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Wang X, Liu H, Shen Y, Li W, Chen Y, Wang H. Low-dose computed tomography (LDCT) versus other cancer screenings in early diagnosis of lung cancer: A meta-analysis. Medicine (Baltimore) 2018; 97:e11233. [PMID: 29979385 PMCID: PMC6076107 DOI: 10.1097/md.0000000000011233] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer mortality worldwide. It is often diagnosed at an advanced stage when treatment is no longer possible. Early population-based screening may provide an opportunity for early diagnosis and reduce mortality rates. METHODS Study characteristics were collected and outcome data (lung cancer diagnosis and mortality) were extracted and used for meta-analysis. Statistical analyses were performed using OpenMetaAnalyst-0.1503 software. The odds ratio (OR) and 95% confidence interval (CI) were used to assess LDCT compared to other screening methods under the random-effects model. The I2 statistic was used to assess heterogeneity. RESULTS Pooling data from 4 studies (64,129 patients) showed a higher incidence of diagnosed lung cancer with LDCT screening (OR = 1.86, 95% CI: 1.02-3.37), compared to other screening tools. However, no significant difference (OR = 1.13, 95% CI: 0.78-1.64) was found in lung cancer mortality between both groups. CONCLUSIONS Although no significant difference was found between LDCT and other control groups in terms of lung cancer mortality, this meta-analysis suggests an increased diagnosis of lung cancer with LDCT as compared with other screening modalities. This meta-analysis displays the potential but also the limitations of LDCT for early lung cancer detection.
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Affiliation(s)
- Xiaojing Wang
- Anhui Clinical and Preclinical Key Laboratory of Respiratory Disease, Department of Respiration
| | - Hongli Liu
- Department of Gynecological Oncology, First Affiliated Hospital, Bengbu Medical College, Bengbu
| | - Yuanbing Shen
- Anhui Clinical and Preclinical Key Laboratory of Respiratory Disease, Department of Respiration
| | - Wei Li
- Anhui Clinical and Preclinical Key Laboratory of Respiratory Disease, Department of Respiration
| | - Yuqing Chen
- Anhui Clinical and Preclinical Key Laboratory of Respiratory Disease, Department of Respiration
| | - Hongtao Wang
- Department of Immunology, Research Center of Immunology, Bengbu Medical College, Anhui, P.R. China
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2
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Rangel MP, Antonangelo L, Acencio MMP, Faria CS, de Sá VK, Leão PS, Farhat C, Fabro AT, Longatto Filho A, Reis RM, Takagaki T, Capelozzi VL. Detection of sputum cofilin-1 as indicator of malignancy. ACTA ACUST UNITED AC 2018; 51:e7138. [PMID: 29846436 PMCID: PMC5999062 DOI: 10.1590/1414-431x20187138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 01/12/2018] [Indexed: 11/21/2022]
Abstract
Cofilin-1 (CFL1), a small protein of 18 kDa, has been studied as a biomarker due to its involvement in tumor cell migration and invasion. Our aim was to evaluate CFL1 as an indicator of malignancy and aggressiveness in sputum samples. CFL1 was analyzed by ELISA immunoassay in the sputum of 73 lung cancer patients, 13 cancer-free patients, and 6 healthy volunteers. Statistical analyses included ANOVA, ROC curves, Spearman correlation, and logistic regression. Sputum CFL1 levels were increased in cancer patients compared to cancer-free patients and volunteers (P<0.05). High expression of sputum CFL1 was correlated to T4 stage (P=0.01) and N stage (P=0.03), tobacco history (P=0.01), and squamous cell carcinoma histologic type (P=0.04). The accuracy of sputum CFL1 in discriminating cancer patients from cancer-free patients and healthy volunteers were 0.78 and 0.69, respectively. CFL1 at a cut-off value of 415.25 pg/mL showed sensitivity/specificity of 0.80/0.70 in differentiating between healthy volunteers and cancer patients. Sputum CFL1 was also able to identify cancer-free patients from patients with lung cancer. The AUC was 0.70 and, at a cut-off point ≥662.63 pg/mL, we obtained 60% sensitivity and 54% specificity. Logistic regression analysis controlled for tobacco history, histologic types, and N stage showed that cancer cell-associated CFL1 was an independent predictor of death. Smoker patients with squamous cell carcinoma, lymph node metastasis and sputum CFL1>1.475 pg/mL showed augmented chance of death, suggesting lung cancer aggressiveness. CFL1 presented diagnostic value in detecting lung cancer and was associated to tumor aggressiveness.
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Affiliation(s)
- M P Rangel
- Departmento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L Antonangelo
- Departmento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M M P Acencio
- Divisão de Pneumologia, Instituto do Coração (Incor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C S Faria
- Laboratório de Investigação Médica (LIM 03), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - V K de Sá
- Departmento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P S Leão
- Divisão de Pneumologia, Instituto do Coração (Incor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C Farhat
- Departmento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A T Fabro
- Departmento de Patologia, Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo, Ribeirão Prêto, SP, Brasil
| | - A Longatto Filho
- Laboratório de Investigação Médica (LIM 14), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R M Reis
- Centro de Pesquisa em Oncologia Molecular, Hospital de Câncer de Barretos, Fundação Pio XII, Barretos, SP, Brasil
| | - T Takagaki
- Divisão de Pneumologia, Instituto do Coração (Incor), Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - V L Capelozzi
- Departmento de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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3
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Silva M, Sverzellati N, Colombi D, Milanese G, La Vecchia C, Galeone C, Marchianò A, Pastorino U. Pleural plaques in lung cancer screening by low-dose computed tomography: prevalence, association with lung cancer and mortality. BMC Pulm Med 2017; 17:155. [PMID: 29178853 PMCID: PMC5702182 DOI: 10.1186/s12890-017-0506-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
Background To report the prevalence of pleural plaques in a lung cancer screening trial by low-dose computed tomography (LDCT) and to test the association with incidence of lung cancer and mortality. Methods The LDCT of 2303 screenees were retrospectively reviewed with the specific aim of describing the prevalence and features of pleural plaques. Self-administered questionnaire was used to assess asbestos exposure. Frequency of lung cancer, lung cancer mortality, and overall mortality were detailed according to presence of pleural findings. Statistical analyses included comparison of mean or median, contingency tables, and Cox model for calculation of hazard ratio (HR) and its 95% confidence interval (CI). Results Among male screenees, 31/1570 (2%) showed pleural abnormalities, 128/1570 (8.2%) disclosed asbestos exposure, 23/31 (74.2%) subjects with pleural plaques consistently denied exposure to asbestos. There was a trend for higher frequency of lung cancer among subjects with pleural plaques (9.7% vs 4.2%). Lung cancer in subjects with pleural plaques was always diagnosed in advanced stage. Subjects with pleural plaques showed HR 5.48 (95% CI 1.61–18.70) for mortality from lung cancer. Conclusions Pleural plaques are a risk factor for lung cancer mortality that can be detected in lung cancer screening by LDCT, also in subjects that are not aware of asbestos exposure. Trial registration NCT02837809 - Retrospectively registered July 1, 2016 - Enrolment of first participant September 2005.
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Affiliation(s)
- Mario Silva
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy. .,Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy.,Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Colombi
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy
| | - Gianluca Milanese
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Padiglione Barbieri, Via Gramsci 14, 43126, Parma, Italy.,Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Carlotta Galeone
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alfonso Marchianò
- Department of Radiology and Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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4
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Abstract
CLINICAL/METHODICAL ISSUE Attempts at the early detection of lung cancer using imaging methods began as far back as the 1950s. STANDARD RADIOLOGICAL METHODS Several studies attempted to demonstrate a reduction of lung cancer mortality by chest radiography screening but all were unsuccessful. METHODICAL INNOVATIONS Even the first small screening studies using computed tomography (CT) could not demonstrate a reduction in lung cancer-specific mortality until in 2011 the results of the largest randomized controlled low-dose CT screening study in the USA (NLST) were published. The NLST results could show a significant 20 % reduction of lung cancer mortality in elderly and heavy smokers using CT. PERFORMANCE Confirmation of the NLST results are urgently needed so that the data of the largest European study (NELSON) are eagerly awaited. ACHIEVEMENTS Pooled with the data from several smaller European studies these results will provide important information and evidence for the establishment of future CT screening programs in Europe. PRACTICAL RECOMMENDATIONS Randomized controlled trials are the basis of evidence-based medicine; therefore, the positive results of the methodologically very good NLST study cannot be ignored, even if it is the only such study completed so far with highly convincing conclusions. The NLST results clearly demonstrate that positive effects for the health of the population can only be expected if the processes are clearly defined and the quality is assured.
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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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6
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Ağababaoğlu İ, Önen A, Demir AB, Aktaş S, Altun Z, Ersöz H, Şanlı A, Özdemir N, Akkoçlu A. Chaperonin (HSP60) and annexin-2 are candidate biomarkers for non-small cell lung carcinoma. Medicine (Baltimore) 2017; 96:e5903. [PMID: 28178129 PMCID: PMC5312986 DOI: 10.1097/md.0000000000005903] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lung cancer is responsible of 12.4% and 17.6% of all newly diagnosed cancer cases and mortality due to cancer, respectively, and 5-year survival rate despite all improved treatment options is 15%. This survival rate reaches 66% in the Stage 1 and surgically treated patients. Early diagnosis which could not be definitely and commonly achieved yet is extremely critical in obtaining high survival rate in this disease. For this reason; proteomic differences were evaluated using matrix assisted laser desorption ionization (MALDI) mass spectrometry in the subgroups of lung adenocarcinoma and squamous cell carcinoma. METHODS Fresh tissue samples of 36 malignant cases involving 83.3% (n = 30) men and 16.7% (n = 6) women patients were distributed into 2 groups as early and end stage lung cancer and each group were composed of subgroups including 18 squamous cell carcinoma (9 early stage cases, 9 end stage cases) and 18 adenocarcinoma cases (9 early stage cases, 9 end stage cases). The fresh tissues obtained from the tumoral and matched normal sites after surgical intervention. The differences in protein expression levels were determined by comparing proteomic changes in each patient. RESULTS In the subgroups of advanced stage adenocarcinoma; tumoral tissue revealed differences in expression of 2 proteins compared with normal parenchymal tissue. Of those; difference in protein expression in heat shock protein 60 (HSP60) was found statistically significant (P = 0.0001). Subgroups of early and advanced stage squamos cell carcinoma have differed in certain 20 protein expression of normal tissue and diseased squamos cell carcinoma. Of those, increased protein expression level of only annexin-2 protein was found statistically significant (P = 0.002). No significant difference was detected in early and advanced stage protein expressions of the tumoral tissues in the subgroups of adenocarcinoma and squamous cell carcinoma. CONCLUSIONS We conclude that with respect to early diagnosis of lung cancer that HSP60 and annexin-2 proteins are the important biomarkers in the subgroups of adenocarcinoma and squamous cell carcinoma. We also consider that these 2 proteins are molecules which may provide critical contribution in evaluation of prognosis, metastatic potential, response to treatment, and in establishment of differential diagnosis between adenocarcinoma and squamous cell carcinoma.
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Affiliation(s)
| | - Ahmet Önen
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Ayşe Banu Demir
- Department of Medical Biology, Izmir University of Economics Faculty of Medicine
| | - Safiye Aktaş
- Department of Basic Oncology, Dokuz Eylül University Institute of Oncology
| | - Zekiye Altun
- Department of Basic Oncology, Dokuz Eylül University Institute of Oncology
| | - Hasan Ersöz
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Aydın Şanlı
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Nezih Özdemir
- Department of Thoracic Surgery, Dokuz Eylül University
| | - Atila Akkoçlu
- Department of Chest Diseases, Dokuz Eylül University Medicine School, İzmir, Turkey
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7
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Bunn PA. Karnofsky Award 2016: A Lung Cancer Journey, 1973 to 2016. J Clin Oncol 2016; 35:243-252. [PMID: 28056194 DOI: 10.1200/jco.2016.70.4064] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Paul A Bunn
- From University of Colorado Cancer Center, Aurora, CO
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8
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Abstract
Lung cancer is the leading cause of cancer mortality in the United States and worldwide. Since lung cancer outcomes are dependent on stage at diagnosis with early disease resulting in longer survival, the goal of screening is to capture lung cancer in its early stages when it can be treated and cured. Multiple studies have evaluated the use of chest X-ray (CXR) with or without sputum cytologic examination for lung cancer screening, but none has demonstrated a mortality benefit. In contrast, the multicenter National Lung Screening Trial (NLST) from the United States found a 20 % reduction in lung cancer mortality following three consecutive screenings with low-dose computed tomography (LDCT) in high-risk current and former smokers. Data from European trials are not yet available. In addition to a mortality benefit, lung cancer screening with LDCT also offers a unique opportunity to promote smoking cessation and abstinence and may lead to the diagnoses of treatable chronic diseases, thus decreasing the overall disease burden. The risks of lung cancer screening include overdiagnosis, radiation exposure, and false-positive results leading to unnecessary testing and possible patient anxiety and distress. However, the reduction in lung cancer mortality is a benefit that outweighs the risks and major health organizations currently recommend lung cancer screening using age, smoking history, and quit time criteria derived from the NLST. Although more research is needed to clearly define and understand the application and utility of lung cancer screening in the general population, current data support that lung cancer screening is effective and should be offered to eligible beneficiaries.
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9
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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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10
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Recurrence of squamous cell lung carcinoma is associated with the co-presence of reactive lesions in tumor-adjacent bronchial epithelium. Tumour Biol 2015; 37:3599-607. [PMID: 26456960 DOI: 10.1007/s13277-015-4196-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/01/2015] [Indexed: 01/01/2023] Open
Abstract
Recurrences occur in 30 % of lung cancer patients after radical therapy; however, known prognostic factors are not always effective. In this study, we investigated whether the frequency of squamous non-small cell lung cancer (NSCLC) recurrence depends on the presence of reactive lesions in tumor-adjacent bronchial epithelium. Specimens of adjacent lung tissue from 104 patients with squamous NSCLC were used for the determination of basal cell hyperplasia (BCH) and squamous metaplasia (SM) and for the analysis of the expression of Ki-67, p53, Bcl-2, and CD138. We found that recurrence was observed in 36.7 % of patients with BCH combined with SM (BCH + SM+) in the same bronchus, compared with 1.8 % in patients with isolated BCH (BCH + SM-; odds ratio (OR) 31.26, 95 % confidence interval (CI) 3.77-258.60; p = 0.00002). The percentage of Ki-67-positive cells was significantly higher in BCH + SM+ than in BCH + SM- (34.9 vs. 18.3 %; effect size 2.86, 95 % CI 2.23-3.47; p = 0.003). P53 expression was also more significant in BCH + SM+ than in BCH + SM- (14.4 vs. 9.6 %; effect size 1.22, 95 % CI 0.69-1.76; p = 0.0008). In contrast, CD138 expression was lower in BCH + SM+ than in BCH + SM- (21.8 vs. 38.5 %; effect size -6.26, 95 % CI -7.31 to -5.22; p = 0.003). Based on our results, we concluded that the co-presence of reactive bronchial lesions is associated with the development of recurrent squamous NSCLC and may be a negative prognostic indicator. In addition, significant differences in Ki-67, p53, and CD138 expression exist between isolated BCH and BCH combined with SM that probably reflect part of biological differences, which could relate to the mechanism of lung cancer recurrence.
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11
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Fu C, Liu Z, Zhu F, Li S, Jiang L. A meta-analysis: is low-dose computed tomography a superior method for risky lung cancers screening population? CLINICAL RESPIRATORY JOURNAL 2014; 10:333-41. [PMID: 25307063 DOI: 10.1111/crj.12222] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/30/2014] [Accepted: 09/29/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Low-dose computed tomography (LDCT) has been proposed to be a new screening method to discover lung cancers in an early stage, especially those patients who are in a high risk of lung cancer. The primary objective of this meta-analysis is to systematically review the effect of LDCT on screening for lung cancers among the risky population who are older than 49 years old and with smoking exposure. METHODS We searched randomized controlled clinical trials (RCTs) about comparing LDCT and chest X-ray or usual caring from MEDLINE, EMBASE, and the Cochrane Library, Web of Knowledge and SpringerLink databases (January 1994 to September 2013). RESULTS Nine RCTs met criteria for inclusion. Screening for lung cancer using LDCT resulted in a significantly higher number of stage I lung cancers [odds ratio (OR) 2.15, 95% confidence interval (CI) 1.88-2.47], higher number of total lung cancers (OR 1.31, 95% CI 1.20-1.43) than the control. Four of the nine studies indicated that the screening method did not decrease all-cause mortality (OR 0.96, 95% CI 0.90-1.02), but decreased lung cancer-specific mortality (OR 0.84, 95% CI 0.74-0.96). Five studies showed that LDCT had higher false-positive rates (OR 8.7, 95% CI 7.43-10.19) than the group of control. CONCLUSION Among the risky population, LDCT screening find out more stage I lung cancers and total lung cancers compared with chest X-ray or no screening, and also shows advantages in decreasing lung cancer-specific mortality, but the screening method does not decrease all-cause mortality and have a higher false-positive rates in diagnosis.
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Affiliation(s)
- Cuiping Fu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zilong Liu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fen Zhu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanqun Li
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liyan Jiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
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12
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13
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Lung Cancer in Older Adults. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-014-0092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Gómez-Sáez N, González-Álvarez I, Vilar J, Hernández-Aguado I, Domingo ML, Lorente MF, Pastor-Valero M, Parker LA, Picazo N, Calbo J, Lumbreras B. Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study. Eur Radiol 2014; 24:2174-82. [PMID: 24962823 PMCID: PMC4126995 DOI: 10.1007/s00330-014-3249-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 05/06/2014] [Accepted: 05/15/2014] [Indexed: 12/19/2022]
Abstract
Objective To determine the prevalence of solitary pulmonary nodules (SPNs) in chest radiology studies and patient’s features associated with malignancy in a non-high-risk clinical population. Methods Patients ≥35 years were referred for thoracic imaging in two hospitals (2010-2011). Eight radiologists determined the presence and characteristics of SPN. Selected variables were collected from radiological register and medical records. Observer agreement in the diagnosis of SPN was assessed. Results 25,529 patients were included: 23,102 (90.5 %) underwent chest radiograph and 2,497 (9.5 %) a CT. The prevalence of SPN was 2.1 % (95 % CI 1.9 – 2.3) in radiographs and 17.0 % (95 % CI 15.5 – 18.5) in CT. In patients undergoing chest radiograph, detection of SPN with an irregular border was more frequent among smokers. In patients who had a CT, larger SPNs appeared to be associated with 60 years of age or over, diagnosis of a respiratory illness, or male gender. In addition, an irregular border was also more common among men. Conclusions The prevalence of SPNs detected by both radiograph and CT was lower than that shown in screening studies. Patient characteristics such as age, sex, respiratory disease, or smoking habit were associated with nodule characteristics that are known to be related with malignancy. Key Points • There is a lower SPN prevalence in the clinical population than in screening studies. • SPN prevalence is associated with some patient characteristics: sex, age, imaging test. • Nodule characteristics related to malignancy were associated with some patient characteristics.
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Affiliation(s)
- N. Gómez-Sáez
- Public Health Department, Miguel Hernández University, Alicante, Spain
| | | | - J. Vilar
- Radiodiagnostic Department, Peset Hospital, Valencia, Spain
| | - I. Hernández-Aguado
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
| | - M. L. Domingo
- Radiodiagnostic Department, Peset Hospital, Valencia, Spain
| | - M. F. Lorente
- Radiodiagnostic Department, San Juan Hospital, Alicante, Spain
| | - M. Pastor-Valero
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
| | - L. A. Parker
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
| | - N. Picazo
- Radiodiagnostic Department, San Juan Hospital, Alicante, Spain
| | - J. Calbo
- Radiodiagnostic Department, San Juan Hospital, Alicante, Spain
| | - B. Lumbreras
- Public Health Department, Miguel Hernández University, Alicante, Spain
- Ciber en Epidemiología y Salud Pública, Barcelona, Spain
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15
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Pillai RN, Ramalingam SS. Advances in the diagnosis and treatment of non-small cell lung cancer. Mol Cancer Ther 2014; 13:557-64. [PMID: 24516099 DOI: 10.1158/1535-7163.mct-13-0669] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The diagnostic and therapeutic landscape of non-small cell lung cancer (NSCLC) has changed dramatically in the past 50 years since the Surgeon General's report on smoking and lung cancer. Early detection is now a reality for lung cancer. The use of low-dose computed tomography scans for early detection decreases mortality and is beginning to be used in routine clinical practice. Technological advances such as positron emission tomography and endobronchial ultrasound have improved the accuracy of NSCLC staging. The cure rate for early-stage NSCLC has improved as a result of multimodality treatment approaches. The role of systemic therapy has also expanded to earlier stages of the disease. In recent years, the initial steps toward personalized medicine by utilization of targeted treatments based on tumor genotype have been undertaken. Emerging technological advances and greater insights into tumor biology are poised to greatly reduce the burden of lung cancer in the years to come.
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Affiliation(s)
- Rathi N Pillai
- Corresponding Author: Suresh S. Ramalingam, 1365 Clifton Road NE, Room C-3090, Atlanta, GA 30322.
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16
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Mascaux C, Peled N, Garg K, Kato Y, Wynes MW, Hirsch FR. Early detection and screening of lung cancer. Expert Rev Mol Diagn 2014; 10:799-815. [PMID: 20843203 DOI: 10.1586/erm.10.60] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Celine Mascaux
- University of Colorado Denver, Anschutz Medical Campus, 12801 East 17th Avenue, Aurora, CO 80045, USA.
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17
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Frauenfelder T, Puhan M, Lazor R, von Garnier C, Bremerich J, Niemann T, Christe A, Montet X, Gautschi O, Weder W, Kohler M. Early Detection of Lung Cancer: A Statement from an Expert Panel of the Swiss University Hospitals on Lung Cancer Screening. Respiration 2014; 87:254-64. [DOI: 10.1159/000357049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/19/2013] [Indexed: 11/19/2022] Open
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Abstract
Low-dose CT (LDCT) is effective in the early detection of lung cancer, providing higher resectability and long-term survival rates. The National Lung Screening Trial shows a statistically significant mortality reduction in LDCT compared with chest radiography. The efficacy and safety of annual LDCT screening in heavy smokers must be explored, and the magnitude of benefit compared with the cost of large-scale screening. Trials in Europe have different study designs and an observational arm. Strategies to reduce lung cancer mortality should combine early detection with primary prevention and innovative biologic approaches.
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Affiliation(s)
- Ugo Pastorino
- Division of Thoracic Surgery, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy.
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19
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Hensing TA, Salgia R. Molecular biomarkers for future screening of lung cancer. J Surg Oncol 2013; 108:327-33. [PMID: 23893423 DOI: 10.1002/jso.23382] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 06/28/2013] [Indexed: 12/28/2022]
Abstract
The Landmark National Lung Screening Trial established the potential for low dose CT screening (LDCT) to reduce lung cancer-specific mortality in high-risk patients as defined by smoking history and age. However, the prevalence of lung cancer in asymptomatic smokers selected based on the NLST criteria is low. Recent advances have facilitated biomarker discovery for early diagnosis of lung cancer through the analysis of surrogate tissues, including airway epithelium, sputum, exhaled breath, and blood. Although a number of candidate diagnostic biomarkers have been described, none have been validated for use in the clinical setting. The NLST ACRIN biomarker repository is a valuable resource of annotated biological specimens that were collected during the NLST trial, which has the potential to facilitate validation of candidate biomarkers for early diagnosis identified in discovery trials. It will be important to perform retrospective and prospective analysis of biomarkers to screen for lung cancer. The review below summarizes some of our understanding of biomarkers in screening.
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Affiliation(s)
- Thomas A Hensing
- NorthShore University HealthSystem, Clinical Associate Professor of Medicine, University of Chicago Pritzker, Chicago, Illinois
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20
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Quintans JSS, Antoniolli AR, Onofre FMB, Onofre ASC. Detection of lung cancer using multiple genetic markers--a systematic review. Diagn Cytopathol 2013; 41:834-42. [PMID: 23513001 DOI: 10.1002/dc.22978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 01/01/2013] [Indexed: 11/08/2022]
Abstract
Lung cancer is the leading cause of cancer deaths worldwide, and has one of the lowest survival rates of any solid tumor. In recent years, several attempts have been conducted to improve an early or accelerated diagnosis due to better overall prognosis after therapy. The aim of this study was evaluating the use of genetic markers for diagnosis of lung cancer. This study was conducted in accordance to Transparent Reporting of Systematic Reviews and Meta-Analyses. Three Internet sources were used to search: MEDLINE-PubMed, EMBASE, and LILACS. The databases were searched for studies conducted in the period up to and including May 10, 2011. The following inclusion criteria were applied: lung cancer studies, and the use of genetic markers for diagnosis. Studies using animal models, review articles, meta-analyses, abstracts, conference proceedings, editorials/letters, case reports, incorrect study population, inadequate data, and cytology was not obtained, were excluded. A total of 1,901 abstracts/citations were identified for preliminary review. From 24 final selected studies, 17 referred to chromosomal markers diagnosis, eight to genes as marker, and one to both subjects. Fluorescence in situ hybridization (FISH) was applied in all studies. Despite the limitations of this study, application of genetic markers to lung cancer diagnosis seems to have prognosis value irrespective of detection methodology used. FISH was the main technique applied to diagnose genetics alterations and revealed a high specificity, although some authors reported low sensitivity.
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21
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Aberle DR, Abtin F, Brown K. Computed tomography screening for lung cancer: has it finally arrived? Implications of the national lung screening trial. J Clin Oncol 2013; 31:1002-8. [PMID: 23401434 DOI: 10.1200/jco.2012.43.3110] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The National Lung Screening Trial (NLST) has provided compelling evidence of the efficacy of lung cancer screening using low-dose helical computed tomography (LDCT) to reduce lung cancer mortality. The NLST randomized 53,454 older current or former heavy smokers to receive LDCT or chest radiography (CXR) for three annual screens. Participants were observed for a median of 6.5 years for outcomes. Vital status was available in more than 95% of participants. LDCT was positive in 24.2% of screens, compared with 6.9% of CXRs; more than 95% of all positive LDCT screens were not associated with lung cancer. LDCT detected more than twice the number of early-stage lung cancers and resulted in a stage shift from advanced to early-stage disease. Complications of LDCT screening were minimal. Lung cancer-specific mortality was reduced by 20% relative to CXR; all-cause mortality was reduced by 6.7%. The major harms of LDCT are radiation exposure, high false-positive rates, and the potential for overdiagnosis. This review discusses the risks and benefits of LDCT screening as well as an approach to LDCT implementation that incorporates systematic screening practice with smoking cessation programs and offers opportunities for better determination of appropriate risk cohorts for screening and for better diagnostic prediction of lung cancer in the setting of screen-detected nodules. The challenges of implementation are considered for screening programs, for primary care clinicians, and across socioeconomic strata. Considerations for future research to complement imaging-based screening to reduce the burden of lung cancer are discussed.
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Affiliation(s)
- Denise R Aberle
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90024, USA.
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22
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Fardanesh M, White C. Missed lung cancer on chest radiography and computed tomography. Semin Ultrasound CT MR 2012; 33:280-7. [PMID: 22824118 DOI: 10.1053/j.sult.2012.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Missed lung cancer raises an important medicolegal issue and contributes to one of the most common causes for malpractice actions against radiologists. Lung cancer may be missed on either chest radiography or computed tomography. Although most malpractice cases involve lesions overlooked on the former, a small and increasing portion of cases are related to chest computed tomography scan. Factors contributing to overlooked lung cancer can be attributed to observer performance, lesion characteristics, and technical considerations.
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Affiliation(s)
- Mahmoudreza Fardanesh
- Department of Radiology, University of Maryland School of Medicine, 22 S. Greene Street, Baltimore, Maryland 21201, USA.
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23
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Stapleford LJ, Curran WJ. Optimal management of patients with stage I non-small-cell lung cancer and compromised cardiopulmonary function. Lung Cancer Manag 2012. [DOI: 10.2217/lmt.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Lobectomy with systematic lymph node evaluation is the standard of care for medically fit patients with stage I non-small-cell lung cancer. The definition of ‘medically inoperable’ has evolved over time as technological advances have reduced the morbidity and mortality associated with surgery. Operability is currently more appropriately described as a gradient of risk, rather than a strict characterization of inoperable versus operable. For patients who cannot tolerate a lobectomy, multiple treatment options exist: sublobar resection, fractionated radiation, stereotactic body radiation therapy (SBRT) and radiofrequency ablation. Ongoing randomized studies will provide direct comparisons of surgery versus SBRT for both standard- and high-risk operable patients. For medically inoperable patients, radiation is the standard of care, and SBRT offers high rates of local control with limited morbidity. Prospective trials will continue to inform, but in the meantime, the best approach is a multidisciplinary one in which treatment is optimized for individual patients.
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Affiliation(s)
- Liza J Stapleford
- Department of Radiation Oncology & Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - Walter J Curran
- Department of Radiation Oncology & Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
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24
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Hassanein M, Callison JC, Callaway-Lane C, Aldrich MC, Grogan EL, Massion PP. The state of molecular biomarkers for the early detection of lung cancer. Cancer Prev Res (Phila) 2012; 5:992-1006. [PMID: 22689914 DOI: 10.1158/1940-6207.capr-11-0441] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Using biomarkers to select the most at-risk population, to detect the disease while measurable and yet not clinically apparent has been the goal of many investigations. Recent advances in molecular strategies and analytic platforms, including genomics, epigenomics, proteomics, and metabolomics, have identified increasing numbers of potential biomarkers in the blood, urine, exhaled breath condensate, bronchial specimens, saliva, and sputum, but none have yet moved to the clinical setting. Therefore, there is a recognized gap between the promise and the product delivery in the cancer biomarker field. In this review, we define clinical contexts where risk and diagnostic biomarkers may have use in the management of lung cancer, identify the most relevant candidate biomarkers of early detection, provide their state of development, and finally discuss critical aspects of study design in molecular biomarkers for early detection of lung cancer.
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Affiliation(s)
- Mohamed Hassanein
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt-Ingram Cancer Center, Nashville TN 37232, USA
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25
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Mani D, Haigentz M, Aboulafia DM. Lung cancer in HIV Infection. Clin Lung Cancer 2012; 13:6-13. [PMID: 21802373 PMCID: PMC3256276 DOI: 10.1016/j.cllc.2011.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 05/14/2011] [Accepted: 05/23/2011] [Indexed: 12/20/2022]
Abstract
Lung cancer is the most prevalent non-AIDS-defining malignancy in the highly active antiretroviral therapy era. Smoking plays a significant role in the development of HIV-associated lung cancer, but the cancer risk is two to four times greater in HIV-infected persons than in the general population, even after adjusting for smoking intensity and duration. Lung cancer is typically diagnosed a decade or more earlier among HIV-infected persons (mean age, 46 years) compared to those without HIV infection. Adenocarcinoma is the most common histological subtype, and the majority of patients are diagnosed with locally advanced or metastatic carcinoma. Because pulmonary infections are common among HIV-infected individuals, clinicians may not suspect lung cancer in this younger patient population. Surgery with curative intent remains the treatment of choice for early-stage disease. Although there is increasing experience in using radiation and chemotherapy for HIV-infected patients who do not have surgical options, there is a need for prospective studies because this population is frequently excluded from participating in cancer trials. Evidence-based treatments for smoking-cessation with demonstrated efficacy in the general population must be routinely incorporated into the care of HIV-positive smokers.
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Affiliation(s)
- Deepthi Mani
- Division of Internal Medicine, Providence Sacred Heart Medical Center, Spokane, WA 98111, USA
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26
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Jayaprakash V, Loewen GM, Dhillon SS, Moysich KB, Mahoney MC, Yendamuri S, Hogarth DK, Reid ME. Early Detection of Lung Cancer Using CT Scan and Bronchoscopy in a High Risk Population. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jct.2012.324051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Martínez-Girón R, van Woerden HC. Clinical and immunological characteristics associated with the presence of protozoa in sputum smears. Diagn Cytopathol 2011; 41:22-7. [PMID: 21681974 DOI: 10.1002/dc.21752] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Accepted: 05/05/2011] [Indexed: 12/24/2022]
Abstract
The objective of this study is to assess the relationship between protozoa in spontaneously expectorated sputum samples and a range of clinical and immunological variables. Clinical details including age, gender, smoking status, and use of oral or inhaled steroids were recorded for a cohort of 199 patients whose spontaneously expectorated sputum samples were submitted to a Cytology Laboratory in Spain between January 2005 and December 2006. Slides were scanned for protozoa under light microscopy and scanned for monocytes/small macrophages highlighted by immunocytochemistry (CD68 monoclonal antibody). One hundred ninety-one patients provided adequate sputum samples, of whom 70 had protozoa in their sputum. There was a strong relationship between the presence of protozoa and monocytes/small macrophages identified under light microscopy (P < 0.001). A binary logistic regression model also indicated a relationship between protozoa and both smoking status and steroid use. The diagnoses in those with protozoa included infection (including tuberculosis), chronic obstructive pulmonary disease (COPD), lung fibrosis, asthma, chronic liver disease, immunosuppression, cancer, pancreatic or renal disease, heart failure, and AIDS. The identified association between protozoa and monocytes/small macrophages in sputum suggests an immune response and warrants further investigation to clarify whether or not these organisms have any pathological significance in this wide range of conditions.
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28
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Kramer BS, Berg CD, Aberle DR, Prorok PC. Lung cancer screening with low-dose helical CT: results from the National Lung Screening Trial (NLST). J Med Screen 2011; 18:109-11. [PMID: 22045816 PMCID: PMC3204895 DOI: 10.1258/jms.2011.011055] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Barnett S Kramer
- Editor-in-Chief, National Cancer Institute Physician Data Query (PDQ) Screening and Prevention Editorial Board, Bethesda, MD, USA
| | - Christine D Berg
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Denise R Aberle
- Department of Radiological Services, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Philip C Prorok
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
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29
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Screening for lung cancer with low-dose computed tomography: a systematic review and meta-analysis of the baseline findings of randomized controlled trials. J Thorac Oncol 2010; 5:1233-9. [PMID: 20548246 DOI: 10.1097/jto.0b013e3181e0b977] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Lung cancer is the leading cause of death among all cancers. An estimated 29% of the global population older than 15 years currently smokes tobacco. The presence of a high risk population, relatively asymptomatic nature of the disease in the early phase, and relatively good prognosis when discovered early makes screening for lung cancer an attractive proposition. We performed a systematic review and a meta-analysis of the baseline results of randomized controlled trials so far published, which included more than 14,000 patients. Analysis was used to determine whether data was for or against the screening of lung cancers using low-dose computed tomography (LDCT). DESIGN Random effect meta regression model of meta-analysis and systematic review. METHODS We performed a systematic review and a meta-analysis of the current literature to determine whether screening for lung cancer in a high-risk population with computed tomography improves outcomes. A search strategy using Medline was employed, studies selected based on preset criteria and application of exclusion criteria, and data collected and analyzed for statistical significance. RESULTS Screening for lung cancer using LDCT resulted in a significantly higher number of stage I lung cancers (odds ratio 3.9, 95% confidence interval [CI] 2.0-7.4), higher number of total non-small cell lung cancers (odds ratio 5.5, 95% CI 3.1-9.6), and higher total lung cancers (odds ratio 4.1, 95% CI 2.4-7.1). Screening using LDCT also resulted in increased detection of false-positive nodules (odds ratio 3.1, 95% CI 2.6-3.7) and more unnecessary thoracotomies for benign lesions (event rate 3.7 per 1000, 95% CI 3.5-3.8). For every 1000 individuals screened with LDCT for lung cancer, 9 stage I non-small cell lung cancer and 235 false-positive nodules were detected, and 4 thoracotomies for benign lesions were performed. CONCLUSIONS The baseline data from six randomized controlled trials offer no compelling data in favor or against the use of LDCT screening for lung cancer. We await the final results of these randomized controlled trials to improve our understanding of the effectiveness of LDCT in the screening for lung cancer and its effect on mortality.
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30
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Aberle DR, Berg CD, Black WC, Church TR, Fagerstrom RM, Galen B, Gareen IF, Gatsonis C, Goldin J, Gohagan JK, Hillman B, Jaffe C, Kramer BS, Lynch D, Marcus PM, Schnall M, Sullivan DC, Sullivan D, Zylak CJ. The National Lung Screening Trial: overview and study design. Radiology 2010; 258:243-53. [PMID: 21045183 DOI: 10.1148/radiol.10091808] [Citation(s) in RCA: 808] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography (CT) with chest radiography in the screening of older current and former heavy smokers for early detection of lung cancer, which is the leading cause of cancer-related death in the United States. Five-year survival rates approach 70% with surgical resection of stage IA disease; however, more than 75% of individuals have incurable locally advanced or metastatic disease, the latter having a 5-year survival of less than 5%. It is plausible that treatment should be more effective and the likelihood of death decreased if asymptomatic lung cancer is detected through screening early enough in its preclinical phase. For these reasons, there is intense interest and intuitive appeal in lung cancer screening with low-dose CT. The use of survival as the determinant of screening effectiveness is, however, confounded by the well-described biases of lead time, length, and overdiagnosis. Despite previous attempts, no test has been shown to reduce lung cancer mortality, an endpoint that circumvents screening biases and provides a definitive measure of benefit when assessed in a randomized controlled trial that enables comparison of mortality rates between screened individuals and a control group that does not undergo the screening intervention of interest. The NLST is such a trial. The rationale for and design of the NLST are presented.
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Affiliation(s)
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- Center for Statistical Sciences, Brown University, Box G-S121, 121 S Main St, 7th Floor, Providence, RI 02912, USA
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31
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Du dépistage au diagnostic des cancers en 2010. ONCOLOGIE 2010. [DOI: 10.1007/s10269-010-1859-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Chirieac LR, Flieder DB. High-resolution computed tomography screening for lung cancer: unexpected findings and new controversies regarding adenocarcinogenesis. Arch Pathol Lab Med 2010; 134:41-8. [PMID: 20073604 DOI: 10.5858/134.1.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Recent advances in human imaging technologies reawakened interest in lung cancer screening. Although historic and current preliminary and noncontrolled studies have not shown a decrease in lung cancer mortality in screened populations, many explanations have been proffered while the lung cancer community awaits the results of several large controlled population studies. OBJECTIVE To critically review the current model of adenocarcinoma development against the background of lung cancer screening results combined with observational pathologic and radiographic studies. DATA SOURCES Published articles pertaining to lung cancer screening, lung adenocarcinoma pathology, and radiology accessible through PubMed form the basis for this review. CONCLUSIONS The current adenocarcinogenesis model is probably valid for many but not all lung adenocarcinomas. Screening data combined with radiographic and pathologic studies suggest that not all lung adenocarcinomas are clinically aggressive, and it is uncertain whether all aggressive adenocarcinomas arise from identified precursors.
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Affiliation(s)
- Lucian R Chirieac
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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33
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Giles TE, McCarthy J, Gray W. Respiratory tract. Diagn Cytopathol 2010. [DOI: 10.1016/b978-0-7020-3154-0.00002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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34
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The role of routine bronchoscopy for early detection of bronchial stump recurrence of lung cancer—1 year post-surgery. Lung Cancer 2009; 65:319-23. [DOI: 10.1016/j.lungcan.2008.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 12/02/2008] [Accepted: 12/03/2008] [Indexed: 12/25/2022]
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35
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The Future of Cancer Screening. Prim Care 2009; 36:623-39. [DOI: 10.1016/j.pop.2009.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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36
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Kim JM, Hwang SH, Song EJ, Sang-Yull L, Kim YD, Lee CH, Lee MK, Chang CL, Lee EY. Comparative Quantification of Plasma hnRNP B1 mRNA in Non-small Cell Lung Cancer Patients by Real-time PCR. Ann Lab Med 2009; 29:249-55. [DOI: 10.3343/kjlm.2009.29.3.249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Jeong-Man Kim
- Department of Laboratory Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Sang Hyun Hwang
- Department of Laboratory Medicine, School of Medicine, Pusan National University, Busan, Korea
- Medical Research Institute, Pusan National University, Busan, Korea
| | - Eun Ju Song
- Department of Laboratory Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Lee Sang-Yull
- Department of Biochemistry, School of Medicine, Pusan National University, Busan, Korea
| | - Yeong-Dae Kim
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, Busan, Korea
| | - Chang Hun Lee
- Department of Pathology, School of Medicine, Pusan National University, Busan, Korea
| | - Min Ki Lee
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Chulhun L. Chang
- Department of Laboratory Medicine, School of Medicine, Pusan National University, Busan, Korea
- Medical Research Institute, Pusan National University, Busan, Korea
| | - Eun Yup Lee
- Department of Laboratory Medicine, School of Medicine, Pusan National University, Busan, Korea
- Medical Research Institute, Pusan National University, Busan, Korea
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37
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Automated detection of genetic abnormalities combined with cytology in sputum is a sensitive predictor of lung cancer. Mod Pathol 2008; 21:950-60. [PMID: 18500269 PMCID: PMC3377448 DOI: 10.1038/modpathol.2008.71] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Detection of lung cancer by sputum cytology has low sensitivity but is noninvasive and, if improved, could be a powerful tool for early lung cancer detection. To evaluate whether the accuracy of diagnosing lung cancer by evaluating sputa for cytologic atypia and genetic abnormalities is greater than that of conventional cytology alone, automated scoring of genetic abnormalities for 3p22.1 and 10q22.3 (SP-A) by fluorescence in situ hybridization (FISH) and conventional cytology was done on sputa from 35 subjects with lung cancer, 25 high-risk smokers, and 6 healthy control subjects. Multivariate analysis was performed to select variables that most accurately predicted lung cancer. A model of probability for the presence of lung cancer was derived for each subject. Cells exfoliated from patients with lung cancer contained genetic aberrations and cytologic atypias at significantly higher levels than in those from control subjects. When combined with cytologic atypia, a model of risk for lung cancer was derived that had 74% sensitivity and 82% specificity to predict the presence of lung cancer, whereas conventional cytology achieved only 37% sensitivity and 87% specificity. For diagnosing lung cancer in sputum, a combination of molecular and cytologic variables was superior to using conventional cytology alone.
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38
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Abstract
For screening to be successful in lung cancer, programmes need to identify a precursor of fatal disease that is highly treatable. This precursor is currently presumed to be early-stage lung cancer, and thus our current efforts in lung-cancer screening have focused on finding, and treating, early-stage lung cancer. In other words, our current natural-history model of lung cancer is based on the notion that for a period before a lung cancer becomes advanced and fatal, it is localised and treatable. Empirical findings emerging from studies of lung-cancer screening suggest this notion to be incorrect. These studies all suggest that early-stage histologically confirmed lung cancers identified by screening are not precursors of advanced or incurable disease. If true, these findings have potentially important implications for the development and assessment of new lung-cancer screening approaches.
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Affiliation(s)
- Peter B Bach
- Health Outcomes Group, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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39
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Gasent Blesa JM, Esteban González E, Alberola Candel V. Screening and chemoprevention in lung cancer. Clin Transl Oncol 2008; 10:274-80. [PMID: 18490244 DOI: 10.1007/s12094-008-0197-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lung cancer is a major health problem due to its incidence and mortality. The risk factors, the existence of a preclinical phase, and the relationship between stage at diagnosis and survival are known. A number of strategies that aim to diagnose lung cancer in its earliest stages, based principally on imaging studies, are therefore being tested. Several drugs aimed at reducing the probability of developing lung cancer in the at-risk population are also under study. At the present time, the results obtained have not been encouraging and we do not have a clear strategy either for early diagnosis or for the use of chemopreventive agents.
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Affiliation(s)
- J M Gasent Blesa
- Dpto. Oncología Médica, Hospital General Universitario Marina Alta, Dènia, Alacant, Spain.
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40
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Wu MH, Gotway M, Lee T, Chern MS, Cheng HC, Ko JC, Sheu MH, Chang CY. Features of non-small cell lung carcinomas overlooked at digital chest radiography. Clin Radiol 2008; 63:518-28. [DOI: 10.1016/j.crad.2007.09.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Revised: 09/22/2007] [Accepted: 09/24/2007] [Indexed: 10/22/2022]
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41
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Abstract
Lung cancer is the leading cause of cancer-related death worldwide. Most patients present symptomatically when the disease is often at an advanced stage and prognosis is poor. In contrast, outcomes are significantly better in patients diagnosed at earlier stages, with a 5-year survival for stage I approaching 75%. Screening for lung cancer may detect potentially fatal cases earlier in their disease course, at a stage when a curative surgical intervention is feasible. The objective of this review is to examine the current evidence for lung cancer screening and the clinical effectiveness of screening for lung cancer by using computed tomography.
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42
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43
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44
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Bach PB, Elkin EB, Pastorino U, Kattan MW, Mushlin AI, Begg CB, Parkin DM. Benchmarking Lung Cancer Mortality Rates in Current and Former Smokers. Chest 2004; 126:1742-9. [PMID: 15596668 DOI: 10.1378/chest.126.6.1742] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To develop and validate a model for estimating the risk of lung cancer death in current and former smokers. The model is intended for use in analyzing a population of subjects who are undergoing lung cancer screening or receiving lung cancer chemoprevention, to determine whether the intervention has altered lung cancer mortality. DESIGN/SETTING/PATIENTS Model derivation was based on analyses of the placebo arm of the Carotene and Retinol Efficacy Trial. Model validation was based on analyses of three other longitudinal cohorts. MEASUREMENTS Observed and predicted number of deaths due to lung cancer. RESULTS In internal validation, the model was highly concordant and well calibrated. In external validation, the model predictions were similar to what was observed in all of the validation analyses. The predicted and observed deaths within 6 years were very similar when assessed in the Johns Hopkins Hospital trial of chest radiography and sputum cytology screening (176 predicted, 184 observed, p = 0.53), the Memorial Sloan-Kettering Cancer Center trial of chest radiography and sputum cytology screening (108 predicted, 114 observed, p = 0.57), and the National Health and Nutrition Evaluation Survey part I (24 predicted, 21 observed, p = 0.52). CONCLUSIONS The number of lung cancer deaths in a population of current or former smokers can be accurately predicted, making model-based evaluations of prevention and early detection interventions a useful adjunct to definitive randomized trials. We illustrate this potential use with a small example.
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Affiliation(s)
- Peter B Bach
- Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Box 221, New York, NY 10021, USA.
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Abstract
PURPOSE OF REVIEW With the development of newer forms of technology such as low-dose spiral computed tomography, there has been a resurgent interest in screening for lung cancer. The purpose of this review is to highlight recent advances in screening for lung cancer. Articles published since September 2002 are reviewed here. RECENT FINDINGS More frequent screenings (every 4 or 6 months) showed increased mortality from lung cancer, compared with annual screening. A mass screening conducted in 1990 was effective in a case-control study. The results of lung cancer screening by low-dose spiral computed tomography were reported from the Milan group and the Mayo Clinic. Computed tomography depicted peripheral early lung cancer, especially adenocarcinoma. These results are consistent with previous reports from other groups. Screening with imaging becomes more sensitive with automated computerized methods. SUMMARY A high percentage of stage IA lung cancers were detected by screening with low-dose helical computed tomography. The characteristics of the nodules detected by low-dose spiral computed tomography have been clarified. There have been many controversial discussions about cost effectiveness and overdiagnosis. There is still no evidence that screening tests reduce the rate of cancer-specific mortality. Several studies of screening for lung cancer are under way.
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Affiliation(s)
- Masaaki Kawahara
- Department of Internal Medicine, National Kinki Central Hospital for Chest Diseases, 1180 Nagasone, Sakai, Osaka 591-8555, Japan.
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Kraemer PS, Sanchez CA, Goodman GE, Jett J, Rabinovitch PS, Reid BJ. Flow cytometric enrichment for respiratory epithelial cells in sputum. ACTA ACUST UNITED AC 2004; 60:1-7. [PMID: 15229852 DOI: 10.1002/cyto.a.20041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Induced sputum, in contrast to bronchoscopic biopsies and lavages, is an easily obtained source of biological specimens. However, obtaining abnormal exfoliated cells for detailed molecular studies is limited because respiratory epithelial cells comprise only about 1% of sputum cell populations. METHODS We developed a multiparameter flow sorting strategy to purify epithelial cells from nonepithelial sputum cells, using anti-cytokeratin antibody AE1/AE3 to recognize human epithelial cells and DAPI to stain DNA. We excluded cells with a high degree of side-scatter, which were composed predominantly of squamous cells and contaminating macrophages. The remaining cytokeratin-positive respiratory epithelial cells were then sorted based on anti-cytokeratin (PE) vs DNA (DAPI) parameters. RESULTS In this proof of principle study, the AE1AE3 cytokeratin/DNA flow sorting strategy enriched rare diploid respiratory epithelial cells from an average of 1.1% of cells in unsorted induced sputum samples to average purities of 42%. Thus, AE1AE3 flow-sorting results in a 38-fold enrichment of these cells. CONCLUSIONS We report a multiparameter flow cytometric assay to detect and enrich rare respiratory epithelial cells from induced sputum samples to average purities of 42%. With further development, this methodology may be useful as part of a molecular screening approach of populations at high risk for lung cancer.
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Affiliation(s)
- Petra S Kraemer
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA
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Fischer BM, Mortensen J, Dirksen A, Eigtved A, Højgaard L. Positron emission tomography of incidentally detected small pulmonary nodules. Nucl Med Commun 2004; 25:3-9. [PMID: 15061259 DOI: 10.1097/00006231-200401000-00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the value of fluorodeoxyglucose positron emission tomography (FDG PET) imaging of small pulmonary nodules incidentally detected by spiral computed tomography (CT) in a high-risk population. Ten patients (five females, five males, aged 54-72 years) were recruited from an ongoing 4-year placebo controlled intervention study of the effect of inhaled steroids in 300 smokers with moderate to severe chronic obstructive pulmonary disease. The participants received yearly CT scans of the chest. Patients with a negative chest radiograph at the time of inclusion, but with pulmonary nodules indeterminate for malignancy detected by conventional spiral CT on a subsequent scan, were referred for FDG PET. Histological diagnoses were sought for all nodules with FDG uptake or where CT showed that they had grown. Ten patients had pulmonary nodules indeterminate for malignancy (approx. 3.3% of the entire study population). The prevalence of malignancy in this group was 50%. The accuracy of PET was high, in spite of the fact that seven patients had nodules smaller than 15 mm and two patients had bronchoalveolar cell carcinoma. This small prospective study indicates that subsequent assessment with FDG PET of small pulmonary nodules incidentally detected by CT has the potential to minimize the numbers of invasive procedures performed in individuals with a benign pulmonary lesion. FDG PET also increases the possibility of an early diagnosis as compared to the strategy of watchful waiting.
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Affiliation(s)
- B M Fischer
- Department of Clinical Physiology and Nuclear Medicine, Diagnostic Centre, Rigshopitalet, Copenhagen, Denmark
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Wilkinson NW, Loewen GM, Klippenstein DL, Litwin AM, Anderson TM. The evolution of lung cancer screening. J Surg Oncol 2003; 84:234-8. [PMID: 14756435 DOI: 10.1002/jso.10315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In the 1970s, four trials failed to demonstrate any mortality reduction using a combination of chest X-ray (CXR) and/or sputum cytology. The recent early lung cancer action project (ELCAP) demonstrated that modern screening is capable of detecting Stage I lung cancers. Bronchial epithelial changes leading up to cancers are now being understood to include histologic changes and genetic alterations. Emerging molecular markers detected in sputum and serum show promise in the future of lung cancer screening.
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Affiliation(s)
- Neal W Wilkinson
- Division of Thoracic Surgical Oncology, State University of New York and Roswell Park Cancer Institute, Buffalo, New York 14263-0001, USA
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Li F, Sone S, Abe H, MacMahon H, Doi K. Low-dose computed tomography screening for lung cancer in a general population. Acad Radiol 2003; 10:1013-20. [PMID: 13678090 DOI: 10.1016/s1076-6332(03)00150-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES To report the detection rate for lung cancers in computed tomography (CT) screening in Japanese adults, and to analyze differences in the appearance of the cancers in non-smokers versus smokers. MATERIALS AND METHODS Subjects consisted of 7,847 Japanese adults who received low-dose CT screening at least once in a 3-year period. The detection rate of lung cancers and the correlation of imaging, clinical, and pathologic findings of cancers in non-smokers versus smokers were examined. RESULTS The detection rate for lung cancer was 1.1% for both non-smokers (45 of 4,251) and smokers (39 of 3,596). The prevalence of well-differentiated adenocarcinomas was greater in non-smokers (88%; 22 of 25) than in smokers (29%; 4 of 14) (P < .001). The prevalence and incidence of pathologic stage IA disease were greater in non-smokers than in smokers (92%; [22 of 24] vs 58% [7 of 12], and 100% [19 of 19] vs 70% [14 of 20]) (both P < .05). The mean size of the tumors in the non-smokers (12.4 mm) was smaller than that in smokers (18.2 mm) (P < .001). The percentage of cancers categorized as pure or mixed ground-glass opacity (86%; 38 of 44) on CT was greater in non-smokers than in smokers (46%; 16 of 35) (P < .001). CONCLUSION Most of the lung cancers in non-smokers were slow-growing adenocarcinomas appearing as faint ground-glass opacities on CT, whereas rapidly growing cancers appearing as solid nodules were more commonly seen in smokers.
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Affiliation(s)
- Feng Li
- Kurt Rossmann Laboratories for Radiologic Image Research, Department of Radiology, The University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA
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Eberly LE, Ockene J, Sherwin R, Yang L, Kuller L. Pulmonary function as a predictor of lung cancer mortality in continuing cigarette smokers and in quitters. Int J Epidemiol 2003; 32:592-9. [PMID: 12913035 DOI: 10.1093/ije/dyg177] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Forced expiratory volume in 1 second (FEV(1)) may be useful for identifying smokers at higher risk of lung cancer. We examined the association of FEV(1) with lung cancer mortality (LCM) among cigarette smokers in the Multiple Risk Factor Intervention Trial (MRFIT). METHODS In all, 6613 MRFIT baseline smokers alive at trial end in 1982 had acceptable FEV(1) measures and complete smoking history; men were classified as during-trial long-term quitters (N = 1292), intermittent quitters (1961), and never quitters (3360). Proportional hazards models for LCM were fit with quintiles of average FEV(1), adjusted for age, height, race, smoking history, and other risk factors. RESULTS For long-term, intermittent, and never quitters respectively, mean baseline cigarettes/ day was 28, 32, and 35; trial-averaged FEV(1) was 3201, 3146, and 3082 ml; and average decline in FEV(1) was -46.0, -54.6, and -62.5 ml/year. With median post-trial mortality follow-up of 18 years, there were 363 lung cancer deaths. Age-adjusted LCM rates varied across FEV(1) quintiles from 50 (lowest quintile) to 11 (highest quintile), 58 to 11, and 76 to 20, per 10 000 person-years, for long-term quitters, intermittent quitters, and never quitters, respectively. Multivariate adjusted hazard ratios for 100 ml higher FEV(1) were 0.92 [P = 0.004], 0.95 [P = 0.003], and 0.95 [P < 0.0001] respectively. CONCLUSIONS These results demonstrate the strong predictive value of FEV(1) for lung cancer among cigarette smokers independent of smoking history; results did not differ by during-trial quit status. FEV(1) may be a biological marker for smoking dose or it may be that genetic susceptibilities to both decreased FEV(1) and lung cancer are associated.
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Affiliation(s)
- Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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