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Affiliation(s)
- Eugenio Paci
- Formerly Clinical Epidemiology Unit, ISPRO-Oncological Network, Prevention and Research Institute Oncological Network, Prevention and Research Institute, Florence, Italy
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Real-World Lung Cancer CT Screening Performance, Smoking Behavior, and Adherence to Recommendations: Lung-RADS Category and Smoking Status Predict Adherence. AJR Am J Roentgenol 2021; 216:919-926. [PMID: 32755178 DOI: 10.2214/ajr.20.23637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND. Low-dose CT (LDCT) lung cancer screening (LCS) has been shown to decrease mortality in persons with a significant smoking history. However, adherence in real-world LCS programs is significantly lower than in randomized controlled trials. OBJECTIVE. The purpose of this article is to assess real-world LDCT LCS performance and factors predictive of adherence to LCS recommendations. METHODS. We retrospectively identified all persons who underwent at least two LCS examinations from 2014 to 2019. Patient demographics, smoking history and behavior changes, Lung-RADS category, PPV, NPV, and adherence to screening recommendations were recorded. Predictors of adherence were assessed via univariate comparisons and multivariate logistic regression. RESULTS. A total of 260 persons returned for follow-up LDCT (57.7% had two, 34.2% had three, 7.7% had four, and 0.4% had five LDCT examinations). A total of 43 of 260 (16.5%) had positive (Lung-RADS category 3 or above) scans, of which 27 of 260 persons (10.3%) were graded as Lung-RADS category 3, eight of 260 (3.1%) were category 4A, six of 260 (2.3%) were category 4B, and two of 260 (0.8%) were category 4X. Cancer was diagnosed in four of the 260 (three with lung cancer and one with metastatic melanoma). A total of 143 of 260 (55.0%) persons were current smokers at baseline and 121 of 260 (46.5%) were current smokers at the last round of LCS. LCS had sensitivity of 100.0%, specificity of 84.8%, PPV of 9.3%, and NPV of 100%. Overall adherence was 43.0% but increased progressively with higher Lung-RADS category (Lung-RADS 1: 33.2%; Lung-RADS 2: 46.3%; Lung-RADS 3: 53.8%; Lung-RADS 4A: 77.8%; Lung-RADS 4B: 83.3%; Lung-RADS 4X: 100%; p < .001). was also higher in former versus current smokers (50.0% vs 36.2%; p < .001). Being a former smoker and having a nodule that is Lung-RADS category 3 or greater were the only significant independent predictors of adherence. CONCLUSION. Our real-world LCS program showed very high sensitivity and NPV, but moderate specificity and very low PPV. Adherence to LCS recommendations increased with former versus current smokers and in those with positive (Lung-RADS categories 3, 4A, 4B, or 4X) LCS examinations. Adherence was less than 50.0% in current smokers and persons with negative (Lung-RADS categories 1 or 2) LCS examinations. CLINICAL IMPACT. Our results offer a road map for targeted performance improvement by focusing on LCS subjects less likely to remain in the program, such as persons with negative LCS examinations and persons who continue to smoke, potentially improving LCS cost effectiveness and maximizing its societal benefits.
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Alishahi Tabriz A, Neslund-Dudas C, Turner K, Rivera MP, Reuland DS, Elston Lafata J. How Health-Care Organizations Implement Shared Decision-making When It Is Required for Reimbursement: The Case of Lung Cancer Screening. Chest 2020; 159:413-425. [PMID: 32798520 DOI: 10.1016/j.chest.2020.07.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services stipulate shared decision-making (SDM) counseling as a prerequisite to lung cancer screening (LCS) reimbursement, despite well-known challenges implementing SDM in practice. RESEARCH QUESTION How have health-care organizations implemented SDM for LCS? STUDY DESIGN AND METHODS For this qualitative study, we used data from in-depth, semistructured interviews with key informants directly involved in implementing SDM for LCS, managing SDM for LCS, or both. We identified respondents using a snowball sampling technique and used template analysis to identify and analyze responses thematically. RESULTS We interviewed 30 informants representing 23 health-care organizations located in 12 states and 4 Census regions. Respondents described two types of SDM for LCS programs: centralized models (n = 7), in which front-end practitioners (eg, primary care providers) referred patients to an LCS clinic where trained staff (eg, advanced practice nurses) delivered SDM at the time of screening, or decentralized models (n = 10), in which front-end practitioners delivered SDM before referring patients for screening. Some organizations used both models simultaneously (n = 6). Respondents discussed tradeoffs between SDM quality and access. They perceived centralized models as enhancing SDM quality, but limiting patient access to care, and vice versa. Respondents reported ongoing challenges with limited resources and budgetary constraints, ambiguity regarding what constitutes SDM, and an absence of benchmarks for evaluating SDM for LCS quality. INTERPRETATION Those responsible for developing and managing SDM for LCS programs voiced concerns regarding both patient access and SDM quality, regardless of organizational context, or the SDM for LCS model implemented. The challenge facing these organizations, and those wanting to help patients and clinicians balance the tradeoffs inherent with LCS, is how to move beyond a check-box documentation requirement to a process that enables LCS to be offered to all high-risk patients, but used only by those who are informed and for whom screening represents a value-concordant service.
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Affiliation(s)
| | | | - Kea Turner
- University of South Florida College of Medicine, Tampa, FL; Moffitt Cancer Center, Tampa, FL
| | - M Patricia Rivera
- School of Medicine, University of North Carolina, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Daniel S Reuland
- School of Medicine, University of North Carolina, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Jennifer Elston Lafata
- Eshelman School of Pharmacy, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Henry Ford Health System, Detroit, MI.
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Differences in lung cancer characteristics and mortality rate between screened and non-screened cohorts. Sci Rep 2019; 9:19386. [PMID: 31852960 PMCID: PMC6920422 DOI: 10.1038/s41598-019-56025-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022] Open
Abstract
Screening programs for lung cancer aim to allow diagnosis at the early stage, and therefore the decline in mortality rates. Thus, the aim of this retrospective cohort study was to the comparison of screened and non-screened lung cancer in terms of lung cancer characteristics, overdiagnosis and survival rate. A retrospective study in which 2883 patients with 2883 lung cancer diagnosed according to the hospital-based lung cancer register database between 2007 and 2017. A comparison was performed in term of clinical characteristics and outcomes of lung cancer between the screened and non-screening patient groups. 2883 subjects were identified (93 screened and 2790 non-screened). Screened group patients were younger (59.91 ± 8.14 versus 67.58 ± 12.95; p < 0.0001), and were more likely to be female than non-screened group (61.3% versus 36.8%; p < 0.0001). The screened group showed significantly better outcomes in overall mortality than the non-screened group (10.75% versus 79.06%; <0.0001). In a Cox proportional hazard model, lung cancer in the screened group proved to be an independent prognostic factor in lung cancer subjects. Our findings point to the improved survival outcome in the screened group and might underline the benefit of low-dose computed tomography (LDCT) screening program in Asian populations with the high prevalence of non-smoking-related lung cancer. Further study aimed at the LDCT mass screening program targeting at light smokers and non-smoker outside of existing screening criteria is warranted.
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Hammer MM, Palazzo LL, Kong CY, Hunsaker AR. Cancer Risk in Subsolid Nodules in the National Lung Screening Trial. Radiology 2019; 293:441-448. [PMID: 31526256 PMCID: PMC6823608 DOI: 10.1148/radiol.2019190905] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/20/2019] [Accepted: 07/30/2019] [Indexed: 01/03/2023]
Abstract
Background Subsolid pulmonary nodules, comprising pure ground-glass nodules (GGNs) and part-solid nodules (PSNs), have a high risk of indolent malignancy. Lung Imaging Reporting and Data System (Lung-RADS) nodule management guidelines are based on expert opinion and lack independent validation. Purpose To evaluate Lung-RADS estimates of the malignancy rates of subsolid nodules, using nodules from the National Lung Screening Trial (NLST), and to compare Lung-RADS to the NELSON trial classification as well as the Brock University calculator. Materials and Methods Subsets of GGNs and PSNs were selected from the NLST for this retrospective study. A thoracic radiologist reviewed the baseline and follow-up CT images, confirmed that they were true subsolid nodules, and measured the nodules. The primary outcome for each nodule was the development of malignancy within the follow-up period (median, 6.5 years). Nodules were stratified according to Lung-RADS, NELSON trial criteria, and the Brock model. For analyses, nodule subsets were weighted on the basis of frequency in the NLST data set. Nodule stratification models were tested by using receiver operating characteristic curves. Results A total of 622 nodules were evaluated, of which 434 nodules were subsolid. At baseline, 304 nodules were classified as Lung-RADS category 2, with a malignancy rate of 3%, which is greater than the 1% in Lung-RADS (P = .004). The malignancy rate for GGNs smaller than 10 mm (two of 129, 1.3%) was smaller than that for GGNs measuring 10-19 mm (11 of 153, 6%) (P = .01). The malignancy rate for Lung-RADS category 3 was 14% (13 of 67), which is greater than the reported 2% in Lung-RADS (P < .001). The Brock model predicted malignancy better than Lung-RADS and the NELSON trial scheme (area under the receiver operating characteristic curve = 0.78, 0.70, and 0.67, respectively; P = .02 for Brock model vs NELSON trial scheme). Conclusion Subsolid nodules classified as Lung Imaging Reporting and Data System (Lung-RADS) categories 2 and 3 have a higher risk of malignancy than reported. The Brock risk calculator performed better than measurement-based classification schemes such as Lung-RADS. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Kauczor and von Stackelberg in this issue.
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Affiliation(s)
- Mark M. Hammer
- From the Department of Radiology, Brigham and Women’s
Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.,
A.R.H.); and Institute for Technology Assessment, Massachusetts General
Hospital, Boston, Mass (L.L.P., C.Y.K.)
| | - Lauren L. Palazzo
- From the Department of Radiology, Brigham and Women’s
Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.,
A.R.H.); and Institute for Technology Assessment, Massachusetts General
Hospital, Boston, Mass (L.L.P., C.Y.K.)
| | - Chung Yin Kong
- From the Department of Radiology, Brigham and Women’s
Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.,
A.R.H.); and Institute for Technology Assessment, Massachusetts General
Hospital, Boston, Mass (L.L.P., C.Y.K.)
| | - Andetta R. Hunsaker
- From the Department of Radiology, Brigham and Women’s
Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.M.H.,
A.R.H.); and Institute for Technology Assessment, Massachusetts General
Hospital, Boston, Mass (L.L.P., C.Y.K.)
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Ozdemir Y, Topkan E. Second primary malignancies in laryngeal carcinoma patients treated with definitive radiotherapy. Indian J Cancer 2019; 56:29-34. [PMID: 30950440 DOI: 10.4103/ijc.ijc_273_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Second primary malignancy (SPM) is associated with decreased overall survival (OS) in laryngeal carcinomas (LC). METHODS One hundred eighty three LC patients were analyzed retrospectively. The primary and secondary endpoints were the incidence of SPM and the OS difference between patients with and without SPM. RESULTS SPM developed in 22 (12.0%) patients at median 52 months (range, 4-131 months), with a yearly 2.8% incidence, of which 19 (10.4%) and 3 (1.6%) were metachronous and synchronous, respectively. Lung was the commonest SPM (72.7%). Of 47 deaths, 12 (25.5%) were SPM related. Comparatively SPM patients had significantly shorter median OS (68.0 months vs. median not reached; P = 0.005), with lower 5-year (67.0% vs. 78.9%) and 8-year (32.6 vs. 69.8%) survival rates. CONCLUSION The present findings suggested the SPM as a competing risk factor for death in index LC patients with its annual incidence rate of 2.8% and for accounting one of every four deaths in this patients group. Emergence of lung carcinoma as the most frequent type of SPM and the ability to treat >50% of them with an estimated long-term outcomes emphasizes the importance of early diagnosis and curative treatment of SPMs.
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Affiliation(s)
- Yurday Ozdemir
- Department of Radiation Oncology, Baskent University Adana Treatment and Research Center, Adana, Turkey
| | - Erkan Topkan
- Department of Radiation Oncology, Baskent University Adana Treatment and Research Center, Adana, Turkey
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Zehentmayr F, Sprenger M, Rettenbacher L, Wass R, Porsch P, Fastner G, Pirich C, Studnicka M, Sedlmayer F. Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation. Thorac Cancer 2019; 10:321-329. [PMID: 30618120 PMCID: PMC6360228 DOI: 10.1111/1759-7714.12966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Approximately 15% of lung cancer patients are diagnosed in early stages. Microscopic proof of disease cannot always be obtained because of comorbidity or reluctance to undergo invasive diagnostic procedures. In the current study, survival data of patients with and without pathology are compared. METHODS One hundred and sixty three patients with NSCLC I-IIb (T3 N0) treated between 2002 and 2016 were eligible: 123 (75%) had pathological confirmation of disease, whereas 40 (25%) did not. In accordance with international guidelines, both groups received radiotherapy. Comorbidity was assessed with the Charlson Comorbidity Index (CCI). RESULTS The median follow-up was 28.6 months (range: 0.3-162): 66 (40%) patients are still alive, while 97 (59%) patients died: 48 (29%) cancer-related deaths and 49 (30%) from causes other than cancer. Median overall survival (OS) in patients without pathological confirmation was 58.6 months (range: 0.5-162), which did not differ from those with microscopic proof of disease (39.4 months, range: 0.3-147.5; logrank P = 0.481). Median cancer-specific survival (CSS) also did not differ at 113.4 months (range: 0.5-162) in the non-confirmation group (logrank P = 0.763) versus 51.5 months (range: 3.7-129.5) in patients with pathology. In Cox regression, a CCI of ≥ 3 was associated with poor OS (hazard ratio 2.0; range 1.2-3.4; P = 0.010) and CSS (hazard ratio 2.0; 1.0-4.0; P = 0.043). CONCLUSION OS and CSS in early lung cancer patients depend on comorbidity rather than on pathological confirmation of disease.
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Affiliation(s)
- Franz Zehentmayr
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria.,radART, Paracelsus Medical University, Salzburg, Austria
| | - Martin Sprenger
- Postgraduate Public Health Program, Medical University of Graz, Graz, Austria
| | - Lukas Rettenbacher
- Department of Nuclear Medicine, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Romana Wass
- Department of Pneumology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Peter Porsch
- Department of Pneumology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Gerd Fastner
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Christian Pirich
- Department of Nuclear Medicine, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Michael Studnicka
- Department of Pneumology, Paracelsus Medical University, SALK, Salzburg, Austria
| | - Felix Sedlmayer
- Department of Radiation Oncology, Paracelsus Medical University, SALK, Salzburg, Austria.,radART, Paracelsus Medical University, Salzburg, Austria
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An Update on the European Lung Cancer Screening Trials and Comparison of Lung Cancer Screening Recommendations in Europe. J Thorac Imaging 2019; 34:65-71. [DOI: 10.1097/rti.0000000000000367] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Hammer MM, Palazzo LL, Eckel AL, Barbosa EM, Kong CY. A Decision Analysis of Follow-up and Treatment Algorithms for Nonsolid Pulmonary Nodules. Radiology 2018; 290:506-513. [PMID: 30457486 DOI: 10.1148/radiol.2018180867] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To evaluate management strategies and treatment options for patients with ground-glass nodules (GGNs) by using decision-analysis models. Materials and Methods A simulation was developed for 1 000 000 hypothetical patients with GGNs undergoing follow-up per the Lung Imaging Reporting and Data System (Lung-RADS) recommendations. The initial age range was 55-75 years (mean, 64 years). Nodules could grow and develop solid components over time. Clinically significant malignancy rates were calibrated to data from the National Lung Screening Trial. Annual versus 3-year-interval follow-up of Lung-RADS category 2 nodules was compared, and different treatment strategies were tested (stereotactic body radiation therapy, surgery, and no therapy). Results Overall, 2.3% (22 584 of 1 000 000) of nodules were clinically significant malignancies; 6.3% (62 559 of 1 000 000) of nodules were treated. Only 30% (18 668 of 62 559) of Lung-RADS category 4B or 4X nodules were clinically significant malignancies. The risk of clinically significant malignancy for persistent nonsolid nodules after baseline was higher than Lung-RADS estimates for categories 2 and 3 (3% vs <1% and 1%-2%, respectively). Overall survival (OS) at 10 years was 72% (527 827 of 737 306; 95% confidence interval [CI]: 71%, 72%) with annual follow-up and 71% (526 507 of 737 306; 95% CI: 71%, 72%) with 3-year-interval follow-up (P < .01). At 10 years, OS among patients whose nodules progressed to Lung-RADS category 4B or 4X was 80% after radiation therapy (49 945 of 62 559; 95% CI: 80%, 80%), 79% after surgery (49 139 of 62 559; 95% CI: 78%, 79%), and 74% after no therapy (46 512 of 62 559; 95% CI: 74%, 75%) (P < .01). Conclusion Simulation modeling suggests that the follow-up interval for evaluating ground-glass nodules can be increased from 1 year to 3 years with minimal change in outcomes. Stereotactic body radiation therapy demonstrated the best outcomes compared with lobectomy and with no therapy for nonsolid nodules. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Mark M Hammer
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Lauren L Palazzo
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Andrew L Eckel
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Eduardo M Barbosa
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
| | - Chung Yin Kong
- From the Department of Radiology, Brigham and Women's Hospital, Boston, Mass (M.M.H.); Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114 (L.L.P., A.L.E., C.Y.K.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa, (E.M.B.); and Harvard Medical School, Boston, Mass (C.Y.K.)
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He Y, Ren S, Wang Y, Li X, Zhou C, Hirsch FR. Serum microRNAs improving the diagnostic accuracy in lung cancer presenting with pulmonary nodules. J Thorac Dis 2018; 10:5080-5085. [PMID: 30233883 DOI: 10.21037/jtd.2018.07.138] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background MicroRNA (miRNA) is an approach for early diagnosing of cancer. We validated a panel of miRNAs (hsa-miR-199a-3p, hsa-miR-148a-3p, hsa-miR-210-3p, hsa-miR-378d and hsa-miR-138-5p) to aid early diagnosis of lung adenocarcinoma by blood test in lung cancer presenting with pulmonary nodules. Methods A total of 369 individuals who were detected pulmonary nodules by computed tomography (CT) scan were enrolled into this study. These patients included 274 pulmonary malignant or borderline lung diseases and 122 lung benign pulmonary nodules. When the lung nodules were detected by combining with CT scan, we got patient blood samples in 2 days. Patients' serum was collected within 2 days prior to miRNAs analyses. We performed miRNAs panel by reverse transcription-polymerase chain reaction (RT-PCR). Results The sensitivity of miRNAs panel was 34.0% and the specificity of miRNAs panel was 90.2%. In invasive adenocarcinoma, the sensitivity of miRNAs panel was 44.7%. The overall false positive rate of CT imaging for nodules and glass ground nodules (GGNs) was 33.1%. When miRNAs panel test positive patients combined with the nodule size, the false positive rate was decreased to 3.2%. Conclusions The greatest impact of using the miRNAs panel CT scan was decreasing the false positive. miRNAs panel can improve the diagnosis of lung cancer presenting with nodules combined with CT.
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Affiliation(s)
- Yayi He
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China.,Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China.,Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Yan Wang
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Xuefei Li
- Department of Lung Cancer and Immunology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai 200433, China
| | - Fred R Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Pedersen JH, Sørensen JB, Saghir Z, Fløtten Ø, Brustugun OT, Ashraf H, Strand TE, Friesland S, Koyi H, Ek L, Nyrén S, Bergman P, Jekunen A, Nieminen EM, Gudbjartsson T. Implementation of lung cancer CT screening in the Nordic countries. Acta Oncol 2017; 56:1249-1257. [PMID: 28571524 DOI: 10.1080/0284186x.2017.1329592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We review the current knowledge of CT screening for lung cancer and present an expert-based, joint protocol for the proper implementation of screening in the Nordic countries. MATERIALS AND METHODS Experts representing all the Nordic countries performed literature review and concensus for a joint protocol for lung cancer screening. RESULTS AND DISCUSSION Areas of concern and caution are presented and discussed. We suggest to perform CT screening pilot studies in the Nordic countries in order to gain experience and develop specific and safe protocols for the implementation of such a program.
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Affiliation(s)
- Jesper Holst Pedersen
- Department of Cardiothoracic Surgery RT Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Benn Sørensen
- Department of Oncology, Finsen Centre/Rigshospitalet Copenhagen, Copenhagen, Denmark
| | - Zaigham Saghir
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
| | - Øystein Fløtten
- Department of Pulmonary Medicine, Haukeland universitetssjukehus, Bergen, Norway
| | - Odd Terje Brustugun
- Section of Oncology, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Haseem Ashraf
- Department of Pulmonary Medicine, Gentofte University Hospital, Hellerup, Denmark
- Department of Radiology, Akershus University Hospital, Loerenskog, Norway
| | | | - Signe Friesland
- Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Hirsh Koyi
- Department of Respiratory Medicine, Gävle Hospital, Gävle, Sweden
| | - Lars Ek
- Department of Heart and Lung Diseases, Skåne University Hospital, Sweden
| | - Sven Nyrén
- Department of Thoraxradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Per Bergman
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Antti Jekunen
- Vaasa Oncology Clinic, Turku University, Turku, Finland
| | - Eeva-Maija Nieminen
- Helsinki University, Helsinki University Hospital, Heart and Lung Centre, Helsinki, Finland
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Faculty of Medicine, Landspitli University Hospital, University of Iceland, Reykjavik, Iceland
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Mortani Barbosa EJ. Overdiagnosis in Lung Cancer Screening can be Reduced to a Low, Manageable Level via a Multilayered Strategy Involving Perfecting Reporting Systems, Restricting Screening to High-Risk Groups, Developing Better Risk Stratification Models, and Improving Management Algorithms. Acad Radiol 2016; 23:113-5. [PMID: 26514433 DOI: 10.1016/j.acra.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 08/18/2015] [Accepted: 09/20/2015] [Indexed: 11/27/2022]
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Overdiagnosis Detrimental, Resection Consequential, NLST Challengeable. Acad Radiol 2016; 23:112-3. [PMID: 26601896 DOI: 10.1016/j.acra.2015.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 11/21/2022]
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