Xiaoju Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Chinese Alliance Against Lung Cancer, China.,Henan Provincial People's Hospital, Zhengzhou, China
| | - Charles A Powell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jun Ni
- Chinese Alliance Against Lung Cancer, China.,Department of Oncology, Peking University International Hospital, Beijing, China
| | - Bin Wang
- Chinese Alliance Against Lung Cancer, China.,Third Military Medical University, Chongqing, China
| | - Jianya Zhang
- Chinese Alliance Against Lung Cancer, China.,Nanjing People's Liberation Army General Hospital, Nanjing, China
| | - Yafei Zhang
- Chinese Alliance Against Lung Cancer, China.,The Chest Hospital of Henan Province, Zhengzhou, China
| | - Lijie Wang
- Shanghai Second Military College, Shanghai, China
| | - Zhihong Xu
- Chinese Alliance Against Lung Cancer, China.,Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhang
- Chinese Alliance Against Lung Cancer, China.,Peking Union Medical College Hospital, Beijing, China
| | - Guoming Wu
- Chinese Alliance Against Lung Cancer, China.,Third Military Medical University, Chongqing, China
| | - Yong Song
- Chinese Alliance Against Lung Cancer, China.,Nanjing People's Liberation Army General Hospital, Nanjing, China
| | - Wenhua Tian
- Shanghai Second Military College, Shanghai, China
| | - Jia-An Hu
- Chinese Alliance Against Lung Cancer, China.,Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Chinese Alliance Against Lung Cancer, China.,Shanghai Respiratory Research Institution, Shanghai, China
| | - Jie Hu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Chinese Alliance Against Lung Cancer, China.,Shanghai Respiratory Research Institution, Shanghai, China
| | - Qunying Hong
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Chinese Alliance Against Lung Cancer, China.,Shanghai Respiratory Research Institution, Shanghai, China
| | - Yuanlin Song
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Chinese Alliance Against Lung Cancer, China.,Shanghai Respiratory Research Institution, Shanghai, China
| | - Jian Zhou
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Chinese Alliance Against Lung Cancer, China.,Shanghai Respiratory Research Institution, Shanghai, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Chinese Alliance Against Lung Cancer, China.,Shanghai Respiratory Research Institution, Shanghai, China.,State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, China
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102
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Del Ciello A, Franchi P, Contegiacomo A, Cicchetti G, Bonomo L, Larici AR. Missed lung cancer: when, where, and why? Diagn Interv Radiol 2017; 23:118-126. [PMID: 28206951 DOI: 10.5152/dir.2016.16187] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Missed lung cancer is a source of concern among radiologists and an important medicolegal challenge. In 90% of the cases, errors in diagnosis of lung cancer occur on chest radiographs. It may be challenging for radiologists to distinguish a lung lesion from bones, pulmonary vessels, mediastinal structures, and other complex anatomical structures on chest radiographs. Nevertheless, lung cancer can also be overlooked on computed tomography (CT) scans, regardless of the context, either if a clinical or radiologic suspect exists or for other reasons. Awareness of the possible causes of overlooking a pulmonary lesion can give radiologists a chance to reduce the occurrence of this eventuality. Various factors contribute to a misdiagnosis of lung cancer on chest radiographs and on CT, often very similar in nature to each other. Observer error is the most significant one and comprises scanning error, recognition error, decision-making error, and satisfaction of search. Tumor characteristics such as lesion size, conspicuity, and location are also crucial in this context. Even technical aspects can contribute to the probability of skipping lung cancer, including image quality and patient positioning and movement. Albeit it is hard to remove missed lung cancer completely, strategies to reduce observer error and methods to improve technique and automated detection may be valuable in reducing its likelihood.
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Affiliation(s)
- Annemilia Del Ciello
- Institute of Radiology, Department of Radiological Sciences, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, Rome, Italy.
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103
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Abstract
Lung cancer screening has demonstrated a reduction in lung cancer mortality by 20%. Annual low-dose computed tomography examination in high-risk individuals is now recommended by multiple national health care organizations and is covered under Medicare and Medicaid services. The impact of this public health intervention is projected to increase the case load for the thoracic surgery workforce.
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Affiliation(s)
- Andrew P Dhanasopon
- Section of Thoracic Surgery, Yale-New Haven Hospital, Yale School of Medicine, 330 Cedar Street, BB205, New Haven, CT 06520, USA
| | - Anthony W Kim
- Division of Thoracic Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA 90033, USA.
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104
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Modélisation de l’impact économique d’un dépistage organisé du cancer du poumon en France. Rev Mal Respir 2017; 34:717-728. [DOI: 10.1016/j.rmr.2015.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/05/2015] [Indexed: 12/27/2022]
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105
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Binkley MS, King MT, Shrager JB, Bush K, Chaudhuri AA, Popat R, Gensheimer MF, Maxim PG, Henry Guo H, Diehn M, Nair VS, Loo BW. Pulmonary function after lung tumor stereotactic ablative radiotherapy depends on regional ventilation within irradiated lung. Radiother Oncol 2017; 123:270-275. [PMID: 28460826 DOI: 10.1016/j.radonc.2017.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/07/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine if regional ventilation within irradiated lung volume predicts change in pulmonary function test (PFT) measurements after stereotactic ablative radiotherapy (SABR) of lung tumors. METHODS We retrospectively identified 27 patients treated from 2007 to 2014 at our institution who received: (1) SABR without prior thoracic radiation; (2) pre-treatment 4-dimensional computed tomography (4-D CT) imaging; (3) pre- and post-SABR PFTs <15months from treatment. We defined the ventilation ratio (VR20BED3) as the quotient of mean ventilation (mean Jacobian-based per-voxel volume change on deformably registered inhale/exhale 4-D CT phases) within the 20Gy biologically effective dose (α/β=3Gy) isodose volume and that of the total lung volume (TLV). RESULTS Most patients had moderate to very severe COPD by GOLD criteria (n=19, 70.1%). Higher VR20BED3 significantly predicted worse change in Forced Expiratory Volume/s normalized by baseline value (ΔFEV1/FEV1pre, p=0.04); n=7 had VR20BED3>1 (high regional ventilation) and worse ΔFEV1/FEV1pre (median=-0.16, range=-0.230 to -0.20). Five had VR20BED3<1 (low regional ventilation) and improved ΔFEV1/FEV1pre (median=0.13, range=0.07 to 0.20). In a multivariable linear model, increasing VR20BED3 and time to post-SABR PFT predicted decreasing ΔFEV1/FEV1pre (R2=0.25, p=0.03). CONCLUSIONS After SABR to high versus low functioning lung regions, we found worsened or improved global pulmonary function, respectively. If pre-SABR VR20BED3 is validated as a predictor of eventual post-SABR PFT in larger studies, it may be used for individualized treatment planning to preserve or even improve pulmonary function after SABR.
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Affiliation(s)
- Michael S Binkley
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Martin T King
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Joseph B Shrager
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - Karl Bush
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Aadel A Chaudhuri
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Rita Popat
- Department of Health Research & Policy, Stanford University School of Medicine, United States
| | - Michael F Gensheimer
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Peter G Maxim
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - H Henry Guo
- Department of Radiology, Stanford University School of Medicine, United States
| | - Maximilian Diehn
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Institute for Stem Cell Biology & Regenerative Medicine, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - Viswam S Nair
- Department of Radiology, Stanford University School of Medicine, United States; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford Cancer Institute and Department of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States.
| | - Billy W Loo
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States.
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106
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Yang SC, Lai WW, Lin CC, Su WC, Ku LJ, Hwang JS, Wang JD. Cost-effectiveness of implementing computed tomography screening for lung cancer in Taiwan. Lung Cancer 2017. [PMID: 28625633 DOI: 10.1016/j.lungcan.2017.04.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A screening program for lung cancer requires more empirical evidence. Based on the experience of the National Lung Screening Trial (NLST), we developed a method to adjust lead-time bias and quality-of-life changes for estimating the cost-effectiveness of implementing computed tomography (CT) screening in Taiwan. METHODS The target population was high-risk (≥30 pack-years) smokers between 55 and 75 years of age. From a nation-wide, 13-year follow-up cohort, we estimated quality-adjusted life expectancy (QALE), loss-of-QALE, and lifetime healthcare expenditures per case of lung cancer stratified by pathology and stage. Cumulative stage distributions for CT-screening and no-screening were assumed equal to those for CT-screening and radiography-screening in the NLST to estimate the savings of loss-of-QALE and additional costs of lifetime healthcare expenditures after CT screening. Costs attributable to screen-negative subjects, false-positive cases and radiation-induced lung cancer were included to obtain the incremental cost-effectiveness ratio from the public payer's perspective. RESULTS The incremental costs were US$22,755 per person. After dividing this by savings of loss-of-QALE (1.16 quality-adjusted life year (QALY)), the incremental cost-effectiveness ratio was US$19,683 per QALY. This ratio would fall to US$10,947 per QALY if the stage distribution for CT-screening was the same as that of screen-detected cancers in the NELSON trial. CONCLUSIONS Low-dose CT screening for lung cancer among high-risk smokers would be cost-effective in Taiwan. As only about 5% of our women are smokers, future research is necessary to identify the high-risk groups among non-smokers and increase the coverage.
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Affiliation(s)
- Szu-Chun Yang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan.
| | - Wu-Wei Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan.
| | - Chien-Chung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan.
| | - Wu-Chou Su
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan.
| | - Li-Jung Ku
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan.
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, No. 128 Academia Road, Section 2, Taipei 115, Taiwan.
| | - Jung-Der Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan 701, Taiwan; Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng Li Road, Tainan 704, Taiwan.
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107
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Pedersen JH, Rzyman W, Veronesi G, D’Amico TA, Van Schil P, Molins L, Massard G, Rocco G. Recommendations from the European Society of Thoracic Surgeons (ESTS) regarding computed tomography screening for lung cancer in Europe. Eur J Cardiothorac Surg 2017; 51:411-420. [PMID: 28137752 PMCID: PMC6279064 DOI: 10.1093/ejcts/ezw418] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/03/2016] [Accepted: 11/30/2016] [Indexed: 12/17/2022] Open
Abstract
In order to provide recommendations regarding implementation of computed tomography (CT) screening in Europe the ESTS established a working group with eight experts in the field. On a background of the current situation regarding CT screening in Europe and the available evidence, ten recommendations have been prepared that cover the essential aspects to be taken into account when considering implementation of CT screening in Europe. These issues are: (i) Implementation of CT screening in Europe, (ii) Participation of thoracic surgeons in CT screening programs, (iii) Training and clinical profile for surgeons participating in screening programs, (iv) the use of minimally invasive thoracic surgery and other relevant surgical issues and (v) Associated elements of CT screening programs (i.e. smoking cessation programs, radiological interpretation, nodule evaluation algorithms and pathology reports). Thoracic Surgeons will play a key role in this process and therefore the ESTS is committed to providing guidance and facilitating this process for the benefit of patients and surgeons.
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Affiliation(s)
- Jesper Holst Pedersen
- Department of Thoracic Surgery RT 2152, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | | | - Thomas A D’Amico
- Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Laureano Molins
- Thoracic Surgery Respiratory Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gilbert Massard
- Service de Chirurgie Thoracique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Gaetano Rocco
- Division of Thoracic Surgery, Department of Thoracic Surgical and Medical Oncology, National Cancer Institute, Naples, Italy
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108
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MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, Mehta AC, Ohno Y, Powell CA, Prokop M, Rubin GD, Schaefer-Prokop CM, Travis WD, Van Schil PE, Bankier AA. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology 2017; 284:228-243. [PMID: 28240562 DOI: 10.1148/radiol.2017161659] [Citation(s) in RCA: 1340] [Impact Index Per Article: 191.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. © RSNA, 2017 Online supplemental material is available for this article. An earlier incorrect version of this article appeared online. This article was corrected on March 13, 2017.
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Affiliation(s)
- Heber MacMahon
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - David P Naidich
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Jin Mo Goo
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Kyung Soo Lee
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Ann N C Leung
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - John R Mayo
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Atul C Mehta
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Yoshiharu Ohno
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Charles A Powell
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Mathias Prokop
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Geoffrey D Rubin
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Cornelia M Schaefer-Prokop
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - William D Travis
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Paul E Van Schil
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
| | - Alexander A Bankier
- From the Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637 (H.M.); Department of Radiology, New York University Langone Medical Center, New York, NY (D.P.N.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea (K.S.L.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Department of Radiology, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada (J.R.M.); Department of Medicine, Cleveland Clinic, Cleveland, Ohio (A.C.M.); Department of Radiology, Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (Y.O.); Pulmonary and Critical Care Medicine, ICAHN School of Medicine at Mount Sinai, New York, NY (C.A.P.); Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands (M.P.); Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.M.S.); Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY (W.D.T.); Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium (P.E.V.S.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (A.A.B)
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109
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Walter JE, Heuvelmans MA, Oudkerk M. Small pulmonary nodules in baseline and incidence screening rounds of low-dose CT lung cancer screening. Transl Lung Cancer Res 2017; 6:42-51. [PMID: 28331823 DOI: 10.21037/tlcr.2016.11.05] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Currently, lung cancer screening by low-dose computed tomography (LDCT) is widely recommended for high-risk individuals by US guidelines, but there still is an ongoing debate concerning respective recommendations for European countries. Nevertheless, the available data regarding pulmonary nodules released by lung cancer screening studies could improve future screening guidelines, as well as the clinical practice of incidentally detected pulmonary nodules on routine CT scans. Most lung cancer screening trials present results for baseline and incidence screening rounds separately, clustering pulmonary nodules initially found at baseline screening and newly detected pulmonary nodules after baseline screening together. This approach does not appreciate possible differences among pulmonary nodules detected at baseline and firstly detected at incidence screening rounds and is heavily influenced by methodological differences of the respective screening trials. This review intends to create a basis for assessing non-calcified pulmonary nodules detected during LDCT lung cancer screening in a more clinical relevant manner. The aim is to present data of non-calcified pulmonary baseline nodules and new non-calcified pulmonary incident nodules without clustering them together, thereby also simplifying translation to the clinical practice of incidentally detected pulmonary nodules. Small pulmonary nodules newly detected at incidence screening rounds of LDCT lung cancer screening may possess a greater lung cancer probability than pulmonary baseline nodules at a smaller size, which is essential for the development of new guidelines.
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Affiliation(s)
- Joan E Walter
- University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
| | - Marjolein A Heuvelmans
- University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
| | - Matthijs Oudkerk
- University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
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110
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Sagawa M, Sugawara T, Ishibashi N, Koyanagi A, Kondo T, Tabata T. Efficacy of low-dose computed tomography screening for lung cancer: the current state of evidence of mortality reduction. Surg Today 2016; 47:783-788. [PMID: 27815717 DOI: 10.1007/s00595-016-1438-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/04/2016] [Indexed: 12/17/2022]
Abstract
The interim and final results of randomized controlled trials on the efficacy of lung cancer computed tomography (CT) screening have been reported recently from Western countries. The outcome of the National Lung Screening Trial (NLST) demonstrated the efficacy of low-dose thoracic CT screening for heavy smokers; however, other studies have found no apparent reduction in the mortality rate, and the outcome of the NELSON study is awaited. To date, a few studies have reported on the efficacy of lung cancer CT screening for non-/light smokers. A report from the Hitachi district, which is an ecological/time series study where non-/light smokers account for approximately half of the CT screening examinees, was published in 2012, with an outcome suggesting efficacy. Currently, a randomized controlled trial (JECS Study) is underway in Japan with non-/light smokers as the subjects, and this trial is very important in terms of cancer prevention.
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Affiliation(s)
- Motoyasu Sagawa
- Department of Endoscopy, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan.
| | - Takafumi Sugawara
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
| | - Naoya Ishibashi
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
| | - Akira Koyanagi
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
| | - Takashi Kondo
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
| | - Toshiharu Tabata
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University, 1-12-1 Fukumuro, Miyagino-ku, Sendai, Miyagi, 983-8512, Japan
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111
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Broodman I, Lindemans J, van Sten J, Bischoff R, Luider T. Serum Protein Markers for the Early Detection of Lung Cancer: A Focus on Autoantibodies. J Proteome Res 2016; 16:3-13. [DOI: 10.1021/acs.jproteome.6b00559] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
| | | | | | - Rainer Bischoff
- Analytical
Biochemistry, Department of Pharmacy, University of Groningen, Antonius
Deusinglaan 1, 9713 AV Groningen, The Netherlands
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112
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Ma X, Siegelman J, Paik DS, Mulshine JL, St Pierre S, Buckler AJ. Volumes Learned: It Takes More Than Size to "Size Up" Pulmonary Lesions. Acad Radiol 2016; 23:1190-8. [PMID: 27287713 DOI: 10.1016/j.acra.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to review the current understanding and capabilities regarding use of imaging for noninvasive lesion characterization and its relationship to lung cancer screening and treatment. MATERIALS AND METHODS Our review of the state of the art was broken down into questions about the different lung cancer image phenotypes being characterized, the role of imaging and requirements for increasing its value with respect to increasing diagnostic confidence and quantitative assessment, and a review of the current capabilities with respect to those needs. RESULTS The preponderance of the literature has so far been focused on the measurement of lesion size, with increasing contributions being made to determine the formal performance of scanners, measurement tools, and human operators in terms of bias and variability. Concurrently, an increasing number of investigators are reporting utility and predictive value of measures other than size, and sensitivity and specificity is being reported. Relatively little has been documented on quantitative measurement of non-size features with corresponding estimation of measurement performance and reproducibility. CONCLUSIONS The weight of the evidence suggests characterization of pulmonary lesions built on quantitative measures adds value to the screening for, and treatment of, lung cancer. Advanced image analysis techniques may identify patterns or biomarkers not readily assessed by eye and may also facilitate management of multidimensional imaging data in such a way as to efficiently integrate it into the clinical workflow.
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Affiliation(s)
- Xiaonan Ma
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984.
| | - Jenifer Siegelman
- Department of Radiology, Brigham and Women's Hospital, Boston Massachusetts; Department of Radiology (hospital-based), Harvard Medical School, Boston, Massachusetts
| | - David S Paik
- Elucid Bioimaging Inc., 225 Main Street, Wenham, MA 01984
| | - James L Mulshine
- Department of Internal Medicine, Rush University, Chicago, Illinois
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113
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Billiet C, De Ruysscher D, Peeters S, Decaluwé H, Vansteenkiste J, Dooms C, Deroose CM, De Leyn P, Hendrikx M, Bulens P, Le Péchoux C, Mebis J. Patterns of Locoregional Relapses in Patients with Contemporarily Staged Stage III-N2 NSCLC Treated with Induction Chemotherapy and Resection: Implications for Postoperative Radiotherapy Target Volumes. J Thorac Oncol 2016; 11:1538-49. [DOI: 10.1016/j.jtho.2016.05.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/17/2016] [Accepted: 05/21/2016] [Indexed: 12/26/2022]
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Usman Ali M, Miller J, Peirson L, Fitzpatrick-Lewis D, Kenny M, Sherifali D, Raina P. Screening for lung cancer: A systematic review and meta-analysis. Prev Med 2016; 89:301-314. [PMID: 27130532 DOI: 10.1016/j.ypmed.2016.04.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 04/12/2016] [Accepted: 04/16/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To examine evidence on benefits and harms of screening average to high-risk adults for lung cancer using chest radiology (CXR), sputum cytology (SC) and low-dose computed tomography (LDCT). METHODS This systematic review was conducted to provide up to date evidence for Canadian Task Force on Preventive Health Care (CTFPHC) lung cancer screening guidelines. Four databases were searched to March 31, 2015 along with utilizing a previous Cochrane review search. Randomized trials reporting benefits were included; any design was included for harms. Meta-analyses were performed if possible. PROSPERO #CRD42014009984. RESULTS Thirty-four studies were included. For lung cancer mortality there was no benefit of CXR screening, with or without SC. Pooled results from three small trials comparing LDCT to usual care found no significant benefits for lung cancer mortality. One large high quality trial showed statistically significant reductions of 20% in lung cancer mortality over a follow-up of 6.5years, for LDCT compared with CXR. LDCT screening was associated with: overdiagnosis of 10.99-25.83%; 11.18 deaths and 52.03 patients with major complications per 1000 undergoing invasive follow-up procedures; median estimate for false positives of 25.53% for baseline/once-only screening and 23.28% for multiple rounds; and 9.74 and 5.28 individuals per 1000 screened, with benign conditions underwent minor and major invasive follow-up procedures. CONCLUSION The evidence does not support CXR screening with or without sputum cytology for lung cancer. High quality evidence showed that in selected high-risk individuals, LDCT screening significantly reduced lung cancer mortality and all-cause mortality. However, for its implementation at a population level, the current evidence warrants the development of standardized practices for screening with LDCT and follow-up invasive testing to maximize accuracy and reduce potential associated harms.
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Affiliation(s)
- Muhammad Usman Ali
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | - John Miller
- Department of Surgery, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - Leslea Peirson
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre Room HSC-3N25F, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - Donna Fitzpatrick-Lewis
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre Room HSC-3N25F, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - Meghan Kenny
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
| | - Diana Sherifali
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; School of Nursing, Faculty of Health Sciences, McMaster University, Health Sciences Centre Room HSC-3N25F, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | - Parminder Raina
- McMaster Evidence Review and Synthesis Centre, McMaster University, 1280 Main St. W., McMaster Innovation Park, Room 207A, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Room HSC-2C, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada.
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115
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Park S, Park IK, Kim ER, Hwang Y, Lee HJ, Kang CH, Kim YT. Current Trends of Lung Cancer Surgery and Demographic and Social Factors Related to Changes in the Trends of Lung Cancer Surgery: An Analysis of the National Database from 2010 to 2014. Cancer Res Treat 2016; 49:330-337. [PMID: 27456943 PMCID: PMC5398405 DOI: 10.4143/crt.2016.196] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 06/21/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE We investigated current trends in lung cancer surgery and identified demographic and social factors related to changes in these trends. MATERIALS AND METHODS We estimated the incidence of lung cancer surgery using a procedure code-based approach provided by the Health Insurance Review and Assessment Service (http://opendata.hira.or.kr). The population data were obtained every year from 2010 to 2014 from the Korean Statistical Information Service (http://kosis.kr/). The annual percent change (APC) and statistical significance were calculated using the Joinpoint software. RESULTS From January 2010 to December 2014, 25,687 patients underwent 25,921 lung cancer surgeries, which increased by 45.1% from 2010 to 2014. The crude incidence rate of lung cancer surgery in each year increased significantly (APC, 9.5; p < 0.05). The male-to-female ratio decreased from 2.1 to 1.6 (APC, -6.3; p < 0.05). The incidence increased in the age group of ≥ 70 years for both sexes (male: APC, 3.7; p < 0.05; female: APC, 5.96; p < 0.05). Furthermore, the proportion of female patients aged ≥ 65 years increased (APC, 7.2; p < 0.05), while that of male patients aged < 65 years decreased (APC, -3.9; p < 0.05). The proportions of segmentectomies (APC, 17.8; p < 0.05) and lobectomies (APC, 7.5; p < 0.05) increased, while the proportion of pneumonectomies decreased (APC, -6.3; p < 0.05). Finally, the proportion of patients undergoing surgery in Seoul increased (APC, 1.1; p < 0.05), while the proportion in other areas decreased (APC, -1.5; p < 0.05). CONCLUSION An increase in the use of lung cancer surgery in elderly patients and female patients, and a decrease in the proportion of patients requiring extensive pulmonary resection were identified. Furthermore, centralization of lung cancer surgery was noted.
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Affiliation(s)
- Samina Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - In Kyu Park
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eung Re Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoohwa Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Joo Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Setio AAA, Jacobs C, Gelderblom J, van Ginneken B. Automatic detection of large pulmonary solid nodules in thoracic CT images. Med Phys 2016; 42:5642-53. [PMID: 26429238 DOI: 10.1118/1.4929562] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Current computer-aided detection (CAD) systems for pulmonary nodules in computed tomography (CT) scans have a good performance for relatively small nodules, but often fail to detect the much rarer larger nodules, which are more likely to be cancerous. We present a novel CAD system specifically designed to detect solid nodules larger than 10 mm. METHODS The proposed detection pipeline is initiated by a three-dimensional lung segmentation algorithm optimized to include large nodules attached to the pleural wall via morphological processing. An additional preprocessing is used to mask out structures outside the pleural space to ensure that pleural and parenchymal nodules have a similar appearance. Next, nodule candidates are obtained via a multistage process of thresholding and morphological operations, to detect both larger and smaller candidates. After segmenting each candidate, a set of 24 features based on intensity, shape, blobness, and spatial context are computed. A radial basis support vector machine (SVM) classifier was used to classify nodule candidates, and performance was evaluated using ten-fold cross-validation on the full publicly available lung image database consortium database. RESULTS The proposed CAD system reaches a sensitivity of 98.3% (234/238) and 94.1% (224/238) large nodules at an average of 4.0 and 1.0 false positives/scan, respectively. CONCLUSIONS The authors conclude that the proposed dedicated CAD system for large pulmonary nodules can identify the vast majority of highly suspicious lesions in thoracic CT scans with a small number of false positives.
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Affiliation(s)
- Arnaud A A Setio
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Colin Jacobs
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Jaap Gelderblom
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Bram van Ginneken
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands and Fraunhofer MEVIS, Bremen 28359, Germany
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Walter JE, Heuvelmans MA, de Jong PA, Vliegenthart R, van Ooijen PMA, Peters RB, ten Haaf K, Yousaf-Khan U, van der Aalst CM, de Bock GH, Mali W, Groen HJM, de Koning HJ, Oudkerk M. Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: analysis of data from the randomised, controlled NELSON trial. Lancet Oncol 2016; 17:907-916. [DOI: 10.1016/s1470-2045(16)30069-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 12/17/2022]
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Yousaf-Khan U, van der Aalst C, de Jong PA, Heuvelmans M, Scholten E, Lammers JW, van Ooijen P, Nackaerts K, Weenink C, Groen H, Vliegenthart R, ten Haaf K, Oudkerk M, de Koning H. Final screening round of the NELSON lung cancer screening trial: the effect of a 2.5-year screening interval. Thorax 2016; 72:48-56. [DOI: 10.1136/thoraxjnl-2016-208655] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/09/2016] [Accepted: 06/02/2016] [Indexed: 01/11/2023]
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Subsolid pulmonary nodule morphology and associated patient characteristics in a routine clinical population. Eur Radiol 2016; 27:689-696. [PMID: 27255399 PMCID: PMC5209441 DOI: 10.1007/s00330-016-4429-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/11/2016] [Accepted: 05/20/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To determine the presence and morphology of subsolid pulmonary nodules (SSNs) in a non-screening setting and relate them to clinical and patient characteristics. METHODS A total of 16,890 reports of clinically obtained chest CT (06/2011 to 11/2014, single-centre) were searched describing an SSN. Subjects with a visually confirmed SSN and at least two thin-slice CTs were included. Nodule volumes were measured. Progression was defined as volume increase exceeding the software interscan variation. Nodule morphology, location, and patient characteristics were evaluated. RESULTS Fifteen transient and 74 persistent SSNs were included (median follow-up 19.6 [8.3-36.8] months). Subjects with an SSN were slightly older than those without (62 vs. 58 years; p = 0.01), but no gender predilection was found. SSNs were mostly located in the upper lobes. Women showed significantly more often persistent lesions than men (94 % vs. 69 %; p = 0.002). Part-solid lesions were larger (1638 vs. 383 mm3; p < 0.001) and more often progressive (68 % vs. 38 %; p = 0.02), compared to pure ground-glass nodules. Progressive SSNs were rare under the age of 50 years. Logistic regression analysis did not identify additional nodule parameters of future progression, apart from part-solid nature. CONCLUSIONS This study confirms previously reported characteristics of SSNs and associated factors in a European, routine clinical population. KEY POINTS • SSNs in women are significantly more often persistent compared to men. • SSN persistence is not associated with age or prior malignancy. • The majority of (persistent) SSNs are located in the upper lung lobes. • A part-solid nature is associated with future nodule growth. • Progressive solitary SSNs are rare under the age of 50 years.
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Le dépistage du cancer bronchopulmonaire par tomodensitométrie thoracique à faible dose en France : enjeux et perspectives. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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121
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Adamek M, Wachuła E, Szabłowska-Siwik S, Boratyn-Nowicka A, Czyżewski D. Risk factors assessment and risk prediction models in lung cancer screening candidates. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:151. [PMID: 27195269 DOI: 10.21037/atm.2016.04.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
From February 2015, low-dose computed tomography (LDCT) screening entered the armamentarium of diagnostic tools broadly available to individuals at high-risk of developing lung cancer. While a huge number of pulmonary nodules are identified, only a small fraction turns out to be early lung cancers. The majority of them constitute a variety of benign lesions. Although it entails a burden of the diagnostic work-up, the undisputable benefit emerges from: (I) lung cancer diagnosis at earlier stages (stage shift); (II) additional findings enabling the implementation of a preventive action beyond the realm of thoracic oncology. This review presents how to utilize the risk factors from distinct categories such as epidemiology, radiology and biomarkers to target the fraction of population, which may benefit most from the introduced screening modality.
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Affiliation(s)
- Mariusz Adamek
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Ewa Wachuła
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Sylwia Szabłowska-Siwik
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Boratyn-Nowicka
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
| | - Damian Czyżewski
- 1 The Chair and Department of Thoracic Surgery, The Professor S. Szyszko Teaching Hospital No. 1, Zabrze, Poland ; 2 Department of Clinical Oncology, Medical University of Silesia, Katowice, Poland
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Pedersen JH, Ashraf H. Implementation and organization of lung cancer screening. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:152. [PMID: 27195270 DOI: 10.21037/atm.2016.03.59] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CT screening for lung cancer is now being implemented in the US and China on a widespread national scale but not in Europe so far. The review gives a status for the implementation process and the hurdles to overcome in the future. It also describes the guidelines and requirements for the structure and components of high quality CT screening programs. These are essential in order to achieve a successful program with the fewest possible harms and a possible mortality benefit like that documented in the American National Lung Screening Trial (NLST). In addition the importance of continued research in CT screening methods is described and discussed with focus on the great potential to further improve this method in the future for the benefit of patients and society.
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Affiliation(s)
- Jesper Holst Pedersen
- 1 Rigshospitalet, Department of Cardiothoracic Surgery, University of Copenhagen, Copenhagen, Denmark ; 2 Department of Pulmonary Medicine, Gentofte University Hospital and University of Copenhagen, Denmark ; 3 Department of Radiology, Akershus University Hospital, Lørenskog, Norway
| | - Haseem Ashraf
- 1 Rigshospitalet, Department of Cardiothoracic Surgery, University of Copenhagen, Copenhagen, Denmark ; 2 Department of Pulmonary Medicine, Gentofte University Hospital and University of Copenhagen, Denmark ; 3 Department of Radiology, Akershus University Hospital, Lørenskog, Norway
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Rampinelli C, Calloni SF, Minotti M, Bellomi M. Spectrum of early lung cancer presentation in low-dose screening CT: a pictorial review. Insights Imaging 2016; 7:449-59. [PMID: 27188380 PMCID: PMC4877352 DOI: 10.1007/s13244-016-0487-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/20/2016] [Accepted: 03/18/2016] [Indexed: 12/14/2022] Open
Abstract
The typical presentation of early stage lung cancers on low-dose CT screening are non-calcified pulmonary nodules. However, there is a wide spectrum of unusual focal abnormalities that can be early presentations of lung cancer. These abnormalities include, for example, cancers associated with 'cystic airspaces' or scar-like cancers. The detection of lung cancer with low-dose CT can be affected by the absence of intravenous contrast medium. As a consequence, endobronchial and central lesions can be difficult to recognize, raising the potential for missed cancers. Focal lesions arising within pre-existing lung disease, such as lung fibrosis or apical scars, can also be early lung cancer manifestations and deserve particular consideration as recognition of these lesions may be hindered by the underlying disease. Furthermore, the unpredictable growth rate of lung cancer, which ranges from indolent to aggressive cancers, necessitates attention to the wide spectrum of progression in lung cancer appearance on serial low-dose CT scans. In this pictorial review we discuss the spectrum of early lung cancer presentation in low-dose CT screening, highlighting typical as well as unusual radiological features and the varied growth rates of early lung cancer. Teaching Points • There is a wide spectrum of early presentations of lung cancer on LDCT. • Low radiation dose and the absence of contrast medium injection can affect lung cancer detection. • Lung cancer growth shows various behaviours, ranging from indolent to aggressive cancers. • Familiarity with LDCT technique can improve CT screening effectiveness and avoid missed diagnosis.
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Affiliation(s)
- Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy.
| | | | - Marta Minotti
- School of Medicine, University of Milan, Milan, Italy
| | - Massimo Bellomi
- Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy
- School of Medicine, University of Milan, Milan, Italy
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The IASLC Lung Cancer Staging Project: Proposals for the Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 10:990-1003. [PMID: 26134221 DOI: 10.1097/jto.0000000000000559] [Citation(s) in RCA: 528] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION An international database was collected to inform the 8 edition of the anatomic classification of lung cancer. The present analyses concern its primary tumor (T) component. METHODS From 1999 to 2010, 77,156 evaluable patients, 70,967 with non-small-cell lung cancer, were collected; and 33,115 had either a clinical or a pathological classification, known tumor size, sufficient T information, and no metastases. Survival was measured from date of diagnosis or surgery for clinically and pathologically staged tumors. Tumor-size cutpoints were evaluated by the running log-rank statistics. T descriptors were evaluated in a multivariate Cox regression analysis adjusted for age, gender, histological type, and geographic region. RESULTS The 3-cm cutpoint significantly separates T1 from T2. From 1 to 5 cm, each centimeter separates tumors of significantly different prognosis. Prognosis of tumors greater than 5 cm but less than or equal to 7 cm is equivalent to T3, and that of those greater than 7 cm to T4. Bronchial involvement less than 2 cm from carina, but without involving it, and total atelectasis/pneumonitis have a T2 prognosis. Involvement of the diaphragm has a T4 prognosis. Invasion of the mediastinal pleura is a descriptor seldom used. CONCLUSIONS Recommended changes are as follows: to subclassify T1 into T1a (≤1 cm), T1b (>1 to ≤2 cm), and T1c (>2 to ≤3 cm); to subclassify T2 into T2a (>3 to ≤4 cm) and T2b (>4 to ≤5 cm); to reclassify tumors greater than 5 to less than or equal to 7 cm as T3; to reclassify tumors greater than 7 cm as T4; to group involvement of main bronchus as T2 regardless of distance from carina; to group partial and total atelectasis/pneumonitis as T2; to reclassify diaphragm invasion as T4; and to delete mediastinal pleura invasion as a T descriptor.
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Young RP, Duan F, Chiles C, Hopkins RJ, Gamble GD, Greco EM, Gatsonis C, Aberle D. Airflow Limitation and Histology Shift in the National Lung Screening Trial. The NLST-ACRIN Cohort Substudy. Am J Respir Crit Care Med 2016. [PMID: 26199983 DOI: 10.1164/rccm.201505-0894oc] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
RATIONALE Annual computed tomography (CT) is now widely recommended for lung cancer screening in the United States, although concerns remain regarding the potential harms, including those from overdiagnosis. OBJECTIVES To examine the effect of airflow limitation on overdiagnosis by comparing lung cancer incidence, histology, and stage shift in a subgroup of the National Lung Screening Trial (NLST). METHODS In an NLST subgroup (n = 18,714), screening participants were randomized to annual computed tomography (CT, n = 9,357) or chest radiograph (n = 9,357) screening and monitored for a mean of 6.1 years. After baseline prebronchodilator spirometry, to identify the presence of airflow limitation, 18,475 subjects (99%) were assigned as having chronic obstructive pulmonary disease (COPD) or no COPD. Lung cancer prevalence, incidence, histology, and stage shift were compared after stratification by COPD. MEASUREMENTS AND MAIN RESULTS For screening participants with spirometric COPD (n = 6,436), there was a twofold increase in lung cancer incidence (incident rate ratio, 2.15; P < 0.001) and, when compared according to screening arm, no excess lung cancers and comparable histology. Compared with chest radiography, there was also a trend favoring reduced late-stage and increased early-stage cancers in the CT arm (P = 0.054). For those with normal baseline spirometry (n = 12,039), we found an excess of lung cancers during screening in the CT arm, almost exclusively early-stage adenocarcinoma-related cancers (histology shift and overdiagnosis). After correction for these excess cancers, stage shift was marginal (P = 0.077). CONCLUSIONS In the CT arm of the NLST-ACRIN (American College of Radiology Imaging Network) cohort, COPD status was associated with a doubling of lung cancer incidence, no apparent overdiagnosis, and a more favorable stage shift.
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Affiliation(s)
- Robert P Young
- 1 School of Biological Sciences and.,2 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Fenghai Duan
- 3 Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Caroline Chiles
- 4 Department of Radiology, Comprehensive Cancer Center, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; and
| | - Raewyn J Hopkins
- 2 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Greg D Gamble
- 2 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Erin M Greco
- 3 Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine Gatsonis
- 3 Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Denise Aberle
- 5 Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Perandini S, Soardi G, Motton M, Oliboni E, Zantedeschi L, Montemezzi S. Distribution of Solid Solitary Pulmonary Nodules within the Lungs on Computed Tomography: A Review of 208 Consecutive Lesions of Biopsy-Proven Nature. Pol J Radiol 2016; 81:146-51. [PMID: 27103946 PMCID: PMC4824344 DOI: 10.12659/pjr.895417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/13/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The solitary pulmonary nodule (SPN) is a common radiologic abnormality on chest x-rays or computed tomography (CT) scans of the lungs. The differential diagnosis of SPNs is particularly wide as it includes a multitude of benign as well as malignant entities. Nodule location within the lungs has been proposed as a predictive feature in the literature. This study aims at illustrating the distribution within the lungs of a large current series of consecutive SPNs according to their histological subtype, which was definitely proved at core biopsy. MATERIAL/METHODS Two hundred-eight SPNs referred to our center for characterization were reviewed in this single-centre retrospective study. Histological subtypes were defined following the IASLC/ATS/ERS and WHO (2004) histological classification. RESULTS This study provides evidence with respect to the prevalence of adenocarcinomas and other non-neuroendocrine primary lung cancer types in the right upper lobe. It also provides new evidence with respect to the prevalence of carcinoid tumors in the middle and right lower lobe, with a tendency to occur in the central lung parenchyma. CONCLUSIONS This work updates existing knowledge of solid SPNs location within the lungs by providing a current picture of SPN distribution according to their nature.
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Affiliation(s)
- Simone Perandini
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Gianalberto Soardi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Massimiliano Motton
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Eugenio Oliboni
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Lisa Zantedeschi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy
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Kauczor HU, Bonomo L, Gaga M, Nackaerts K, Peled N, Prokop M, Remy-Jardin M, von Stackelberg O, Sculier JP. Lung cancer screening white paper: a slippery step forward? Eur Respir J 2016; 46:1521-2. [PMID: 26521283 DOI: 10.1183/13993003.01103-2015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany
| | - Lorenzo Bonomo
- Institute of Radiology, A. Gemelli University Hospital, Rome, Italy
| | - Mina Gaga
- 7th Respiratory Medicine Dept and Asthma Center, Athens Chest Hospital, Athens, Greece
| | - Kristiaan Nackaerts
- Dept of Respiratory Diseases/Respiratory Oncology Unit, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Nir Peled
- Davidoff Cancer Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Mathias Prokop
- Dept of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martine Remy-Jardin
- Dept of Thoracic Imaging, Hospital Calmette (EA 2694), CHRU et Universite de Lille, Lille, France
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany
| | - Jean-Paul Sculier
- Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Perandini S, Soardi GA, Motton M, Augelli R, Zantedeschi L, Montemezzi S. CT Imaging Features in the Characterization of Non-Growing Solid Pulmonary Nodules in Non-Smokers. Pol J Radiol 2016; 81:46-50. [PMID: 26937261 PMCID: PMC4754093 DOI: 10.12659/pjr.895307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/28/2016] [Indexed: 11/14/2022] Open
Abstract
Background A disappearing or persistent solid pulmonary nodule is a neglected clinical entity that still poses serious interpretative issues to date. Traditional knowledge deriving from previous reports suggests particular features, such as smooth edges or regular shape, to be significantly associated with benignity. A large number of benign nodules are reported among smokers in lung cancer screening programmes. The aim of this single-center retrospective study was to correlate specific imaging features to verify if traditional knowledge as well as more recent acquisitions regarding benign SPNs can be considered reliable in a current case series of nodules collected in a non-smoker cohort of patients. Material/Methods Fifty-three solid SPNs proven as non-growing during follow-up imaging were analyzed with regard to their imaging features at thin-section CT, their predicted malignancy risk according to three major risk assessment models, minimum density analysis and contrast enhanced-CT in the relative subgroups of nodules which underwent such tests. Results Eleven nodules disappeared during follow-up, 29 showed volume loss and 16 had a VDT of 1121 days or higher. There were 48 nodules located peripherally (85.71%). Evaluation of the enhancement after contrast media (n=29) showed mean enhancement ±SD of 25.72±35.03 HU, median of 18 HU, ranging from 0 to 190 HU. Minimum density assessment (n=30) showed mean minimum HU ±SD of −28.27±47.86 HU, median of −25 HU, ranging from −144 to 68 HU. Mean malignancy risk ±SD was 15.05±26.69% for the BIMC model, 17.22±19.00% for the Mayo Clinic model and 19.07±33.16% for the Gurney’s model. Conclusions Our analysis suggests caution in using traditional knowledge when dealing with current small solid peripheral indeterminate SPNs and highlights how quantitative growth at follow-up should be the cornerstone of characterization.
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Affiliation(s)
- Simone Perandini
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Gian Alberto Soardi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Massimiliano Motton
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Raffaele Augelli
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Lisa Zantedeschi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
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Shikuma K, Menju T, Chen F, Kubo T, Muro S, Sumiyoshi S, Ohata K, Sowa T, Nakanishi T, Cho H, Neri S, Aoyama A, Sato T, Sonobe M, Date H. Is volumetric 3-dimensional computed tomography useful to predict histological tumour invasiveness? Analysis of 211 lesions of cT1N0M0 lung adenocarcinoma. Interact Cardiovasc Thorac Surg 2016; 22:831-8. [PMID: 26920725 DOI: 10.1093/icvts/ivw037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 01/18/2016] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The purpose of this study was to use Hounsfield unit (HU) thresholds of computed tomography (CT) images to predict pathological lymph node metastasis and tumour invasiveness of cT1N0M0 lung adenocarcinoma on 3D evaluations. METHODS Preoperative CT images of 211 lesions of surgically resected cT1N0M0 lung adenocarcinoma were retrospectively examined. The tumour size was calculated in 1D, 2D and 3D views. Tumours with -300 HU and over were defined as 'solid tumours', and those between -800 and -301 HU were defined as 'ground glass opacity tumours'. Tumours with -800 HU and over were assumed to be the whole tumour entity. The proportion of 'solid tumour' within the whole tumour entity was also calculated as the 'solid tumour ratio'. These were compared with pathological information. RESULTS Solid tumour size and ratio were positively correlated with microscopic invasion to pleura, vessels and lymphatics in all dimensional evaluations. Pathological lymph node metastases were also well predicted by solid tumour size and ratio in all dimensional evaluations. The P-values for the receiver operating characteristic (ROC) curves of 1D, 1D ×2, 2D and 3D evaluations were: solid tumour size P = 0.013, 0.014 and 0.032; and solid tumour ratio 0.016, 0.0032 and <0.0001. In comparisons of 1D, 2D and 3D evaluations, 'solid tumour size' of the area under the curve (AUC) of ROC to detect pathological lymph node metastases was not significant. However, strikingly, the 3D solid tumour ratio was found to be significantly more accurate for the prediction of pathological lymph node metastases than the 1D and 2D solid tumour ratios on ROC evaluation (AUC: 1D 0.736, 2D 0.803 and 3D 0.882; P-values for the AUC comparisons were P = 0.013 for 3D versus 1D and P = 0.022 for 3D versus 2D). The correlations of subtypes of adenocarcinoma and the 3D solid tumour ratio were also investigated. Subtypes of adenocarcinoma were well correlated with the 3D solid tumour ratio. CONCLUSIONS Preoperative 3D CT using threshold values of -800 and -300 HU was useful for predicting pathological lymph node metastases and tumour invasiveness of cT1N0M0 lung adenocarcinoma.
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Affiliation(s)
- Kei Shikuma
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshi Menju
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Fengshi Chen
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigeo Muro
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinji Sumiyoshi
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Keiji Ohata
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Terumasa Sowa
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Nakanishi
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroyuki Cho
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinya Neri
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akihiro Aoyama
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshihiko Sato
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Makoto Sonobe
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Couraud S, Milleron B. Lung cancer screening: what is new since the NLST results? CURRENT PULMONOLOGY REPORTS 2016. [DOI: 10.1007/s13665-016-0139-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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131
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Field JK, Duffy SW, Baldwin DR, Whynes DK, Devaraj A, Brain KE, Eisen T, Gosney J, Green BA, Holemans JA, Kavanagh T, Kerr KM, Ledson M, Lifford KJ, McRonald FE, Nair A, Page RD, Parmar MKB, Rassl DM, Rintoul RC, Screaton NJ, Wald NJ, Weller D, Williamson PR, Yadegarfar G, Hansell DM. UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening. Thorax 2015; 71:161-70. [PMID: 26645413 PMCID: PMC4752629 DOI: 10.1136/thoraxjnl-2015-207140] [Citation(s) in RCA: 224] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 11/03/2015] [Indexed: 12/15/2022]
Abstract
Background Lung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial. Methods The pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based questionnaire was used to identify high-risk individuals. CT screen-detected nodules were managed by a pre-specified protocol. Cost effectiveness was modelled with reference to the National Lung Cancer Screening Trial mortality reduction. Results 247 354 individuals aged 50–75 years were approached; 30.7% expressed an interest, 8729 (11.5%) were eligible and 4055 were randomised, 2028 into the CT arm (1994 underwent a CT). Forty-two participants (2.1%) had confirmed lung cancer, 34 (1.7%) at baseline and 8 (0.4%) at the 12-month scan. 28/42 (66.7%) had stage I disease, 36/42 (85.7%) had stage I or II disease. 35/42 (83.3%) had surgical resection. 536 subjects had nodules greater than 50 mm3 or 5 mm diameter and 41/536 were found to have lung cancer. One further cancer was detected by follow-up of nodules between 15 and 50 mm3 at 12 months. The baseline estimate for the incremental cost-effectiveness ratio of once-only CT screening, under the UKLS protocol, was £8466 per quality adjusted life year gained (CI £5542 to £12 569). Conclusions The UKLS pilot trial demonstrated that it is possible to detect lung cancer at an early stage and deliver potentially curative treatment in over 80% of cases. Health economic analysis suggests that the intervention would be cost effective—this needs to be confirmed using data on observed lung cancer mortality reduction. Trial registration ISRCTN 78513845.
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Affiliation(s)
- J K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - S W Duffy
- Queen Mary University of London, London, UK
| | - D R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - D K Whynes
- School of Economics, University of Nottingham, Nottingham, UK
| | - A Devaraj
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - K E Brain
- Cardiff University School of Medicine, Cardiff, UK
| | - T Eisen
- University of Cambridge, Cambridge Biomedical Research Centre, Cambridge, UK
| | - J Gosney
- Department of Pathology, Royal Liverpool and Broadgreen University Hospital Trust, Liverpool, UK
| | - B A Green
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - J A Holemans
- Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool UK
| | - T Kavanagh
- Lung Cancer Patient Advocate, Liverpool, UK
| | - K M Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - M Ledson
- Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool UK
| | - K J Lifford
- Cardiff University School of Medicine, Cardiff, UK
| | - F E McRonald
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - A Nair
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R D Page
- Liverpool Heart and Chest Hospital, NHS Foundation Trust, Liverpool UK
| | - M K B Parmar
- Medical Research Council Clinical Trials Unit at UCL, London, UK
| | - D M Rassl
- Department of Histopathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - R C Rintoul
- Department of Histopathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - N J Screaton
- Department of Histopathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - N J Wald
- Queen Mary University of London, London, UK
| | - D Weller
- Center for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - P R Williamson
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - G Yadegarfar
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - D M Hansell
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Bergström G, Berglund G, Blomberg A, Brandberg J, Engström G, Engvall J, Eriksson M, de Faire U, Flinck A, Hansson MG, Hedblad B, Hjelmgren O, Janson C, Jernberg T, Johnsson Å, Johansson L, Lind L, Löfdahl CG, Melander O, Östgren CJ, Persson A, Persson M, Sandström A, Schmidt C, Söderberg S, Sundström J, Toren K, Waldenström A, Wedel H, Vikgren J, Fagerberg B, Rosengren A. The Swedish CArdioPulmonary BioImage Study: objectives and design. J Intern Med 2015; 278:645-59. [PMID: 26096600 PMCID: PMC4744991 DOI: 10.1111/joim.12384] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started.
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Affiliation(s)
- G Bergström
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - G Berglund
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - A Blomberg
- Department of Public Health and Clinical Medicine, Division of Medicine/Respiratory Medicine, Umeå University, Umeå, Sweden
| | - J Brandberg
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Radiology, University of Gothenburg, Gothenburg, Sweden
| | - G Engström
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - J Engvall
- Department of Clinical Physiology, County Council of Östergötland, Linköping, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - M Eriksson
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
| | - U de Faire
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - A Flinck
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Radiology, University of Gothenburg, Gothenburg, Sweden
| | - M G Hansson
- Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics, Uppsala University, Uppsala, Sweden
| | - B Hedblad
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - O Hjelmgren
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - C Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - T Jernberg
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Å Johnsson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Radiology, University of Gothenburg, Gothenburg, Sweden
| | - L Johansson
- Department of Radiology, Oncology and Radiation Science, Unit of Radiology, Uppsala, Sweden
| | - L Lind
- Department of Clinical Sciences, Uppsala University, Uppsala, Sweden
| | - C-G Löfdahl
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Respiratory Medicine and Allergology, Lund University Hospital, Lund, Sweden
| | - O Melander
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - C J Östgren
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - A Persson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology in Linkoping, County Council of Östergötland, Linköping, Sweden
| | - M Persson
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - A Sandström
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre, Umeå University, Umeå, Sweden
| | - C Schmidt
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - S Söderberg
- Department of Public Health and Clinical Medicine, Medicine and Heart Centre, Umeå University, Umeå, Sweden
| | - J Sundström
- Department of Clinical Sciences, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Centre, Uppsala, Sweden
| | - K Toren
- Section of Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - A Waldenström
- Department of Public Health and Clinical Medicine Thoracic Center, Umeå University Hospital, Umeå University, Umeå, Sweden
| | - H Wedel
- Epidemiology and Biostatistics, Nordic School of Public Health, Gothenburg, Sweden
| | - J Vikgren
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Radiology, University of Gothenburg, Gothenburg, Sweden
| | - B Fagerberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - A Rosengren
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
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Field JK, Devaraj A, Duffy SW, Baldwin DR. CT screening for lung cancer: Is the evidence strong enough? Lung Cancer 2015; 91:29-35. [PMID: 26711931 DOI: 10.1016/j.lungcan.2015.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
The prevailing questions at this time in both the public mind and the clinical establishment is, do we have sufficient evidence to implement lung cancer Computed Tomography (CT) screening in Europe? If not, what is outstanding? This review addresses the twelve major areas, which are critical to any decision to implement CT screening and where we need to assess whether we have sufficient evidence to proceed to a recommendation for implementation in Europe. The readiness level of these twelve categories in 2015 have been with colour coded, where green indicates we have sufficient evidence, amber is borderline evidence and red requires further evidence. Recruitment from the 'Hard to Reach' community still remains at red, while mortality data, cost effectiveness and screening interval are all categorised as amber. The integration of smoking cessation into CT screening programmes is still considered to be category amber. The US Preventive Services Task Force have recommended that CT screening is implemented in the USA utilising the NLST criteria, apart from continuing screening to 80 years of age. The cost effectiveness of the NLST was calculated to be $81,000/QALY, however, its well recognised that the costs of medical care in the USA, is far higher than that of Europe. Medicare have agreed to cover the cost of screening but have stipulated a number of stringent requirements for inclusion. To date we do not have good CT screening mortality data available in Europe and eagerly await the publication of the NELSON trial data in 2016 and then the pooled UKLS and NELSON data thereafter. However in the meantime we should start planning for implementation in Europe, especially in the areas of the radiological service provision and accreditation, as well as identifying novel mechanisms to recruit from the hardest to reach communities.
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Affiliation(s)
- J K Field
- Roy Castle Lung Cancer Research Programme, The University of Liverpool, Department of Molecular and Clinical Cancer Medicine, The Apex Building 6 West Derby Street, Liverpool L7 8TX, UK.
| | - A Devaraj
- Department of Radiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
| | - S W Duffy
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
| | - D R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, City Campus, Hucknall Road, Nottingham NG5 1PB, UK.
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Abstract
Screening for lung cancer in high-risk individuals with annual low-dose computed tomography has been shown to reduce lung cancer mortality by 20% and is recommended by multiple health care organizations. Lung cancer screening is not a specific test; it is a process that involves appropriate selection of high-risk individuals, careful interpretation and follow-up of imaging, and annual testing. Screening should be performed in the context of a multidisciplinary program experienced in the diagnosis and management of lung nodules and early-stage lung cancer.
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Affiliation(s)
- Mark E Deffebach
- Division of Hospital and Specialty Medicine, Pulmonary and Critical Care Medicine, Portland VA Health Care System, P3PULM, 3710 Southwest US Veterans Hospital Road, Portland, OR 97201, USA; Department of Medicine, Oregon Health and Science University, Portland, OR 97239, USA.
| | - Linda Humphrey
- Department of Medicine, Oregon Health and Science University, Portland, OR 97239, USA; Division of Hospital and Specialty Medicine, Portland VA Health Care System, P3PULM, 3710 Southwest US Veterans Hospital Road, Portland, OR 97201, USA
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135
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Optican RJ, Chiles C. Implementing lung cancer screening in the real world: opportunity, challenges and solutions. Transl Lung Cancer Res 2015; 4:353-64. [PMID: 26380176 DOI: 10.3978/j.issn.2218-6751.2015.07.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 07/18/2015] [Indexed: 12/12/2022]
Abstract
The World Health Organization estimates that, in 2012, there were 1,589,925 deaths from lung cancer worldwide. Screening for lung cancer with low-dose computed tomography (LDCT) has the potential to significantly alter this statistic, by identifying lung cancers in earlier stages, enabling curative treatment. Challenges remain, however, in replicating the 20% mortality benefit demonstrated by the National Lung Screening Trial (NLST), in populations outside the confines of a research trial, not only in the US but around the world. We review the history of lung cancer screening, the current evidence for LDCT screening, and the key elements needed for a successful screening program.
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Affiliation(s)
- Robert J Optican
- 1 Department of Radiology, Baptist Memorial Hospital, Memphis, TN 38120, USA ; 2 Department of Radiology, Wake Forest Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Caroline Chiles
- 1 Department of Radiology, Baptist Memorial Hospital, Memphis, TN 38120, USA ; 2 Department of Radiology, Wake Forest Health Sciences Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA
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136
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Field JK, Devaraj A, Duffy SW, Baldwin DR. Screening. Lung Cancer 2015. [DOI: 10.1183/2312508x.10009214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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137
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Spira A, Halmos B, Powell CA. Update in Lung Cancer 2014. Am J Respir Crit Care Med 2015; 192:283-94. [PMID: 26230235 PMCID: PMC4584253 DOI: 10.1164/rccm.201504-0756up] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/15/2015] [Indexed: 12/14/2022] Open
Abstract
In the past 2 years, lung cancer research and clinical care have advanced significantly. Advancements in the field have improved outcomes and promise to lead to further reductions in deaths from lung cancer, the leading cause of cancer death worldwide. These advances include identification of new molecular targets for personalized targeted therapy, validation of molecular signatures of lung cancer risk in smokers, progress in lung tumor immunotherapy, and implementation of population-based lung cancer screening with chest computed tomography in the United States. In this review, we highlight recent research in these areas and challenges for the future.
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Affiliation(s)
- Avrum Spira
- Division of Computational Biomedicine, Boston University School of Medicine, Boston, Massachusetts
| | - Balazs Halmos
- Department of Medicine, Columbia University Medical Center, New York, New York; and
| | - Charles A. Powell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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138
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Rakha E, Pajares MJ, Ilie M, Pio R, Echeveste J, Hughes E, Soomro I, Long E, Idoate MA, Wagner S, Lanchbury JS, Baldwin DR, Hofman P, Montuenga LM. Stratification of resectable lung adenocarcinoma by molecular and pathological risk estimators. Eur J Cancer 2015; 51:1897-903. [PMID: 26235745 DOI: 10.1016/j.ejca.2015.07.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 07/12/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mortality in early stage, resectable lung cancer is sufficiently high to warrant consideration of post-surgical treatment. Novel markers to stratify resectable lung cancer patients may help with the selection of treatment to improve outcome. METHODS Primary tumour tissue from 485 patients, surgically treated for stage I-II lung adenocarcinoma, was analysed for the RNA expression of 31 cell cycle progression (CCP) genes by quantitative polymerase chain reaction (PCR). The expression average, the CCP score, was combined with pathological stage into a prognostic score (PS). Cox proportional hazards regression assessed prediction of 5-year lung cancer mortality above clinical variables. The PS threshold was tested for risk discrimination by the Mantel-Cox log-rank test. RESULTS The CCP score added significant information above clinical markers (all patients, P=0.0029; stage I patients, P=0.013). The prognostic score was a superior predictor of outcome compared to pathological stage alone (PS, P=0.00084; stage, P=0.24). Five-year lung cancer mortality was significantly different between the low-risk (90%, 95% confidence interval (CI) 81-95%), and high-risk groups (65%, 95% CI 57-72%), P=4.2×10(-6)). CONCLUSIONS The CCP score is an independent prognostic marker in early stage lung adenocarcinoma. The prognostic score provides superior risk estimates than stage alone. The threefold higher risk in the high-risk group defines a subset of patients that should consider therapeutic choices to improve outcome.
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Affiliation(s)
- Emad Rakha
- Division of Cancer and Stem Cells, School of Medicine, The University of Nottingham, Nottingham NG7 2RD, UK; The Nottingham Health Science Biobank (NHSB), Nottingham University Hospitals NHS Trust, Nottingham NG7 2RD, UK.
| | - Maria J Pajares
- Program in Solid Tumor and Biomarkers, Center for Applied Medical Research, University of Navarra, Pamplona 31008, Spain
| | - Marius Ilie
- Centre Hospitalier Universitaire de Nice, Louis Pasteur Hospital, Laboratory of Clinical and Experimental Pathology, Hospital-Integrated Biobank, University of Nice Sophia Antipolis, Nice 06003, France
| | - Ruben Pio
- Program in Solid Tumor and Biomarkers, Center for Applied Medical Research, University of Navarra, Pamplona 31008, Spain
| | - Jose Echeveste
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Elisha Hughes
- Myriad Genetics, Inc., Salt Lake City, UT 84108, USA
| | - Irshad Soomro
- Department of Pathology, Nottingham University Hospitals, Nottingham NG7 2RD, UK
| | - Elodie Long
- Centre Hospitalier Universitaire de Nice, Louis Pasteur Hospital, Laboratory of Clinical and Experimental Pathology, Hospital-Integrated Biobank, University of Nice Sophia Antipolis, Nice 06003, France
| | - Miguel A Idoate
- Department of Pathology, Clínica Universidad de Navarra, Pamplona, Spain
| | | | | | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham NG5 1PB, UK
| | - Paul Hofman
- Centre Hospitalier Universitaire de Nice, Louis Pasteur Hospital, Laboratory of Clinical and Experimental Pathology, Hospital-Integrated Biobank, University of Nice Sophia Antipolis, Nice 06003, France
| | - Luis M Montuenga
- Program in Solid Tumor and Biomarkers, Center for Applied Medical Research, University of Navarra, Pamplona 31008, Spain
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Randomized Study on Early Detection of Lung Cancer with MSCT in Germany: Results of the First 3 Years of Follow-up After Randomization. J Thorac Oncol 2015; 10:890-6. [DOI: 10.1097/jto.0000000000000530] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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140
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Serum calprotectin, CD26 and EGF to establish a panel for the diagnosis of lung cancer. PLoS One 2015; 10:e0127318. [PMID: 25992884 PMCID: PMC4436352 DOI: 10.1371/journal.pone.0127318] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/13/2015] [Indexed: 12/15/2022] Open
Abstract
Lung cancer is the most lethal neoplasia, and an early diagnosis is the best way for improving survival. Symptomatic patients attending Pulmonary Services could be diagnosed with lung cancer earlier if high-risk individuals are promptly separated from healthy individuals and patients with benign respiratory pathologies. We searched for a convenient non-invasive serum test to define which patients should have more immediate clinical tests. Six cancer-associated molecules (HB-EGF, EGF, EGFR, sCD26, VEGF, and Calprotectin) were investigated in this study. Markers were measured in serum by specific ELISAs, in an unselected population that included 72 lung cancer patients of different histological types and 56 control subjects (healthy individuals and patients with benign pulmonary pathologies). Boosted regression and random forests analysis were conducted for the selection of the best candidate biomarkers. A remarkable discriminatory capacity was observed for EGF, sCD26, and especially for Calprotectin, these three molecules constituting a marker panel boasting a sensitivity of 83% and specificity of 87%, resulting in an associated misclassification rate of 15%. Finally, an algorithm derived by logistic regression and a nomogram allowed generating classification scores in terms of the risk of a patient of suffering lung cancer. In conclusion, we propose a non-invasive test to identify patients at high-risk for lung cancer from a non-selected population attending a Pulmonary Service. The efficacy of this three-marker panel must be tested in a larger population for lung cancer.
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Prognostic value of heart valve calcifications for cardiovascular events in a lung cancer screening population. Int J Cardiovasc Imaging 2015; 31:1243-9. [PMID: 25962863 PMCID: PMC4486764 DOI: 10.1007/s10554-015-0664-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 04/15/2015] [Indexed: 10/28/2022]
Abstract
To assess the prognostic value of aortic valve and mitral valve/annulus calcifications for cardiovascular events in heavily smoking men without a history of cardiovascular disease. Heavily smoking men without a cardiovascular disease history who underwent non-contrast-enhanced low-radiation-dose chest CT for lung cancer screening were included. Non-imaging predictors (age, smoking status and pack-years) were collected and imaging-predictors (calcium volume of the coronary arteries, aorta, aortic valve and mitral valve/annulus) were obtained. The outcome was the occurrence of cardiovascular events. Multivariable Cox proportional-hazards regression was used to calculate hazard-ratios (HRs) with 95% confidence interval (CI). Subsequently, concordance-statistics were calculated. In total 3111 individuals were included, of whom 186 (6.0%) developed a cardiovascular event during a follow-up of 2.9 (Q1-Q3, 2.7-3.3) years. If aortic (n = 657) or mitral (n = 85) annulus/valve calcifications were present, cardiovascular event incidence increased to 9.0% (n = 59) or 12.9% (n = 11), respectively. HRs of aortic and mitral valve/annulus calcium volume for cardiovascular events were 1.46 (95% CI, 1.09-1.84) and 2.74 (95% CI, 0.92-4.56) per 500 mm(3). The c-statistic of a basic model including age, pack-years, current smoking status, coronary and aorta calcium volume was 0.68 (95% CI, 0.63-0.72), which did not change after adding heart valve calcium volume. Aortic valve calcifications are predictors of future cardiovascular events. However, there was no added prognostic value beyond age, number of pack-years, current smoking status, coronary and aorta calcium volume for short term cardiovascular events.
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Kauczor HU, Bonomo L, Gaga M, Nackaerts K, Peled N, Prokop M, Remy-Jardin M, von Stackelberg O, Sculier JP. ESR/ERS white paper on lung cancer screening. Eur Radiol 2015; 25:2519-31. [PMID: 25929939 PMCID: PMC4529446 DOI: 10.1007/s00330-015-3697-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 02/27/2015] [Indexed: 12/13/2022]
Abstract
Abstract Lung cancer is the most frequently fatal cancer, with poor survival once the disease is advanced. Annual low-dose computed tomography has shown a survival benefit in screening individuals at high risk for lung cancer. Based on the available evidence, the European Society of Radiology and the European Respiratory Society recommend lung cancer screening in comprehensive, quality-assured, longitudinal programmes within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres. Minimum requirements include: standardised operating procedures for low-dose image acquisition, computer-assisted nodule evaluation, and positive screening results and their management; inclusion/exclusion criteria; expectation management; and smoking cessation programmes. Further refinements are recommended to increase quality, outcome and cost-effectiveness of lung cancer screening: inclusion of risk models, reduction of effective radiation dose, computer-assisted volumetric measurements and assessment of comorbidities (chronic obstructive pulmonary disease and vascular calcification). All these requirements should be adjusted to the regional infrastructure and healthcare system, in order to exactly define eligibility using a risk model, nodule management and a quality assurance plan. The establishment of a central registry, including a biobank and an image bank, and preferably on a European level, is strongly encouraged. Key points • Lung cancer screening using low dose computed tomography reduces mortality. • Leading US medical societies recommend large scale screening for high-risk individuals. • There are no lung cancer screening recommendations or reimbursed screening programmes in Europe as of yet. • The European Society of Radiology and the European Respiratory Society recommend lung cancer screening within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres. • High risk, eligible individuals should be enrolled in comprehensive, quality-controlled longitudinal programmes.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany,
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Kauczor HU, Bonomo L, Gaga M, Nackaerts K, Peled N, Prokop M, Remy-Jardin M, von Stackelberg O, Sculier JP. ESR/ERS white paper on lung cancer screening. Eur Respir J 2015; 46:28-39. [PMID: 25929956 PMCID: PMC4486375 DOI: 10.1183/09031936.00033015] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/03/2015] [Indexed: 12/14/2022]
Abstract
Lung cancer is the most frequently fatal cancer, with poor survival once the disease is advanced. Annual low dose computed tomography has shown a survival benefit in screening individuals at high risk for lung cancer. Based on the available evidence, the European Society of Radiology and the European Respiratory Society recommend lung cancer screening in comprehensive, quality-assured, longitudinal programmes within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres. Minimum requirements include: standardised operating procedures for low dose image acquisition, computer-assisted nodule evaluation, and positive screening results and their management; inclusion/exclusion criteria; expectation management; and smoking cessation programmes. Further refinements are recommended to increase quality, outcome and cost-effectiveness of lung cancer screening: inclusion of risk models, reduction of effective radiation dose, computer-assisted volumetric measurements and assessment of comorbidities (chronic obstructive pulmonary disease and vascular calcification). All these requirements should be adjusted to the regional infrastructure and healthcare system, in order to exactly define eligibility using a risk model, nodule management and quality assurance plan. The establishment of a central registry, including biobank and image bank, and preferably on a European level, is strongly encouraged.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany
| | - Lorenzo Bonomo
- Institute of Radiology, A. Gemelli University Hospital, Rome, Italy
| | - Mina Gaga
- 7th Respiratory Medicine Dept and Asthma Center, Athens Chest Hospital, Athens, Greece
| | - Kristiaan Nackaerts
- Dept of Respiratory Diseases/Respiratory Oncology Unit, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Nir Peled
- Davidoff Cancer Center, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Mathias Prokop
- Dept of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martine Remy-Jardin
- Dept of Thoracic Imaging, Hospital Calmette (EA 2694), CHRU et Universite de Lille, Lille, France
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany Translational Lung Research Center, Member of the German Lung Research Center, Heidelberg, Germany
| | - Jean-Paul Sculier
- Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Mazzone P, Powell CA, Arenberg D, Bach P, Detterbeck F, Gould MK, Jaklitsch MT, Jett J, Naidich D, Vachani A, Wiener RS, Silvestri G. Components necessary for high-quality lung cancer screening: American College of Chest Physicians and American Thoracic Society Policy Statement. Chest 2015; 147:295-303. [PMID: 25356819 DOI: 10.1378/chest.14-2500] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lung cancer screening with a low-dose chest CT scan can result in more benefit than harm when performed in settings committed to developing and maintaining high-quality programs. This project aimed to identify the components of screening that should be a part of all lung cancer screening programs. To do so, committees with expertise in lung cancer screening were assembled by the Thoracic Oncology Network of the American College of Chest Physicians (CHEST) and the Thoracic Oncology Assembly of the American Thoracic Society (ATS). Lung cancer program components were derived from evidence-based reviews of lung cancer screening and supplemented by expert opinion. This statement was developed and modified based on iterative feedback of the committees. Nine essential components of a lung cancer screening program were identified. Within these components 21 Policy Statements were developed and translated into criteria that could be used to assess the qualification of a program as a screening facility. Two additional Policy Statements related to the need for multisociety governance of lung cancer screening were developed. High-quality lung cancer screening programs can be developed within the presented framework of nine essential program components outlined by our committees. The statement was developed, reviewed, and formally approved by the leadership of CHEST and the ATS. It was subsequently endorsed by the American Association of Throacic Surgery, American Cancer Society, and the American Society of Preventive Oncology.
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Affiliation(s)
- Peter Mazzone
- Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Charles A Powell
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Douglas Arenberg
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Peter Bach
- Center for Health Policy and Outcomes, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - James Jett
- Division of Oncology, National Jewish Health, Denver, CO
| | - David Naidich
- Department of Radiology, NYU Langone Medical Center, New York, NY
| | - Anil Vachani
- Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania, Philadelphia PA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; The Pulmonary Center, Boston University School of Medicine, Boston, MA
| | - Gerard Silvestri
- Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston, SC
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Abstract
Benefits and risks of computed tomography lung cancer screening are discussed with specific focus on oncologic and financial issues. Earlier disease stage at diagnosis implies that more patients are treated surgically, but the changes in oncologic treatment will not be dramatic. The crucial issue for implementation of screening will be that it is cost effective. Preliminary data from the National Lung Screening Trial indicate that it is cost effective and comparable to screening for other major malignancies. Some future modifications in the computed tomography screening methodology are discussed.
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Affiliation(s)
- Jesper Holst Pedersen
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark.
| | - Jens Benn Sørensen
- Department of Oncology, Finsen Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark
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Kobayashi Y, Mitsudomi T, Sakao Y, Yatabe Y. Genetic features of pulmonary adenocarcinoma presenting with ground-glass nodules: the differences between nodules with and without growth. Ann Oncol 2015; 26:156-161. [PMID: 25361983 DOI: 10.1093/annonc/mdu505] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pulmonary ground-glass nodules (GGNs) include both malignant and benign lesions. Some GGNs become larger, whereas others remain unchanged for years. We have previously reported that smoking history and large diameters are predictors for growth. However, the genetic differences among GGNs remain unclear. PATIENTS AND METHODS GGNs with ground-glass component of ≥50% on a thin-section computed tomography scan that were resected between 2012 and 2014 were evaluated for clinicopathological features and the presence of EGFR/KRAS/ALK/HER2 mutations. 'Incidence of 2-mm growth' and 'Time to 2-mm growth' were analyzed according to the mutational status. RESULTS Among 104 GGNs in 96 patients, this study included 3 atypical adenomatous hyperplasia (AAH), 19 adenocarcinoma in situ (AIS), 27 minimally invasive adenocarcinoma (MIA), and 55 invasive adenocarcinoma (IA). Among the 71 lesions evaluable for growth, 30 GGNs exhibited growth and 5 lesions remained unchanged for ≥2 years before surgery was carried out. We identified mutations or rearrangements in 75% of GGNs (78/104). EGFR mutations were noted in 64% of samples, KRAS in 4%, ALK in 3%, and HER2 in 4%. The remaining 26 quadruple-negative tumors were significantly associated with AAH/AIS (P < 0.01) and no-growth (P < 0.01) compared with driver mutation-positive tumors, whereas EGFR mutation-positive tumors were correlated with MIA/IA (P < 0.01) and growth (P < 0.01) compared with EGFR-negative tumors. CONCLUSIONS Three fourths of resected GGNs were positive for EGFR, KRAS, ALK, or HER2 mutations. Quadruple-negative tumors were associated with a lack of GGN growth, whereas EGFR mutation-positive tumors displayed a correlation with growth.
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Affiliation(s)
- Y Kobayashi
- Department of Thoracic Surgery, Kinki University Faculty of Medicine, Osaka-Sayama; Department of Thoracic Surgery
| | - T Mitsudomi
- Department of Thoracic Surgery, Kinki University Faculty of Medicine, Osaka-Sayama
| | - Y Sakao
- Department of Thoracic Surgery
| | - Y Yatabe
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan.
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Horeweg N, Nackaerts K, Oudkerk M, de Koning HJ. Low-dose computed tomography screening for lung cancer: results of the first screening round. J Comp Eff Res 2014; 2:433-6. [PMID: 24236740 DOI: 10.2217/cer.13.57] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Evaluation of: National Lung Screening Trial Research Team, Church TR, Black WC, Aberle DR et al. Results of initial low-dose computed tomographic screening for lung cancer. N. Engl. J. Med. 368, 1980-1991 (2013). In 2011, the US NLST trial demonstrated that mortality from lung cancer can be reduced by using low-dose computed tomography (LDCT) screening rather than chest x-ray (CXR) screening. This paper from the US NLST research team focuses on the results of the initial round of LDCT for lung cancer. A total of 53,439 participants were included and randomly assigned to LDCT screening (n = 26,715) or CXR screening (n = 26,724). In total, 27.3% of the participants in the LDCT group and 9.2% in the CXR group had a positive screening result. As a result, 3.8% (LDCT group) and 5.7% (CXR group) of these subjects were diagnosed with lung cancer. The sensitivity (93.8%) and specificity (73.4%) for lung cancer were higher for LDCT compared with CXR screening; 73.5 and 91.3%, respectively.
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Affiliation(s)
- Nanda Horeweg
- Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Takx RAP, Išgum I, Willemink MJ, van der Graaf Y, de Koning HJ, Vliegenthart R, Oudkerk M, Leiner T, de Jong PA. Quantification of coronary artery calcium in nongated CT to predict cardiovascular events in male lung cancer screening participants: results of the NELSON study. J Cardiovasc Comput Tomogr 2014; 9:50-7. [PMID: 25533223 DOI: 10.1016/j.jcct.2014.11.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 09/28/2014] [Accepted: 11/08/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the incremental prognostic value of the number and maximum volume of coronary artery calcifications over modified Agatston score strata, age, pack-years, and smoking status for predicting cardiovascular events. METHODS A total of 3559 male current and former smokers received a CT examination for lung cancer screening. Smoking characteristics, patient demographics, and physician-diagnosed cardiovascular events were collected. Images were acquired without electrocardiography gating on 16-slice CT scanners. The association between the presence of both fatal and nonfatal cardiovascular events and the predictors was quantified using Cox proportional hazard analysis. RESULTS Median follow-up period was 2.9 years. Incident cardiovascular events occurred in 186 participants. Adjusted hazard ratios for modified Agatston score strata of 1 to 10, 11 to 100, 101 to 400, and >400 were 3.39 (95% confidence interval [CI], 1.20-9.59), 6.52 (95% CI, 2.73-15.60), 6.58 (95% CI, 2.75-15.78), and 12.58 (95% CI, 5.42-29.16), respectively. Moreover, comparing the models with and without modified Agatston score strata to the model with age, pack-years, and smoking status yielded a significantly better net reclassification improvement (NRI; 27.3%; P < .0001). Adding the number of calcifications to the model with age, pack-years, smoking status, and modified Agatston score strata resulted in a slightly better NRI (1.68%; P = .0490) with a hazard ratio of 1.13 (95% CI, 1.05-1.21) per 10 calcifications. The incremental prognostic information contained in the volume of the largest calcification was not statistically significant (NRI, 0.14%; P = .3458). CONCLUSION Cardiovascular event rate increased with higher numbers of calcified lesions. The number but not maximum volume of calcifications has independent, although minimal, prognostic value over age, pack-years, smoking status, and modified Agatston score strata in our population.
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Affiliation(s)
- Richard A P Takx
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands.
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin J Willemink
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rozemarijn Vliegenthart
- Center for Medical Imaging-North East Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Center for Medical Imaging-North East Netherlands, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
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Detection of lung cancer through low-dose CT screening (NELSON): a prespecified analysis of screening test performance and interval cancers. Lancet Oncol 2014; 15:1342-50. [DOI: 10.1016/s1470-2045(14)70387-0] [Citation(s) in RCA: 224] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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