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Guan S, Xu X, Zhu X, Ge Y, Xie J, Zhou J. Diagnostic value of rEBUS-TBLB combined distance measurement method based on ultrasound images in bronchoscopy for peripheral lung lesions. SLAS Technol 2024:100198. [PMID: 39396733 DOI: 10.1016/j.slast.2024.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 09/05/2024] [Accepted: 10/10/2024] [Indexed: 10/15/2024]
Abstract
Traditional imaging methods have limitations in the diagnosis of peripheral lung lesions. The aim of this study is to evaluate the diagnostic value of the distance measurement method based on ultrasound image-based inverted electrostrain (rEBUS) combined with thoracoscopic lung biopsy (TBLB) for peripheral lung lesions. A group of patients with peripheral lung lesions were recruited for the study, and rEBUS examination was performed simultaneously during TBLB. Using rEBUS ultrasound images combined with electrostrain information, evaluate the morphological characteristics of peripheral lung lesions and the elastic properties of internal tissues. By comparing with pathological examination results, both rEBUS-D-TBLB and rEBUS-GS-TBLB have a higher positive diagnostic rate for PPL under bronchoscopy. However, rEBUS-D-TBLB is more effective in diagnosing benign PPL with ≥ 3cm PPL than rEBUS-GS-TBLB. The rEBUS-TBLB combined ranging method has shown high accuracy and sensitivity in diagnosing peripheral lung lesions. Ultrasound images provide clear morphological features of the tumor, while the electrical strain information of rEBUS provides elastic information of the internal tissue of the tumor, further improving the accuracy of diagnosis.
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Affiliation(s)
- Shuhong Guan
- Intensive Care Unit, The First People's Hospital of Changzhou, Changzhou, 213004, Jiangsu Province, China
| | - Xiaoli Xu
- Department of Integrated Chinese and Western Medicine, The First People's Hospital of Changzhou, Changzhou, 213004, Jiangsu Province, China
| | - Xiaoqin Zhu
- Intensive Care Unit, The First People's Hospital of Changzhou, Changzhou, 213004, Jiangsu Province, China
| | - Yunqi Ge
- Intensive Care Unit, The First People's Hospital of Changzhou, Changzhou, 213004, Jiangsu Province, China
| | - Jun Xie
- Intensive Care Unit, The First People's Hospital of Changzhou, Changzhou, 213004, Jiangsu Province, China
| | - Jun Zhou
- Intensive Care Unit, The First People's Hospital of Changzhou, Changzhou, 213004, Jiangsu Province, China.
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2
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Huang Y, Li N, Jiang J, Pei Y, Gao S, Qian Y, Xing Y, Zhou T, Lian Y, Shi M. Metabolic reprogramming-related gene classifier distinguishes malignant from the benign pulmonary nodules. Heliyon 2024; 10:e37214. [PMID: 39296187 PMCID: PMC11409088 DOI: 10.1016/j.heliyon.2024.e37214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 07/02/2024] [Accepted: 08/29/2024] [Indexed: 09/21/2024] Open
Abstract
The current existing classifiers for distinguishing malignant from benign pulmonary nodules is limited by effectiveness or clinical practicality. In our study, we aimed to develop and validate a gene classifier for lung cancer diagnosis. To identify the genes involved in this process, we used the weighted gene co-expression network analysis to analyze gene expression datasets from Gene Expression Omnibus (GEO). We identified the three most relevant modules associated with malignant nodules and performed functional enrichment analysis on them. The results indicated significant involvement in metabolic, immune-related, cell cycle, and viral-related processes. All three modules showed enrichment in metabolic reprogramming pathways. Based on these genes, we intersected genes from the three modules with metabolic reprogramming-related genes and further intersected with differentially expressed genes to get 78 genes. After machine learning algorithms and manual selection, we finally got a nine-gene classifier consisting of SEC24D, RPSA, PSME3, PSMD8, PSMB7, NCOA1, MED12, LPCAT1, and AKR1C3. Our developed and validated classifier-based model demonstrated good discrimination, with an area under the curve (AUC) of 0.763 in the development cohort, 0.744 in the internal validation cohort, and 0.718 in the external validation cohort, and outperformed previous clinical models. Moreover, the addition of nodule size improved the predictive capability of the classifier. We further verify the expression of the gene in the classifier using TCGA lung cancer samples and found eight of the genes showed significant differential expression in lung adenocarcinoma while all nine genes showed significant differential expression in lung squamous carcinoma. Our findings underscore the significance of metabolic reprogramming pathways in patients with malignant pulmonary nodules, and our gene classifier can assist clinicians in differentiating benign from malignant pulmonary nodules in clinical settings.
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Affiliation(s)
- Yongkang Huang
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China
| | - Na Li
- Department of Respiratory and Critical Care Medicine, the Fourth Affiliated Hospital of Soochow University, 9 Chongwen Road, Suzhou, 215004, Jiangsu, China
| | - Jie Jiang
- Department of Thoracic Surgery, the Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, 210003, Jiangsu, China
| | - Yongjian Pei
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China
| | - Shiyuan Gao
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China
| | - Yajuan Qian
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China
| | - Yufei Xing
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China
| | - Tong Zhou
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China
| | - Yixin Lian
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China
| | - Minhua Shi
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215004, Jiangsu, China
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Gu X, Wei S, Lv X. Circulating tumor cells: from new biological insights to clinical practice. Signal Transduct Target Ther 2024; 9:226. [PMID: 39218931 PMCID: PMC11366768 DOI: 10.1038/s41392-024-01938-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 05/31/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
The primary reason for high mortality rates among cancer patients is metastasis, where tumor cells migrate through the bloodstream from the original site to other parts of the body. Recent advancements in technology have significantly enhanced our comprehension of the mechanisms behind the bloodborne spread of circulating tumor cells (CTCs). One critical process, DNA methylation, regulates gene expression and chromosome stability, thus maintaining dynamic equilibrium in the body. Global hypomethylation and locus-specific hypermethylation are examples of changes in DNA methylation patterns that are pivotal to carcinogenesis. This comprehensive review first provides an overview of the various processes that contribute to the formation of CTCs, including epithelial-mesenchymal transition (EMT), immune surveillance, and colonization. We then conduct an in-depth analysis of how modifications in DNA methylation within CTCs impact each of these critical stages during CTC dissemination. Furthermore, we explored potential clinical implications of changes in DNA methylation in CTCs for patients with cancer. By understanding these epigenetic modifications, we can gain insights into the metastatic process and identify new biomarkers for early detection, prognosis, and targeted therapies. This review aims to bridge the gap between basic research and clinical application, highlighting the significance of DNA methylation in the context of cancer metastasis and offering new avenues for improving patient outcomes.
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Affiliation(s)
- Xuyu Gu
- Department of Oncology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Shiyou Wei
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xin Lv
- Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
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4
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Wang H, Xie J, Chen Y, Jin J, Zhang M, Tung T, Xu Y. Gender-specific outcomes of low-dose computed tomography screening for lung cancer detection: A retrospective study in Chinese never-smoker population. Cancer Med 2024; 13:e70184. [PMID: 39342623 PMCID: PMC11439423 DOI: 10.1002/cam4.70184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 08/14/2024] [Accepted: 08/21/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVES Low-dose computed tomography (LDCT) has emerged as a pivotal tool for detecting lung cancer among ever-smokers. This study aims to evaluate the gender-specific outcomes of LDCT screening within the Chinese never-smoking population. METHODS We conducted a single-center, retrospective cohort study, which analyzed LDCT screening outcomes for 42,018 asymptomatic participants. Specifically, we focused on assessing gender-specific differences in the prevalence of pulmonary nodules, and the incidence of lung cancer diagnosis among never-smokers. RESULTS Among the 42,018 eligible participants, 41.50% were females and 58.50% were males. Most participants were non-smokers (77.57%), with a significantly higher proportion of non-smokers among females than males (99.33% vs. 62.14%). Pulmonary nodules were identified in 2.66% of participants, with a higher prevalence in females (2.99%) than males (2.43%) (p < 0.001). Non-smoking females had a higher incidence of positive nodules than non-smoking males (2.98% vs. 2.38%, p < 0.001). Invasive biopsies were performed in 334 individuals with nodules, confirming lung cancer in 258 cases. The majority of these cancer cases were non-smokers (212), with non-smoking females showing a higher incidence (0.85%) compared to males (0.43%) (p < 0.001). There was no significant difference in the false-positive rates between non-smoking females (0.14%) and males (0.13%). Multivariate analysis showed that never-smoking women were more likely to undergo biopsies (OR 1.65, p = 0.0016) and had a higher, though not statistically significant, probability of lung cancer diagnosis (OR 1.84, p = 0.06). CONCLUSION This study elucidates sex-based differences within the Chinese population, revealing a higher prevalence of pulmonary nodules and lung cancers among non-smoking females. These findings offer valuable reference for both clinical practice and future research initiatives.
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Affiliation(s)
- Huihong Wang
- Department of Respiratory and Critical Care MedicineTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityLinhaiZhejiangChina
| | - Jicheng Xie
- Department of radiologyTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityLinhaiZhejiangChina
| | - Yahong Chen
- Health Management CenterTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityLinhaiZhejiangChina
| | - Jiang Jin
- Department of Thoracic SurgeryTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityLinhaiZhejiangChina
| | - Meixian Zhang
- Public LaboratoryTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityLinhaiZhejiangChina
| | - TaoHsin Tung
- Public LaboratoryTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityLinhaiZhejiangChina
| | - Youzu Xu
- Department of Respiratory and Critical Care MedicineTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityLinhaiZhejiangChina
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5
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Kearney L, Bolton RE, Núñez ER, Boudreau JH, Sliwinski S, Herbst AN, Caverly TJ, Wiener RS. Tackling Guideline Non-concordance: Primary Care Barriers to Incorporating Life Expectancy into Lung Cancer Screening Decision-Making-A Qualitative Study. J Gen Intern Med 2024; 39:2284-2291. [PMID: 38459413 PMCID: PMC11347517 DOI: 10.1007/s11606-024-08705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/27/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Primary care providers (PCPs) are often the first point of contact for discussing lung cancer screening (LCS) with patients. While guidelines recommend against screening people with limited life expectancy (LLE) who are less likely to benefit, these patients are regularly referred for LCS. OBJECTIVE We sought to understand barriers PCPs face to incorporating life expectancy into LCS decision-making for patients who otherwise meet eligibility criteria, and how a hypothetical point-of-care tool could support patient selection. DESIGN Qualitative study based on semi-structured telephone interviews. PARTICIPANTS Thirty-one PCPs who refer patients for LCS, from six Veterans Health Administration facilities. APPROACH We thematically analyzed interviews to understand how PCPs incorporated life expectancy into LCS decision-making and PCPs' receptivity to a point-of-care tool to support patient selection. Final themes were organized according to the Cabana et al. framework Why Don't Physicians Follow Clinical Practice Guidelines, capturing the influence of clinician knowledge, attitudes, and behavior on LCS appropriateness determinations. KEY RESULTS PCP referrals to LCS for patients with LLE were influenced by limited knowledge of the life expectancy threshold at which patients are less likely to benefit from LCS, discomfort estimating life expectancy, fear of missing cancer at the point of early detection, and prioritization of factors such as quality of life, patient values, clinician-patient relationship, and family support. PCPs were receptive to a decision support tool to inform and communicate LCS appropriateness decisions if easy to use and integrated into clinical workflows. CONCLUSIONS Our study suggests knowledge gaps and attitudes may drive decisions to offer screening despite LLE, a behavior counter to guideline recommendations. Integrating a LCS decision support tool that incorporates life expectancy within the electronic medical record and existing clinical workflows may be one acceptable solution to improve guideline concordance and increase confidence in selecting high benefit patients for LCS.
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Affiliation(s)
- Lauren Kearney
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA.
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.
| | - Rendelle E Bolton
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
- The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Eduardo R Núñez
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
- Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Jacqueline H Boudreau
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
| | - Samantha Sliwinski
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
| | - Abigail N Herbst
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
| | - Tanner J Caverly
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA and VA Bedford Healthcare System, Bedford, MA, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA
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6
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Anandakrishnan R, Shahidi R, Dai A, Antony V, Zyvoloski IJ. An approach for developing a blood-based screening panel for lung cancer based on clonal hematopoietic mutations. PLoS One 2024; 19:e0307232. [PMID: 39172974 PMCID: PMC11341013 DOI: 10.1371/journal.pone.0307232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/01/2024] [Indexed: 08/24/2024] Open
Abstract
Early detection can significantly reduce mortality due to lung cancer. Presented here is an approach for developing a blood-based screening panel based on clonal hematopoietic mutations. Animal model studies suggest that clonal hematopoietic mutations in tumor infiltrating immune cells can modulate cancer progression, representing potential predictive biomarkers. The goal of this study was to determine if the clonal expansion of these mutations in blood samples could predict the occurrence of lung cancer. A set of 98 potentially pathogenic clonal hematopoietic mutations in tumor infiltrating immune cells were identified using sequencing data from lung cancer samples. These mutations were used as predictors to develop a logistic regression machine learning model. The model was tested on sequencing data from a separate set of 578 lung cancer and 545 non-cancer samples from 18 different cohorts. The logistic regression model correctly classified lung cancer and non-cancer blood samples with 94.12% sensitivity (95% Confidence Interval: 92.20-96.04%) and 85.96% specificity (95% Confidence Interval: 82.98-88.95%). Our results suggest that it may be possible to develop an accurate blood-based lung cancer screening panel using this approach. Unlike most other "liquid biopsies" currently under development, the approach presented here is based on standard sequencing protocols and uses a relatively small number of rationally selected mutations as predictors.
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Affiliation(s)
- Ramu Anandakrishnan
- Edward Via College of Osteopathic Medicine, Biomedical Sciences, Blacksburg, Virginia, United States of America
- Maryland-Virginia College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, United States of America
| | - Ryan Shahidi
- Edward Via College of Osteopathic Medicine, Biomedical Sciences, Blacksburg, Virginia, United States of America
| | - Andrew Dai
- Edward Via College of Osteopathic Medicine, Biomedical Sciences, Blacksburg, Virginia, United States of America
| | - Veneeth Antony
- Edward Via College of Osteopathic Medicine, Biomedical Sciences, Blacksburg, Virginia, United States of America
| | - Ian J. Zyvoloski
- University of Maryland, Baltimore, Maryland, United States of America
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7
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Tiase VL, Richards G, Taft T, Stevens L, Balbin C, Kaphingst KA, Fagerlin A, Caverly T, Kukhareva P, Flynn M, Butler JM, Kawamoto K. Patient Perspectives on a Patient-Facing Tool for Lung Cancer Screening. Health Expect 2024; 27:e14143. [PMID: 38992907 PMCID: PMC11239535 DOI: 10.1111/hex.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 06/02/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Individuals with high risk for lung cancer may benefit from lung cancer screening, but there are associated risks as well as benefits. Shared decision-making (SDM) tools with personalized information may provide key support for patients. Understanding patient perspectives on educational tools to facilitate SDM for lung cancer screening may support tool development. AIM This study aimed to explore patient perspectives related to a SDM tool for lung cancer screening using a qualitative approach. METHODS We elicited patient perspectives by showing a provider-facing SDM tool. Focus group interviews that ranged in duration from 1.5 to 2 h were conducted with 23 individuals with high risk for lung cancer. Data were interpreted inductively using thematic analysis to identify patients' thoughts on and desires for a patient-facing SDM tool. RESULTS The findings highlight that patients would like to have educational information related to lung cancer screening. We identified several key themes to be considered in the future development of patient-facing tools: barriers to acceptance, preference against screening and seeking empowerment. One further theme illustrated effects of patient-provider relationship as a limitation to meeting lung cancer screening information needs. Participants also noted several suggestions for the design of technology decision aids. CONCLUSION These findings suggest that patients desire additional information on lung cancer screening in advance of clinical visits. However, there are several issues that must be considered in the design and development of technology to meet the information needs of patients for lung cancer screening decisions. PATIENT OR PUBLIC CONTRIBUTION Patients, service users, caregivers or members of the public were not involved in the study design, conduct, analysis or interpretation of the data. However, clinical experts in health communication provided detailed feedback on the study protocol, including the focus group approach. The study findings contribute to a better understanding of patient expectations for lung cancer screening decisions and may inform future development of tools for SDM.
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Affiliation(s)
- Victoria L. Tiase
- Department of Biomedical InformaticsUniversity of UtahSalt Lake CityUtahUSA
| | - Grace Richards
- Department of Biomedical EngineeringUniversity of UtahSalt Lake CityUtahUSA
| | - Teresa Taft
- Department of Biomedical InformaticsUniversity of UtahSalt Lake CityUtahUSA
| | - Leticia Stevens
- Department of Biomedical InformaticsUniversity of UtahSalt Lake CityUtahUSA
| | - Christian Balbin
- Department of Biomedical InformaticsUniversity of UtahSalt Lake CityUtahUSA
| | - Kimberly A. Kaphingst
- Department of Communication and Huntsman Cancer InstituteUniversity of UtahSalt Lake CityUtahUSA
| | - Angela Fagerlin
- Department of Population Health SciencesUniversity of UtahSalt Lake CityUtahUSA
| | - Tanner Caverly
- Department of Internal MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Polina Kukhareva
- Department of Biomedical InformaticsUniversity of UtahSalt Lake CityUtahUSA
| | - Michael Flynn
- Departments of Internal Medicine and Pediatrics, Community Physicians GroupUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Jorie M. Butler
- Department of Biomedical InformaticsUniversity of UtahSalt Lake CityUtahUSA
| | - Kensaku Kawamoto
- Department of Biomedical InformaticsUniversity of UtahSalt Lake CityUtahUSA
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Liang P, Peng M, Tao J, Wang B, Wei J, Lin L, Cheng B, Xiong S, Li J, Li C, Yu Z, Li C, Wang J, Li H, Chen Z, Fan J, Liang W, He J. Development of a genome atlas for discriminating benign, preinvasive, and invasive lung nodules. MedComm (Beijing) 2024; 5:e644. [PMID: 39036344 PMCID: PMC11258453 DOI: 10.1002/mco2.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 07/23/2024] Open
Abstract
To tackle misdiagnosis in lung cancer screening with low-dose computed tomography (LDCT), we aimed to compile a genome atlas for differentiating benign, preinvasive, and invasive lung nodules and characterize their molecular pathogenesis. We collected 432 lung nodule tissue samples from Chinese patients, spanning benign, atypical adenomatous hyperplasia (AAH), adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IA). We performed comprehensive sequencing, examining somatic variants, gene expressions, and methylation levels. Our findings uncovered EGFR and TP53 mutations as key drivers in - early lung cancer development, with EGFR mutation frequency increasing with disease progression. Both EGFR mutations and EGF/EGFR hypo-methylation activated the EGFR pathway, fueling cancer growth. Transcriptome analysis identified four lung nodule subtypes (G1-4) with distinct molecular features and immune cell infiltrations: EGFR-driven G1, EGFR/TP53 co-mutation G2, inflamed G3, stem-like G4. Estrogen/androgen response was associated with the EGFR pathway, proposing a new therapy combining tyrosine kinase inhibitors with antiestrogens. Preinvasive nodules exhibited stem cell pathway enrichment, potentially hindering invasion. Epigenetic regulation of various genes was essential for lung cancer initiation and development. This study provides insights into the molecular mechanism of neoplastic progression and identifies potential diagnostic biomarkers and therapeutic targets for lung cancer.
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Affiliation(s)
- Peng Liang
- Department of Thoracic Surgery and Oncologythe First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory DiseaseGuangzhouGuangdongChina
| | - Minhua Peng
- AnchorDx Medical Co., LtdGuangzhouGuangdongChina
| | - Jinsheng Tao
- AnchorDx Medical Co., LtdGuangzhouGuangdongChina
| | - Bo Wang
- AnchorDx Medical Co., LtdGuangzhouGuangdongChina
| | - Jinwang Wei
- Department of Data ScienceGenomicare Biotechnology (Shanghai) Co., Ltd.ShanghaiChina
- Department of Data ScienceShanghai CreateCured Biotechnology Co., Ltd.ShanghaiChina
| | - Lixuan Lin
- Department of Thoracic Surgery and Oncologythe First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory DiseaseGuangzhouGuangdongChina
| | - Bo Cheng
- Department of Thoracic Surgery and Oncologythe First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory DiseaseGuangzhouGuangdongChina
| | - Shan Xiong
- Department of Thoracic Surgery and Oncologythe First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory DiseaseGuangzhouGuangdongChina
| | - Jianfu Li
- Department of Thoracic Surgery and Oncologythe First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory DiseaseGuangzhouGuangdongChina
| | - Caichen Li
- Department of Thoracic Surgery and Oncologythe First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory DiseaseGuangzhouGuangdongChina
| | - Ziwen Yu
- Department of Thoracic Surgery and Oncologythe First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory DiseaseGuangzhouGuangdongChina
| | - Chunyan Li
- Department of Thoracic Surgery and Oncologythe First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory DiseaseGuangzhouGuangdongChina
| | - Jun Wang
- AnchorDx Medical Co., LtdGuangzhouGuangdongChina
| | - Hui Li
- AnchorDx Medical Co., LtdGuangzhouGuangdongChina
| | - Zhiwei Chen
- AnchorDx Medical Co., LtdGuangzhouGuangdongChina
- AnchorDx Inc.FremontCaliforniaUSA
| | - Jian‐Bing Fan
- AnchorDx Medical Co., LtdGuangzhouGuangdongChina
- Department of PathologySouthern Medical UniversityGuangzhouGuangdongChina
| | - Wenhua Liang
- Department of Thoracic Surgery and Oncologythe First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory DiseaseGuangzhouGuangdongChina
| | - Jianxing He
- Department of Thoracic Surgery and Oncologythe First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory DiseaseGuangzhouGuangdongChina
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Lorenzon M, Zabotti A, Cereser L. Cancer screening before treatments in rheumatoid arthritis: lights and shadows. Rheumatology (Oxford) 2024; 63:1475-1476. [PMID: 37707539 DOI: 10.1093/rheumatology/kead478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Michele Lorenzon
- Department of Medicine, Institute of Radiology, University of Udine-University Hospital 'S. Maria della Misericordia', Udine, Italy
| | - Alen Zabotti
- Department of Medicine, Rheumatology Institute, University of Udine-University Hospital 'S. Maria della Misericordia', Udine, Italy
| | - Lorenzo Cereser
- Department of Medicine, Institute of Radiology, University of Udine-University Hospital 'S. Maria della Misericordia', Udine, Italy
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10
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Ciofiac CM, Mămuleanu M, Florescu LM, Gheonea IA. CT Imaging Patterns in Major Histological Types of Lung Cancer. Life (Basel) 2024; 14:462. [PMID: 38672733 PMCID: PMC11051469 DOI: 10.3390/life14040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/23/2024] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
Lung cancer ranks as the second most prevalent cancer globally and is the primary contributor to neoplastic-related deaths. The approach to its treatment relies on both tumour staging and histological type determination. Data indicate that the prognosis of lung cancer is strongly linked to its clinical stage, underscoring the importance of early diagnosis in enhancing patient outcomes. Consequently, the choice of an appropriate diagnostic method holds significant importance in elevating both the early detection rate and prognosis of lung cancer. This paper aims to assess computer tomography features specific to the most common lung cancer types (adenocarcinoma, squamous cell carcinomas and small cell lung cancer). Data were collected retrospectively from CT scans of 58 patients pathologically diagnosed with lung cancer. The following CT features were evaluated and recorded for each case: location, margins, structure, lymph node involvement, cavitation, vascular bundle-thickening, bronchial obstruction, and pleural involvement. Squamous cell carcinoma (SQCC) and small cell lung cancer (SCLC) showed a higher incidence of central location, while adenocarcinoma (ADC) showed a significant predilection for a peripheral location. Internal cavitation was mostly observed in SQCC, and a solid structure was observed in almost all cases of ADC. These features can provide information about the prognosis of the patient, considering that NSCLCs are more frequent but tend to demonstrate positive results for targetable driver mutations, such as EGFR, thereby increasing the overall survival. In addition, SCLC presents with early distant spreads, which limits the opportunity to investigate the evolution of tumorigenesis and gene alterations at early stages but can have a rapidly positively response to chemotherapy. The location of the lung cancer exhibits distinct forecasts, with several studies suggesting that peripheral lung tumours offer a more favourable prognosis. Cavity formation appears correlate with a poorer prognosis. Histopathological analysis is the gold standard for diagnosing the type of lung cancer; however, using CT scanning for the purpose of a rough, but fast, preliminary diagnosis has the potential to shorten the waiting time for treatment by helping clinicians and patients to know more about the diagnosis and prognosis.
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Affiliation(s)
| | - Mădălin Mămuleanu
- Department of Automatic Control and Electronics, University of Craiova, 200585 Craiova, Romania
| | - Lucian Mihai Florescu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (L.M.F.); (I.A.G.)
| | - Ioana Andreea Gheonea
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (L.M.F.); (I.A.G.)
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11
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Pereira LFF, dos Santos RS, Bonomi DO, Franceschini J, Santoro IL, Miotto A, de Sousa TLF, Chate RC, Hochhegger B, Gomes A, Schneider A, de Araújo CA, Escuissato DL, Prado GF, Costa-Silva L, Zamboni MM, Ghefter MC, Corrêa PCRP, Torres PPTES, Mussi RK, Muglia VF, de Godoy I, Bernardo WM. Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging. J Bras Pneumol 2024; 50:e20230233. [PMID: 38536982 PMCID: PMC11095927 DOI: 10.36416/1806-3756/e20230233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/13/2023] [Indexed: 05/18/2024] Open
Abstract
Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.
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Affiliation(s)
- Luiz Fernando Ferreira Pereira
- . Serviço de Pneumologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Ricardo Sales dos Santos
- . Serviço de Cirurgia Torácica, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
- . Programa ProPulmão, SENAI CIMATEC e SDS Healthline, Salvador (BA) Brasil
| | - Daniel Oliveira Bonomi
- . Departamento de Cirurgia Torácica, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Juliana Franceschini
- . Programa ProPulmão, SENAI CIMATEC e SDS Healthline, Salvador (BA) Brasil
- . Fundação ProAR, Salvador (BA) Brasil
| | - Ilka Lopes Santoro
- . Disciplina de Pneumologia, Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - André Miotto
- . Disciplina de Cirurgia Torácica, Departamento de Cirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
| | - Thiago Lins Fagundes de Sousa
- . Serviço de Pneumologia, Hospital Universitário Alcides Carneiro, Universidade Federal de Campina Grande - UFCG - Campina Grande (PB) Brasil
| | - Rodrigo Caruso Chate
- . Serviço de Radiologia, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
| | - Bruno Hochhegger
- . Department of Radiology, University of Florida, Gainesville (FL) USA
| | - Artur Gomes
- . Serviço de Cirurgia Torácica, Santa Casa de Misericórdia de Maceió, Maceió (AL) Brasil
| | - Airton Schneider
- . Serviço de Cirurgia Torácica, Hospital São Lucas, Escola de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS - Porto Alegre (RS) Brasil
| | - César Augusto de Araújo
- . Programa ProPulmão, SENAI CIMATEC e SDS Healthline, Salvador (BA) Brasil
- . Departamento de Radiologia, Faculdade de Medicina da Bahia - UFBA - Salvador (BA) Brasil
| | - Dante Luiz Escuissato
- . Departamento de Clínica Médica, Universidade Federal Do Paraná - UFPR - Curitiba (PR) Brasil
| | | | - Luciana Costa-Silva
- . Serviço de Diagnóstico por Imagem, Instituto Hermes Pardini, Belo Horizonte (MG) Brasil
| | - Mauro Musa Zamboni
- . Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro (RJ) Brasil
- . Centro Universitário Arthur Sá Earp Neto/Faculdade de Medicina de Petrópolis -UNIFASE - Petrópolis (RJ) Brasil
| | - Mario Claudio Ghefter
- . Serviço de Cirurgia Torácica, Hospital Israelita Albert Einstein, São Paulo (SP) Brasil
- . Serviço de Cirurgia Torácica, Hospital do Servidor Público Estadual, São Paulo (SP) Brasil
| | | | | | - Ricardo Kalaf Mussi
- . Serviço de Cirurgia Torácica, Hospital das Clínicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP) Brasil
| | - Valdair Francisco Muglia
- . Departamento de Imagens Médicas, Oncologia e Hematologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo - USP - Ribeirão Preto (SP) Brasil
| | - Irma de Godoy
- . Disciplina de Pneumologia, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu (SP) Brasil
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12
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Bao T, Liu B, Li R, Li Z, Ji G, Wang Y, Yang H, Li W, Huang W, Huang Y, Tang H. LDCT screening results among eligible and ineligible screening candidates in preventive health check-ups population: a real world study in West China. Sci Rep 2024; 14:4848. [PMID: 38418532 PMCID: PMC10902338 DOI: 10.1038/s41598-024-55475-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 02/23/2024] [Indexed: 03/01/2024] Open
Abstract
To compare the LDCT screening results between eligible and ineligible screening candidates in preventive health check-ups population. Using a real-world LDCT screening results among people who took yearly health check-up in health management center of West China Hospital between 2006 and 2017. Objects were classified according to the China National Lung Cancer Screening Guideline with Low-dose Computed Tomography (2018 version) eligibility criteria. Descriptive analysis were performed between eligible and ineligible screening candidates. The proportion of ineligible screening candidates was 64.13% (10,259), and among them there were 4005 (39.04%) subjects with positive screenings, 80 cases had a surgical lung biopsy. Pathology results from lung biopsy revealed 154 cancers (true-positive) and 26 benign results (false-positive), the surgical false-positive biopsy rate was 4.17%, and ineligible group (7.69%) was higher than eligible group (2.47%), P < 0.05. Further, in ineligible screening candidates, the proportion of current smokers was higher among males compared to females (53.85% vs. 4.88%, P < 0.05). Of the 69 lung cancer patients detected in ineligible screening candidates, lung adenocarcinoma accounts for a high proportion of lung cancers both in male (75.00%) and female (85.00%). The proportion of ineligible screening candidates and the surgical false-positive biopsy rate in ineligible candidates were both high in health check-ups population.
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Affiliation(s)
- Ting Bao
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
- Translational Informatics Center, Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610212, China
| | - Bingqing Liu
- West China School of Public Health, Department of Epidemiology and Health Statistics, Sichuan University, Chengdu, 610041, China
| | - Ruicen Li
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Zhenzhen Li
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Guiyi Ji
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Youjuan Wang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Hanwei Yang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, Sichuan University West China Hospital, Chengdu, 610041, China
| | - Wenxia Huang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Yan Huang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
| | - Huairong Tang
- Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
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13
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van den Broek D, Groen HJM. Screening approaches for lung cancer by blood-based biomarkers: Challenges and opportunities. Tumour Biol 2024; 46:S65-S80. [PMID: 37393461 DOI: 10.3233/tub-230004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023] Open
Abstract
Lung cancer (LC) is one of the leading causes for cancer-related deaths in the world, accounting for 28% of all cancer deaths in Europe. Screening for lung cancer can enable earlier detection of LC and reduce lung cancer mortality as was demonstrated in several large image-based screening studies such as the NELSON and the NLST. Based on these studies, screening is recommended in the US and in the UK a targeted lung health check program was initiated. In Europe lung cancer screening (LCS) has not been implemented due to limited data on cost-effectiveness in the different health care systems and questions on for example the selection of high-risk individuals, adherence to screening, management of indeterminate nodules, and risk of overdiagnosis. Liquid biomarkers are considered to have a high potential to address these questions by supporting pre- and post- Low Dose CT (LDCT) risk-assessment thereby improving the overall efficacy of LCS. A wide variety of biomarkers, including cfDNA, miRNA, proteins and inflammatory markers have been studied in the context of LCS. Despite the available data, biomarkers are currently not implemented or evaluated in screening studies or screening programs. As a result, it remains an open question which biomarker will actually improve a LCS program and do this against acceptable costs. In this paper we discuss the current status of different promising biomarkers and the challenges and opportunities of blood-based biomarkers in the context of lung cancer screening.
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Affiliation(s)
- Daniel van den Broek
- Department of laboratory Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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14
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Melzer AC, Atoma B, Fabbrini AE, Campbell M, Clothier BA, Fu SS. Variation in Reporting of Incidental Findings on Initial Lung Cancer Screening and Associations With Clinician Assessment. J Am Coll Radiol 2024; 21:118-127. [PMID: 37516160 DOI: 10.1016/j.jacr.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE The aim of this study was to quantify the distribution, frequency, and clinical significance of incidental findings (IFs) on initial lung cancer screening (LCS) and the association of report characteristics with subsequent assessment. METHODS Health records of patients undergoing initial LCS from 2015 to 2018 in the Minneapolis VA Health Care System were retrospectively reviewed for demographics, Lung CT Screening Reporting & Data System coding, IFs, and subsequent clinical assessment. IFs were considered potentially significant if they were likely to require any follow-up. High-risk significant IFs (SIFs) were potentially malignant. The primary outcome was the SIF being addressed. Outcomes were analyzed using a mixed-effects model. RESULTS Patients (n = 901) were primarily male (94.1%) smokers (62.1%) with a mean age of 65.2 years. IFs were extremely common (93.9%), with an average of 2.6 IFs per scan (n = 2,296). Seven hundred eighty-six IFs (34.2%) were deemed likely SIFs, of which 58 (7.4%) were high risk. Two hundred twenty-two (28.2%) were addressed by clinicians, of which 104 (13.2%) underwent testing. Reporting of SIFs varied among radiologists, with at least one SIF in the impression in 24% to 78% of low-dose CT studies with the S modifier, used to indicate the presence of a SIF, applied to 0% to 51% of reports. In the mutually adjusted model, radiologist recommendation (adjusted odds ratio [OR], 4.67; 95% confidence interval [CI], 2.23-9.76), high-risk finding (adjusted OR, 4.35; 95% CI, 1.81-10.45), and reporting in the impression (adjusted OR, 2.58; 95% CI, 1.28-5.18) were associated with increased odds of the SIF's being addressed. CONCLUSIONS Radiologists vary in their reporting of IFs on LCS. Further standardization of reporting of SIFs may improve this process, with the simultaneous goals of generating appropriate testing when needed and minimizing low-value care.
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Affiliation(s)
- Anne C Melzer
- Medical Director of Lung Cancer Screening, Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Bethlehem Atoma
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Angela E Fabbrini
- Program Manager, National Center for Lung Cancer Screening, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Megan Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Barbara A Clothier
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Steven S Fu
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Director, Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
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15
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Herbst AN, McCullough MB, Wiener RS, Barker AM, Maguire EM, Fix GM. Proactively tailoring implementation: the case of shared decision-making for lung cancer screening across the VA New England Healthcare Network. BMC Health Serv Res 2023; 23:1282. [PMID: 37993840 PMCID: PMC10664378 DOI: 10.1186/s12913-023-10245-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Shared Decision-Making to discuss how the benefits and harms of lung cancer screening align with patient values is required by the US Centers for Medicare and Medicaid and recommended by multiple organizations. Barriers at organizational, clinician, clinical encounter, and patient levels prevent SDM from meeting quality standards in routine practice. We developed an implementation plan, using the socio-ecological model, for Shared Decision-Making for lung cancer screening for the Department of Veterans Affairs (VA) New England Healthcare System. Because understanding the local context is critical to implementation success, we sought to proactively tailor our original implementation plan, to address barriers to achieving guideline-concordant lung cancer screening. METHODS We conducted a formative evaluation using an ethnographic approach to proactively identify barriers to Shared Decision-Making and tailor our implementation plan. Data consisted of qualitative interviews with leadership and clinicians from seven VA New England medical centers, regional meeting notes, and Shared Decision-Making scripts and documents used by providers. Tailoring was guided by the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). RESULTS We tailored the original implementation plan to address barriers we identified at the organizational, clinician, clinical encounter, and patient levels. Overall, we removed two implementation strategies, added five strategies, and modified the content of two strategies. For example, at the clinician level, we learned that past personal and clinical experiences predisposed clinicians to focus on the benefits of lung cancer screening. To address this barrier, we modified the content of our original implementation strategy Make Training Dynamic to prompt providers to self-reflect about their screening beliefs and values, encouraging them to discuss both the benefits and potential harms of lung cancer screening. CONCLUSIONS Formative evaluations can be used to proactively tailor implementation strategies to fit local contexts. We tailored our implementation plan to address unique barriers we identified, with the goal of improving implementation success. The FRAME-IS aided our team in thoughtfully addressing and modifying our original implementation plan. Others seeking to maximize the effectiveness of complex interventions may consider using a similar approach.
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Affiliation(s)
- Abigail N Herbst
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Megan B McCullough
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- Department of Public Health, Zuckerberg School of Health Sciences, University of Massachusetts, Lowell, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, US, USA
- The Pulmonary Center, Boston University Chobanian &, Avedisian School of Medicine, Boston, MA, USA
| | - Anna M Barker
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Elizabeth M Maguire
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA
| | - Gemmae M Fix
- Center for Healthcare Organization & Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Bedford, MA, 01730, USA.
- General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.
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16
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Whitham T, Wima K, Harnett B, Kues JR, Eckman MH, Starnes SL, Schmidt KA, Kapur S, Salfity H, Van Haren RM. Lung cancer screening utilization rate varies based on patient, provider, and hospital factors. J Thorac Cardiovasc Surg 2023; 166:1331-1339. [PMID: 36934071 DOI: 10.1016/j.jtcvs.2023.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/26/2022] [Accepted: 01/20/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Low-dose computed tomography has been proven to reduce mortality, yet utilization remains low. The purpose of this study is to identify factors that impact the utilization of lung cancer screening. METHODS We performed a retrospective review of our institution's primary care network from November 2012 to June 2022 to identify patients who were eligible for lung cancer screening. Eligible patients were 55 to 80 years of age and current or former smokers with at least a 30 pack-year history. Analyses were performed on the screened populations and patients who met eligibility criteria but were not screened. RESULTS A total of 35,279 patients in our primary care network were current/former smokers aged 55 to 80 years. A total of 6731 patients (19%) had a 30 pack-year or more cigarette history, and 11,602 patients (33%) had an unknown pack-year history. A total of 1218 patients received low-dose computed tomography. The utilization rate of low-dose computed tomography was 18%. The utilization rate was significantly lower (9%) if patients with unknown pack-year history were included (P < .001). The utilization rates between primary care clinic locations were significantly different (range, 18% vs 41%, P < .05). Utilization of low-dose computed tomography on multivariate analysis was associated with Black race, former smoker, chronic obstructive pulmonary disease, bronchitis, family history of lung cancer, and number of primary care visits (all P < .05). CONCLUSIONS Lung cancer screening utilization rates are low and vary significantly on the basis of patient comorbidities, family history of lung cancer, primary care clinic location, and accurate documentation of pack-year cigarette history. The development of programs to address patient, provider, and hospital-level factors is needed to ensure appropriate lung cancer screening.
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Affiliation(s)
- Tarik Whitham
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Koffi Wima
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Brett Harnett
- Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio
| | - John R Kues
- Center for Improvement Science, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Mark H Eckman
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sandra L Starnes
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Katherine A Schmidt
- Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sangita Kapur
- Division of Cardiopulmonary Imaging, Department of Radiology, University of Cincinnati, Ohio
| | - Hai Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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Abstract
Lung cancer represents a large burden on society with a staggering incidence and mortality rate that has steadily increased until recently. The impetus to design an effective screening program for the deadliest cancer in the United States and worldwide began in 1950. It has taken more than 50 years of numerous clinical trials and continued persistence to arrive at the development of modern-day screening program. As the program continues to grow, it is important for clinicians to understand its evolution, track outcomes, and continually assess the impact and bias of screening on the medical, social, and economic systems.
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Affiliation(s)
- Hai V N Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati School of Medicine, 231 Albert Sabin Way Suite 2472, Cincinnati, OH 45267, USA.
| | - Betty C Tong
- Division of Thoracic Surgery, Department of Surgery, Duke University School of Medicine, Box 3531 DUMC, Durham, NC 27710, USA
| | - Madison R Kocher
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University School of Medicine, Box 3808 DUMC, Durham, NC 27710, USA
| | - Tina D Tailor
- Division of Cardiothoracic Imaging, Department of Radiology, Duke University School of Medicine, Box 3808 DUMC, Durham, NC 27710, USA
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18
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Cooley-Rieders K, Glenn C, Van Haren RM, Salfity H, Starnes SL. A decade of surgical outcomes in a structured lung cancer screening program. J Thorac Cardiovasc Surg 2023; 166:1245-1253.e1. [PMID: 36858845 DOI: 10.1016/j.jtcvs.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Lung cancer screening can decrease mortality. The majority of screen-detected cancers are early stage and undergo surgical resection. However, there are little data regarding the outcomes of surgical treatment outside of clinical trials. The purpose of this study was to compare the outcomes of curative resection for screen-detected lung cancers with nonscreened, incidentally detected cancers at an institution with a structured screening program. METHODS Patients undergoing lung cancer curative resection from January 2012 to June 2021 were identified from a prospective database. Baseline patient characteristics, tumor characteristics, and outcomes were compared between cancer detected from screening and cancer detected incidentally. RESULTS There were 199 patients in the incidental group and 82 patients in the screened group. Mean follow-up was 33.3 ± 25 months. The screened group had more African Americans (P = .04), a higher incidence of emphysema (P = .02), less prior cancers (P < .01), and more pack-years smoked (P < .01). The screened group had a smaller size (1.74 vs 2.31 cm, P < .01); however, pathologic stage was similar, with the majority being stage I. Postoperative morbidity, 30-day mortality, and overall and recurrence-free survival were similar between groups. Only 48.7% of the incidental group met current US Preventative Services Task Force screening criteria (age 50-80 years, ≥20 pack-year smoking history). CONCLUSIONS Screen-detected lung cancers have excellent postoperative and long-term outcomes with curative resection, similar to incidentally detected cancers. A large portion of incidentally detected lung cancers do not meet current screening guidelines, which is an opportunity for further refinement of eligibility.
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Affiliation(s)
- Keaton Cooley-Rieders
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carter Glenn
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Hai Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sandra L Starnes
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Amicizia D, Piazza MF, Marchini F, Astengo M, Grammatico F, Battaglini A, Schenone I, Sticchi C, Lavieri R, Di Silverio B, Andreoli GB, Ansaldi F. Systematic Review of Lung Cancer Screening: Advancements and Strategies for Implementation. Healthcare (Basel) 2023; 11:2085. [PMID: 37510525 PMCID: PMC10379173 DOI: 10.3390/healthcare11142085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths in Europe, with low survival rates primarily due to late-stage diagnosis. Early detection can significantly improve survival rates, but lung cancer screening is not currently implemented in Italy. Many countries have implemented lung cancer screening programs for high-risk populations, with studies showing a reduction in mortality. This review aimed to identify key areas for establishing a lung cancer screening program in Italy. A literature search was conducted in October 2022, using the PubMed and Scopus databases. Items of interest included updated evidence, approaches used in other countries, enrollment and eligibility criteria, models, cost-effectiveness studies, and smoking cessation programs. A literature search yielded 61 scientific papers, highlighting the effectiveness of low-dose computed tomography (LDCT) screening in reducing mortality among high-risk populations. The National Lung Screening Trial (NLST) in the United States demonstrated a 20% reduction in lung cancer mortality with LDCT, and other trials confirmed its potential to reduce mortality by up to 39% and detect early-stage cancers. However, false-positive results and associated harm were concerns. Economic evaluations generally supported the cost-effectiveness of LDCT screening, especially when combined with smoking cessation interventions for individuals aged 55 to 75 with a significant smoking history. Implementing a screening program in Italy requires the careful consideration of optimal strategies, population selection, result management, and the integration of smoking cessation. Resource limitations and tailored interventions for subpopulations with low-risk perception and non-adherence rates should be addressed with multidisciplinary expertise.
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Affiliation(s)
- Daniela Amicizia
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Maria Francesca Piazza
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Francesca Marchini
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Matteo Astengo
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Federico Grammatico
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Alberto Battaglini
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Irene Schenone
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Camilla Sticchi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Rosa Lavieri
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Bruno Di Silverio
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Giovanni Battista Andreoli
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
| | - Filippo Ansaldi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (D.A.); (F.M.); (M.A.); (F.G.); (A.B.); (I.S.); (C.S.); (R.L.); (B.D.S.); (G.B.A.); (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
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20
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Silvestri GA, Goldman L, Tanner NT, Burleson J, Gould M, Kazerooni EA, Mazzone PJ, Rivera MP, Doria-Rose VP, Rosenthal LS, Simanowith M, Smith RA, Fedewa S. Outcomes From More Than 1 Million People Screened for Lung Cancer With Low-Dose CT Imaging. Chest 2023; 164:241-251. [PMID: 36773935 PMCID: PMC10331628 DOI: 10.1016/j.chest.2023.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Lung cancer screening (LCS) with low-dose CT (LDCT) imaging was recommended in 2013, making approximately 8 million Americans eligible for LCS. The demographic characteristics and outcomes of individuals screened in the United States have not been reported at the population level. RESEARCH QUESTION What are the outcomes among people screened and entered in the American College of Radiology's Lung Cancer Screening Registry compared with those of trial participants? STUDY DESIGN AND METHODS This was a cohort study of individuals undergoing baseline LDCT imaging for LCS between 2015 and 2019. Predictors of adherence to annual screening were computed. LDCT scan interpretations by Lung Imaging Reporting and Data System (Lung-RADS) score, cancer detection rates (CDRs), and stage at diagnosis were compared with National Lung Cancer Screening Trial data. RESULTS Adherence was 22.3%, and predictors of poor adherence included current smoking status and Hispanic or Black race. On baseline screening, 83% of patients showed negative results and 17% showed positive screening results. The overall CDR was 0.56%. The percentage of people with cancer detected at baseline was higher in the positive Lung-RADS categories at 0.4% for Lung-RADS category 3, 2.6% for Lung-RADS category 4A, 11.1% for Lung-RADS category 4B, and 19.9% for Lung-RADS category 4X. The cancer stage distribution was similar to that observed in the National Lung Cancer Screening Trial, with 53.5% of patients receiving a diagnosis of stage I cancer and 14.3% with stage IV cancer. Underreporting into the registry may have occurred. INTERPRETATION This study revealed both the positive aspects of CT scan screening for lung cancer and the challenges that remain. Findings on CT imaging were correlated accurately with lung cancer detection using the Lung-RADS system. A significant stage shift toward early-stage lung cancer was present. Adherence to LCS was poor and likely contributes to the lower than expected cancer detection rate, all of which will impact the outcomes of patients undergoing screening for lung cancer.
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Affiliation(s)
- Gerard A Silvestri
- Division of Pulmonary Medicine, Thoracic Oncology Research Group, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC.
| | | | - Nichole T Tanner
- Division of Pulmonary Medicine, Thoracic Oncology Research Group, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | | | - Michael Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Ella A Kazerooni
- Departments of Radiology and Internal Medicine, University of Michigan/Michigan Medicine, Ann Arbor, MI
| | | | - M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, NC
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | | | | | | | - Stacey Fedewa
- Intramural Research Department, American Cancer Society, Atlanta, GA
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21
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Tisi S, Creamer AW, Dickson J, Horst C, Quaife S, Hall H, Verghese P, Gyertson K, Bowyer V, Levermore C, Hacker AM, Teague J, Farrelly L, Nair A, Devaraj A, Hackshaw A, Hurst JR, Janes S. Prevalence and clinical characteristics of non-malignant CT detected incidental findings in the SUMMIT lung cancer screening cohort. BMJ Open Respir Res 2023; 10:e001664. [PMID: 37321665 PMCID: PMC10277548 DOI: 10.1136/bmjresp-2023-001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Pulmonary and extrapulmonary incidental findings are frequently identified on CT scans performed for lung cancer screening. Uncertainty regarding their clinical significance and how and when such findings should be reported back to clinicians and participants persists. We examined the prevalence of non-malignant incidental findings within a lung cancer screening cohort and investigated the morbidity and relevant risk factors associated with incidental findings. We quantified the primary and secondary care referrals generated by our protocol. METHODS The SUMMIT study (NCT03934866) is a prospective observational cohort study to examine the performance of delivering a low-dose CT (LDCT) screening service to a high-risk population. Spirometry, blood pressure, height/weight and respiratory history were assessed as part of a Lung Health Check. Individuals at high risk of lung cancer were offered an LDCT and returned for two further annual visits. This analysis is a prospective evaluation of the standardised reporting and management protocol for incidental findings developed for the study on the baseline LDCT. RESULTS In 11 115 participants included in this analysis, the most common incidental findings were coronary artery calcification (64.2%) and emphysema (33.4%). From our protocolised management approach, the number of participants requiring review for clinically relevant findings in primary care was 1 in 20, and the number potentially requiring review in secondary care was 1 in 25. CONCLUSIONS Incidental findings are common in lung cancer screening and can be associated with reported symptoms and comorbidities. A standardised reporting protocol allows systematic assessment and standardises onward management.
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Affiliation(s)
- Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Andrew W Creamer
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Jennifer Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samantha Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Priyam Verghese
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Kylie Gyertson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Vicky Bowyer
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Levermore
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anne-Marie Hacker
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Jonathon Teague
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Laura Farrelly
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Devaraj
- National Heart and Lung Institute, Imperial College London, London, UK
- Royal Brompton and Harefield NHS Trust, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Samuel Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
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Patel P, Abbas H, Alghanim F, Deepak J. Incidental Pulmonary Nodules and Lung Cancer Screening. ATS Sch 2023; 4:243-245. [PMID: 37538072 PMCID: PMC10394585 DOI: 10.34197/ats-scholar.2022-0055vo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 01/31/2023] [Indexed: 08/05/2023] Open
Abstract
Incidental nodules and lung cancer screening nodules are causes of concern and anxiety for the patients. Both these require diligent follow up according to their respective guidelines.
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Affiliation(s)
| | - Hatoon Abbas
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Fahid Alghanim
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Janaki Deepak
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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23
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Galang K, Polychronopoulou E, Sharma G, Nishi SP. A Closer Look-Who Are We Screening for Lung Cancer? Mayo Clin Proc Innov Qual Outcomes 2023; 7:171-177. [PMID: 37293510 PMCID: PMC10244365 DOI: 10.1016/j.mayocpiqo.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/31/2023] [Accepted: 04/05/2023] [Indexed: 06/10/2023] Open
Abstract
Objective To evaluate the characteristics of individuals receiving lung cancer screening (LCS) and identify those with potentially limited benefit owing to coexisting chronic illnesses and/or comorbidities. Patients and Methods In this retrospective study in the United States, patients were selected from a large clinical database who received LCS from January 1, 2019, through December 31, 2019, with at least 1 year of continuous enrollment. We assessed for potentially limited benefit in LCS defined strictly as not meeting the traditional risk factor inclusion criteria (age <55 years or >80 years, previous computed tomography scan within 11 months before an LCS examination, or a history of nonskin cancer) or liberally as having the potential exclusion criteria related to comorbid life-limiting conditions, such as cardiac and/or respiratory disease. Results A total of 51,551 patients were analyzed. Overall, 8391 (16.3%) individuals experienced a potentially limited benefit from LCS. Among those who did not meet the strict traditional inclusion criteria, 317 (3.8%) were because of age, 2350 (28%) reported a history of nonskin malignancy, and 2211 (26.3%) underwent a previous computed tomography thorax within 11 months before an LCS examination. Of those with potentially limited benefit owing to comorbidity, 3680 (43.9%) were because of severe respiratory comorbidity (937 [25.5%] with any hospitalization for coronary obstructive pulmonary disease, interstitial lung disease, or respiratory failure; 131 [3.6%] with hospitalization for respiratory failure requiring mechanical ventilation; or 3197 [86.9%] with chronic obstructive disease/interstitial lung disease requiring outpatient oxygen) and 721 (8.59%) with cardiac comorbidity. Conclusion Up to 1 of 6 low-dose computed tomography examinations may have limited benefit from LCS.
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Affiliation(s)
- Kristine Galang
- Department of Internal Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
| | | | - Gulshan Sharma
- Department of Internal Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
- Sealy Center on Aging, University of Texas Medical Branch–Galveston, Galveston, TX
| | - Shawn P.E. Nishi
- Department of Internal Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch–Galveston, Galveston, TX
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24
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Mankidy BJ, Mohammad G, Trinh K, Ayyappan AP, Huang Q, Bujarski S, Jafferji MS, Ghanta R, Hanania AN, Lazarus DR. High risk lung nodule: A multidisciplinary approach to diagnosis and management. Respir Med 2023; 214:107277. [PMID: 37187432 DOI: 10.1016/j.rmed.2023.107277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/17/2023]
Abstract
Pulmonary nodules are often discovered incidentally during CT scans performed for other reasons. While the vast majority of nodules are benign, a small percentage may represent early-stage lung cancer with the potential for curative treatments. With the growing use of CT for both clinical purposes and lung cancer screening, the number of pulmonary nodules detected is expected to increase substantially. Despite well-established guidelines, many nodules do not receive proper evaluation due to a variety of factors, including inadequate coordination of care and financial and social barriers. To address this quality gap, novel approaches such as multidisciplinary nodule clinics and multidisciplinary boards may be necessary. As pulmonary nodules may indicate early-stage lung cancer, it is crucial to adopt a risk-stratified approach to identify potential lung cancers at an early stage, while minimizing the risk of harm and expense associated with over investigation of low-risk nodules. This article, authored by multiple specialists involved in nodule management, delves into the diagnostic approach to lung nodules. It covers the process of determining whether a patient requires tissue sampling or continued surveillance. Additionally, the article provides an in-depth examination of the various biopsy and therapeutic options available for malignant lung nodules. The article also emphasizes the significance of early detection in reducing lung cancer mortality, especially among high-risk populations. Furthermore, it addresses the creation of a comprehensive lung nodule program, which involves smoking cessation, lung cancer screening, and systematic evaluation and follow-up of both incidental and screen-detected nodules.
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Affiliation(s)
- Babith J Mankidy
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
| | - GhasemiRad Mohammad
- Department of Radiology, Division of Vascular and Interventional Radiology, Baylor College of Medicine, USA.
| | - Kelly Trinh
- Texas Tech University Health Sciences Center, School of Medicine, USA.
| | - Anoop P Ayyappan
- Department of Radiology, Division of Thoracic Radiology, Baylor College of Medicine, USA.
| | - Quillan Huang
- Department of Oncology, Baylor College of Medicine, USA.
| | - Steven Bujarski
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
| | | | - Ravi Ghanta
- Department of Cardiothoracic Surgery, Baylor College of Medicine, USA.
| | | | - Donald R Lazarus
- Division of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, 1Baylor Plaza, Houston, TX, 77030, USA.
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25
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Kugler CM, Perleth M, Mathes T, Goossen K, Pieper D. Evidence-based health policy in Germany: lack of communication and coordination between academia and health authorities? Syst Rev 2023; 12:36. [PMID: 36907893 PMCID: PMC10010027 DOI: 10.1186/s13643-023-02204-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
Health-care decision making should consider the best available evidence, often in the form of systematic reviews (SRs). The number of existing SRs and their overlap make their identification and use difficult. Decision makers often rely on de novo SRs instead of using existing SRs. We describe two cases of duplicate reviews (minimum volume threshold of total knee arthroplasties and lung cancer screening) and one case of duplicate primary data analysis (transcatheter aortic valve implantation). All cases have in common that unintended duplication of research occurred between health authorities and academia, demonstrating a lack of communication and coordination between them.It is important to note that academia and health authorities have different incentives. Academics are often measured by the number of peer-reviewed publications and grants awarded. In contrast, health authorities must comply with laws and are commissioned to deliver a specific report within a defined period of time. Most replication is currently unintended. A solution may be the collaboration of stakeholders commonly referred to as integrated knowledge translation (IKT). The IKT approach means that research is conducted in collaboration with the end users of the research. It requires active collaborations between researchers and decision-makers or knowledge users (clinicians, managers, policy makers) throughout the research process. Wherever cooperation is possible in spite of requirements for independence or confidentiality, legal regulations should facilitate and support collaborative approaches between academia and health authorities.
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Affiliation(s)
- Charlotte Mareike Kugler
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany. .,Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.
| | - Matthias Perleth
- Federal Joint Committee (G-BA), Gutenbergstraße 13, 10587, Berlin, Germany
| | - Tim Mathes
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, 37073, Göttingen, Germany
| | - Kaethe Goossen
- Witten/Herdecke University, Institute for Research in Operative Medicine, Ostmerheimer Straße 200, Haus 38, 51109, Köln, Germany
| | - Dawid Pieper
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.,Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany
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26
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Gautam SK, Khan P, Natarajan G, Atri P, Aithal A, Ganti AK, Batra SK, Nasser MW, Jain M. Mucins as Potential Biomarkers for Early Detection of Cancer. Cancers (Basel) 2023; 15:1640. [PMID: 36980526 PMCID: PMC10046558 DOI: 10.3390/cancers15061640] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/25/2023] [Accepted: 02/27/2023] [Indexed: 03/10/2023] Open
Abstract
Early detection significantly correlates with improved survival in cancer patients. So far, a limited number of biomarkers have been validated to diagnose cancers at an early stage. Considering the leading cancer types that contribute to more than 50% of deaths in the USA, we discuss the ongoing endeavors toward early detection of lung, breast, ovarian, colon, prostate, liver, and pancreatic cancers to highlight the significance of mucin glycoproteins in cancer diagnosis. As mucin deregulation is one of the earliest events in most epithelial malignancies following oncogenic transformation, these high-molecular-weight glycoproteins are considered potential candidates for biomarker development. The diagnostic potential of mucins is mainly attributed to their deregulated expression, altered glycosylation, splicing, and ability to induce autoantibodies. Secretory and shed mucins are commonly detected in patients' sera, body fluids, and tumor biopsies. For instance, CA125, also called MUC16, is one of the biomarkers implemented for the diagnosis of ovarian cancer and is currently being investigated for other malignancies. Similarly, MUC5AC, a secretory mucin, is a potential biomarker for pancreatic cancer. Moreover, anti-mucin autoantibodies and mucin-packaged exosomes have opened new avenues of biomarker development for early cancer diagnosis. In this review, we discuss the diagnostic potential of mucins in epithelial cancers and provide evidence and a rationale for developing a mucin-based biomarker panel for early cancer detection.
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Affiliation(s)
- Shailendra K. Gautam
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Parvez Khan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Gopalakrishnan Natarajan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Pranita Atri
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Abhijit Aithal
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Apar K. Ganti
- Fred & Pamela Buffett Cancer Center, Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Division of Oncology-Hematology, Department of Internal Medicine, VA Nebraska Western Iowa Health Care System, University of Nebraska Medical Center, Omaha, NE 68105, USA
| | - Surinder K. Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Fred & Pamela Buffett Cancer Center, Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Mohd W. Nasser
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Fred & Pamela Buffett Cancer Center, Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Maneesh Jain
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Fred & Pamela Buffett Cancer Center, Eppley Institute for Research in Cancer and Allied Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA
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27
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Zhang Y, Grant BMM, Hope AJ, Hung RJ, Warkentin MT, Lam ACL, Aggawal R, Xu M, Shepherd FA, Tsao MS, Xu W, Pakkal M, Liu G, McInnis MC. Using Recurrent Neural Networks to Extract High-Quality Information From Lung Cancer Screening Computerized Tomography Reports for Inter-Radiologist Audit and Feedback Quality Improvement. JCO Clin Cancer Inform 2023; 7:e2200153. [PMID: 36930839 DOI: 10.1200/cci.22.00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
PURPOSE Lung cancer screening programs generate a high volume of low-dose computed tomography (LDCT) reports that contain valuable information, typically in a free-text format. High-performance named-entity recognition (NER) models can extract relevant information from these reports automatically for inter-radiologist quality control. METHODS Using LDCT report data from a longitudinal lung cancer screening program (8,305 reports; 3,124 participants; 2006-2019), we trained a rule-based model and two bidirectional long short-term memory (Bi-LSTM) NER neural network models to detect clinically relevant information from LDCT reports. Model performance was tested using F1 scores and compared with a published open-source radiology NER model (Stanza) in an independent evaluation set of 150 reports. The top performing model was applied to a data set of 6,948 reports for an inter-radiologist quality control assessment. RESULTS The best performing model, a Bi-LSTM NER recurrent neural network model, had an overall F1 score of 0.950, which outperformed Stanza (F1 score = 0.872) and a rule-based NER model (F1 score = 0.809). Recall (sensitivity) for the best Bi-LSTM model ranged from 0.916 to 0.991 for different entity types; precision (positive predictive value) ranged from 0.892 to 0.997. Test performance remained stable across time periods. There was an average of a 2.86-fold difference in the number of identified entities between the most and the least detailed radiologists. CONCLUSION We built an open-source Bi-LSTM NER model that outperformed other open-source or rule-based radiology NER models. This model can efficiently extract clinically relevant information from lung cancer screening computerized tomography reports with high accuracy, enabling efficient audit and feedback to improve quality of patient care.
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Affiliation(s)
- Yucheng Zhang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Benjamin M M Grant
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew J Hope
- Radiation Medicine Program, Princess Margaret Cancer Centre, and Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew T Warkentin
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Andrew C L Lam
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Reenika Aggawal
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Maria Xu
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Frances A Shepherd
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ming-Sound Tsao
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine and Pathology, University Health Network, Toronto, ON, Canada
| | - Wei Xu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Computational Biology and Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Mini Pakkal
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, Toronto General Hospital, Toronto, ON, Canada
| | - Geoffrey Liu
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Micheal C McInnis
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Cardiothoracic Imaging, Joint Department of Medical Imaging, Toronto General Hospital, Toronto, ON, Canada
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Kim YW, Kim HJ, Yoon SH, Song MJ, Kwon BS, Lim SY, Lee YJ, Park JS, Cho YJ, Lee JH, Lee CT. Electromagnetic Navigation Bronchoscopy Versus Radial Endobronchial Ultrasound for Diagnosing Lung Cancer: A Propensity Score-Matched Analysis. Arch Bronconeumol 2023:S0300-2896(23)00098-4. [PMID: 37005148 DOI: 10.1016/j.arbres.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Electromagnetic navigation bronchoscopy (ENB) and radial endobronchial ultrasound (R-EBUS) are advanced imaging-guided bronchoscopy techniques for diagnosing pulmonary lesions. This study aimed to determine the comparative diagnostic yield of sole ENB and R-EBUS under moderate sedation. METHODS We investigated 288 patients who underwent sole ENB (n=157) or sole R-EBUS (n=131) under moderate sedation for pulmonary lesion biopsy between January 2017 and April 2022. After a 1:1 propensity score-matching to control for pre-procedural factors, the diagnostic yield, sensitivity for malignancy, and procedure-related complications between both techniques were compared. RESULTS The matching resulted in 105 pairs/procedure for analyses with balanced clinical and radiological characteristics. The overall diagnostic yield was significantly higher for ENB than for R-EBUS (83.8% vs. 70.5%, p=0.021). ENB demonstrated a significantly higher diagnostic yield than R-EBUS among those with lesions>20mm in size (85.2% vs. 72.3%, p=0.034), radiologically solid lesions (86.7% vs. 72.7%, p=0.015), and lesions with a class 2 bronchus sign (91.2% vs. 72.3%, p=0.002), respectively. The sensitivity for malignancy was also higher for ENB than for R-EBUS (81.3% vs. 55.1%, p<0.001). After adjusting for clinical/radiological factors in the unmatched cohort, using ENB over R-EBUS was significantly associated with a higher diagnostic yield (odd ratio=3.45, 95% confidence interval=1.75-6.82). Complication rates for pneumothorax did not significantly differ between ENB and R-EBUS. CONCLUSION ENB demonstrated a higher diagnostic yield than R-EBUS under moderate sedation for diagnosing pulmonary lesions, with similar and generally low complication rates. Our data indicate the superiority of ENB over R-EBUS in a least-invasive setting.
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Almatrafi A, Thomas O, Callister M, Gabe R, Beeken RJ, Neal R. The prevalence of comorbidity in the lung cancer screening population: A systematic review and meta-analysis. J Med Screen 2023; 30:3-13. [PMID: 35942779 PMCID: PMC9925896 DOI: 10.1177/09691413221117685] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Comorbidity is associated with adverse outcomes for all lung cancer patients, but its burden is less understood in the context of screening. This review synthesises the prevalence of comorbidities among lung cancer screening (LCS) candidates and summarises the clinical recommendations for screening comorbid individuals. METHODS We searched MEDLINE, EMBASE, EBM Reviews, and CINAHL databases from January 1990 to February 2021. We included LCS studies that reported a prevalence of comorbidity, as a prevalence of a particular condition, or as a summary score. We also summarised LCS clinical guidelines that addressed comorbidity or frailty for LCS as a secondary objective for this review. Meta-analysis was used with inverse-variance weights obtained from a random-effects model to estimate the prevalence of selected comorbidities. RESULTS We included 69 studies in the review; seven reported comorbidity summary scores, two reported performance status, 48 reported individual comorbidities, and 12 were clinical guideline papers. The meta-analysis of individual comorbidities resulted in an estimated prevalence of 35.2% for hypertension, 23.5% for history of chronic obstructive pulmonary disease (COPD) (10.7% for severe COPD), 16.6% for ischaemic heart disease (IHD), 13.1% for peripheral vascular disease (PVD), 12.9% for asthma, 12.5% for diabetes, 4.5% for bronchiectasis, 2.2% for stroke, and 0.5% for pulmonary fibrosis. CONCLUSIONS Comorbidities were highly prevalent in LCS populations and likely to be more prevalent than in other cancer screening programmes. Further research on the burden of comorbid disease and its impact on screening uptake and outcomes is needed. Identifying individuals with frailty and comorbidities who might not benefit from screening should become a priority in LCS research.
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Affiliation(s)
- Anas Almatrafi
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,Department of Epidemiology, Umm Al-Qura University, Makkah, Saudi Arabia,Anas Almatrafi, Leeds Institute of Health
Sciences, University of Leeds, Leeds LS2 9NL, UK.
| | - Owen Thomas
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK
| | - Matthew Callister
- Department of Respiratory Medicine, Leeds
Teaching Hospitals, St James's University Hospital, Leeds, UK
| | - Rhian Gabe
- Center for Evaluation and Methods, Wolfson Institute of Population
Health, Queen Mary University of
London, London, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,Department of Behavioural Science and
Health, University College London, London, UK
| | - Richard Neal
- Leeds Institute of Health Sciences,
University of Leeds, Leeds, UK,College of Medicine and Health, University of Exeter, Exeter, UK
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Horst C, Patel S, Nair A. Reporting and management of incidental lung findings on computed tomography: beyond lung nodules. Br J Radiol 2023; 96:20220207. [PMID: 36124681 PMCID: PMC9975526 DOI: 10.1259/bjr.20220207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 08/03/2022] [Accepted: 08/30/2022] [Indexed: 01/27/2023] Open
Abstract
Non-nodular incidental lung findings can broadly be categorised as airway- or airspace-related abnormalities and diffuse parenchymal abnormalities. Airway-related abnormalities include bronchial dilatation and thickening, foci of low attenuation, emphysema, and congenital variants. Diffuse parenchymal abnormalities relate to the spectrum of diffuse parenchymal lung diseases cover a spectrum from interstitial lung abnormalities (ILAs) and pulmonary cysts to established diffuse parenchymal lung abnormalities such as the idiopathic interstitial pneumonias and cystic lung diseases. In this review, we discuss the main manifestations of these incidental findings, paying attention to their prevalence and importance, descriptors to use when reporting, the limits of what can be considered "normal", and conclude each section with some pragmatic reporting recommendations. We also highlight technical and patient factors which can lead to spurious abnormalities.
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Affiliation(s)
- Carolyn Horst
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | | | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
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Smeltzer MP, Liao W, Faris NR, Fehnel C, Goss J, Shepherd CJ, Ramos R, Qureshi T, Mukhopadhyay A, Ray MA, Osarogiagbon RU. Potential Impact of Criteria Modifications on Race and Sex Disparities in Eligibility for Lung Cancer Screening. J Thorac Oncol 2023; 18:158-168. [PMID: 36208717 DOI: 10.1016/j.jtho.2022.09.220] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Low-dose computed tomography (LDCT) screening reduces lung cancer mortality, but current eligibility criteria underestimate risk in women and racial minorities. We evaluated the impact of screening criteria modifications on LDCT eligibility and lung cancer detection. METHODS Using data from a Lung Nodule Program, we compared persons eligible for LDCT by the following: U.S. Preventive Services Task Force (USPSTF) 2013 criteria (55-80 y, ≥30 pack-years of smoking, and ≤15 y since cessation); USPSTF2021 criteria (50-80 y, ≥20 pack-years of smoking, and ≤15 y since cessation); quit duration expanded to less than or equal to 25 years (USPSTF2021-QD25); reducing the pack-years of smoking to more than or equal to 10 years (USPSTF2021-PY10); and both (USPSTF2021-QD25-PY10). We compare across groups using the chi-square test or analysis of variance. RESULTS The 17,421 individuals analyzed were of 56% female sex, 69% white, 28% black; 13% met USPSTF2013 criteria; 17% USPSTF2021; 18% USPSTF2021-QD25; 19% USPSTF2021-PY10; and 21% USPSTF2021-QD25-PY10. Additional eligible individuals by USPSTF2021 (n = 682) and USPSTF2021-QD25-PY10 (n = 1402) were 27% and 29% black, both significantly higher than USPSTF2013 (17%, p < 0.0001). These additional eligible individuals were 55% (USPSTF2021) and 55% (USPSTF2021-QD25-PY10) of female sex, compared with 48% by USPSTF2013 (p < 0.05). Of 1243 persons (7.1%) with lung cancer, 22% were screening eligible by USPSTF13. USPSTF2021-QD25-PY10 increased the total number of persons with lung cancer by 37%. These additional individuals with lung cancer were of 57% female sex (versus 48% with USPSTF2013, p = 0.0476) and 24% black (versus 20% with USPSTF2013, p = 0.3367). CONCLUSIONS Expansion of LDCT screening eligibility criteria to allow longer quit duration and fewer pack-years of exposure enriches the screening-eligible population for women and black persons.
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Affiliation(s)
- Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Wei Liao
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Nicholas R Faris
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Carrie Fehnel
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Jordan Goss
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Catherine J Shepherd
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Rodolfo Ramos
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Talat Qureshi
- Multidisciplinary Thoracic Oncology Department, Baptist Cancer Center, Memphis, Tennessee
| | - Ayesha Mukhopadhyay
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
| | - Meredith A Ray
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee
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Pozzessere C, von Garnier C, Beigelman-Aubry C. Radiation Exposure to Low-Dose Computed Tomography for Lung Cancer Screening: Should We Be Concerned? Tomography 2023; 9:166-177. [PMID: 36828367 PMCID: PMC9964027 DOI: 10.3390/tomography9010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Lung cancer screening (LCS) programs through low-dose Computed Tomography (LDCT) are being implemented in several countries worldwide. Radiation exposure of healthy individuals due to prolonged CT screening rounds and, eventually, the additional examinations required in case of suspicious findings may represent a concern, thus eventually reducing the participation in an LCS program. Therefore, the present review aims to assess the potential radiation risk from LDCT in this setting, providing estimates of cumulative dose and radiation-related risk in LCS in order to improve awareness for an informed and complete attendance to the program. After summarizing the results of the international trials on LCS to introduce the benefits coming from the implementation of a dedicated program, the screening-related and participant-related factors determining the radiation risk will be introduced and their burden assessed. Finally, future directions for a personalized screening program as well as technical improvements to reduce the delivered dose will be presented.
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Affiliation(s)
- Chiara Pozzessere
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Correspondence:
| | - Christophe von Garnier
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
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Lung cancer screening in primary care. JAAPA 2023; 36:14-18. [PMID: 36573810 DOI: 10.1097/01.jaa.0000902872.28303.ba] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
ABSTRACT This article reviews the evidence supporting low-dose CT to screen for lung cancer, and the risks, costs, and challenges of implementing broad-based screening for eligible patients. Increased familiarity with lung cancer screening guidelines by primary care and specialty clinicians presents an opportunity to improve lung cancer screening rates and to save lives from the most common cause of cancer death in the United States.
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Welcome from the Delaware Health Sciences Alliance. Dela J Public Health 2022; 8:10. [PMID: 36751578 PMCID: PMC9894064 DOI: 10.32481/djph.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Andreasson J, Bodén E, Fakhro M, von Wachter C, Olm F, Malmsjö M, Hallgren O, Lindstedt S. Exhaled phospholipid transfer protein and hepatocyte growth factor receptor in lung adenocarcinoma. Respir Res 2022; 23:369. [PMID: 36544145 PMCID: PMC9768396 DOI: 10.1186/s12931-022-02302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Screening decreases mortality among lung cancer patients but is not widely implemented, thus there is an unmet need for an easily accessible non-invasive method to enable early diagnosis. Particles in exhaled air offer a promising such diagnostic tool. We investigated the validity of a particles in exhaled air device (PExA) to measure the particle flow rate (PFR) and collect exhaled breath particles (EBP) to diagnose primary lung adenocarcinoma (LUAD). METHODS Seventeen patients listed for resection of LUAD stages IA-IIIA and 18 non-cancer surgical control patients were enrolled. EBP were collected before and after surgery for LUAD, and once for controls. Proteomic analysis was carried out using a proximity extension assay technology. Results were validated in both plasma from the same cohort and with microarray data from healthy lung tissue and LUAD tissue in the GSE10072 dataset. RESULTS Of the 92 proteins analyzed, levels of five proteins in EBP were significantly higher in the LUAD patients compared to controls. Levels of phospholipid transfer protein (PLTP) and hepatocyte growth factor receptor (MET) decreased in LUAD patients after surgery compared to control patients. PFR was significantly higher in the LUAD cohort at all timepoints compared to the control group. MET in plasma correlated significantly with MET in EBP. CONCLUSION Collection of EBP and measuring of PFR has never been performed in patients with LUAD. In the present study PFR alone could distinguish between LUAD and patients without LUAD. PLTP and MET were identified as potential biomarkers to evaluate successful tumor excision.
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Affiliation(s)
- Jesper Andreasson
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Entrégatan 7, 22242, Lund, Sweden
| | - Embla Bodén
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Entrégatan 7, 22242, Lund, Sweden
| | - Mohammed Fakhro
- Department of Cardiothoracic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Franziska Olm
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Entrégatan 7, 22242, Lund, Sweden
| | - Malin Malmsjö
- Department of Clinical Sciences, Lund University, Entrégatan 7, 22242, Lund, Sweden
| | - Oskar Hallgren
- Department of Clinical Sciences, Lund University, Entrégatan 7, 22242, Lund, Sweden
| | - Sandra Lindstedt
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden.
- Department of Clinical Sciences, Lund University, Entrégatan 7, 22242, Lund, Sweden.
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Rong F, Shi R, Hu L, Chen R, Wang D, Lv X, Zhao Y, Huang W, Yang Y, Zhou H, Hong K. Low-dose computed tomography for lung cancer screening in Anhui, China: A randomized controlled trial. Front Oncol 2022; 12:1059999. [PMID: 36591449 PMCID: PMC9795014 DOI: 10.3389/fonc.2022.1059999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
Background Lung cancer is the leading cause of cancer-related death worldwide, with risk factors such as age and smoking. Low-dose computed tomography screening can reduce lung cancer mortality. However, its effectiveness in Asian populations remains unclear. Most Asian women with lung cancer are non-smokers who have not been screened. We conducted a randomized controlled trial to evaluate the performance of low-dose computed tomography screening in a Chinese population, including high-risk smokers and non-smokers exposed to passive smoking. The baseline data are reported in this study. Methods Between May and December 2019, eligible participants were randomized in a ratio of 1:1:1 to a screening (two arms) or control cohort. Non-calcified nodules/masses with a diameter >4 mm on low-dose computed tomography were considered positive findings. Results In total, 600 patients (mean age, 59.1 ± 6.9 years) underwent low-dose computed tomography. Women accounted for 31.5% (189/600) of patients; 89.9% (170/189) were non-smokers/passive smokers. At baseline, the incidence of lung cancer was 1.8% (11/600). The incidence of lung cancer was significantly lower in smokers than in female non-smokers/passive smokers (1.0% [4/415] vs. 4.1% [7/170], respectively; P=0.017). Stage 0-I lung cancer accounted for 90.9% (10/11) of cases. Conclusions We demonstrate the importance of including active smokers and female non-smokers/passive smokers in lung cancer screening programs. Further studies are needed to explore the risk factors, and long-term cost-benefit of screening Asian non-smoking women. Clinical trial registration http://chictr.org.cn/showproj.aspx?proj=39003, identifier ChiCTR1900023197.
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Muthusamy B, Raskina K, Lofgren KT, Li G, Tolba K, Schwed K, Castellanos E, Huang RSP, Oxnard GR, Schrock AB, Pennell N. Quantifying the Value of Multigene Testing in Resected Early Stage Lung Adenocarcinoma. J Thorac Oncol 2022; 18:476-486. [PMID: 36494074 DOI: 10.1016/j.jtho.2022.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Tyrosine kinase inhibitors and immune checkpoint inhibitors (ICIs), each requiring testing for precision biomarkers, have recently been approved in the adjuvant setting. We assessed the potential value of multigene testing in early lung adenocarcinoma (LUAD). METHODS Using a real-world clinicogenomic database linking deidentified electronic health record-derived clinical data to genomic data, we selected patients with LUAD who underwent tissue comprehensive genomic profiling (CGP). Using a probabilistic decision tree, we estimated the cost implications of the avoidance of adjuvant ICI in patients with programmed death-ligand 1-positive (PD-L1+) LUAD and an ALK, ROS1 or RET driver. RESULTS The CGP was performed on a specimen collected before advanced disease in 20% (1320 of 6697) of cases and ordered before advanced diagnosis for 12.6% (847 of 6697) of patients. The prevalence of driver alterations in early and advanced-stage specimens was similar, though KRAS mutations were enriched in early disease and drivers including ALK rearrangements in advanced disease. Patients who had CGP results obtained before versus after recurrence had less time between recurrence and the start of any first-line treatment (median 3.6 versus 6 wk, p < 0.001). Through avoidance of ICI in programmed death-ligand 1-positive early LUAD with an ALK, ROS1 or RET driver, we estimated that the universal CGP could reduce expected costs by $1597.23 per patient relative to EGFR single-gene testing. CONCLUSIONS The CGP can identify driver alterations and accelerate the start of first-line therapy at recurrence. It may also represent a cost-effective approach for avoiding futile adjuvant ICI in patients with drivers that have historically lacked activity with ICI in metastatic disease.
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Affiliation(s)
- Bharathi Muthusamy
- Cleveland Clinic Foundation, Department of Hematology and Medical Oncology, Cleveland, Ohio
| | - Kira Raskina
- Foundation Medicine, Inc., Boston, Massachusetts
| | | | - Gerald Li
- Foundation Medicine, Inc., Boston, Massachusetts
| | - Khaled Tolba
- Foundation Medicine, Inc., Boston, Massachusetts
| | | | | | | | | | | | - Nathan Pennell
- Cleveland Clinic Foundation, Department of Hematology and Medical Oncology, Cleveland, Ohio
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Silvestri GA, Goldman L, Burleson J, Gould M, Kazerooni EA, Mazzone PJ, Rivera MP, Doria-Rose VP, Rosenthal LS, Simanowith M, Smith RA, Tanner NT, Fedewa S. Characteristics of Persons Screened for Lung Cancer in the United States : A Cohort Study. Ann Intern Med 2022; 175:1501-1505. [PMID: 36215712 DOI: 10.7326/m22-1325] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was recommended by the U.S. Preventive Services Task Force (USPSTF) in 2013, making approximately 8 million Americans eligible for screening. The demographic characteristics and adherence of persons screened in the United States have not been reported at the population level. OBJECTIVE To define sociodemographic characteristics and adherence among persons screened and entered into the American College of Radiology's Lung Cancer Screening Registry (LCSR). DESIGN Cohort study. SETTING United States, 2015 to 2019. PARTICIPANTS Persons receiving a baseline LDCT for LCS from 3625 facilities reporting to the LCSR. MEASUREMENTS Age, sex, and smoking status distributions (percentages) were computed among persons who were screened and among respondents in the 2015 National Health Interview Survey (NHIS) who were eligible for screening. The prevalence between the LCSR and the NHIS was compared with prevalence ratios (PRs) and 95% CIs. Adherence to annual screening was defined as having a follow-up test within 11 to 15 months of an initial LDCT. RESULTS Among 1 159 092 persons who were screened, 90.8% (n = 1 052 591) met the USPSTF eligibility criteria. Compared with adults from the NHIS who met the criteria (n = 1257), screening recipients in the LCSR were older (34.7% vs. 44.8% were aged 65 to 74 years; PR, 1.29 [95% CI, 1.20 to 1.39]), more likely to be female (41.8% vs. 48.1%; PR, 1.15 [CI, 1.08 to 1.23]), and more likely to currently smoke (52.3% vs. 61.4%; PR, 1.17 [CI, 1.11 to 1.23]). Only 22.3% had a repeated annual LDCT. If follow-up was extended to 24 months and more than 24 months, 34.3% and 40.3% were adherent, respectively. LIMITATIONS Underreporting of LCS and missing data may skew demographic characteristics of persons reported to be screened. Underreporting of adherence may result in underestimates of follow-up. CONCLUSION Approximately 91% of persons who had LCS met USPSTF eligibility criteria. In addition to continuing to target all eligible adults, men, those who formerly smoked, and younger eligible patients may be less likely to be screened. Adherence to annual follow-up screening was poor, potentially limiting screening effectiveness. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Gerard A Silvestri
- Division of Pulmonary Medicine, Thoracic Oncology Research Group, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (G.A.S., N.T.T.)
| | - Lenka Goldman
- American College of Radiology, Reston, Virginia (L.G., J.B., M.S.)
| | - Judy Burleson
- American College of Radiology, Reston, Virginia (L.G., J.B., M.S.)
| | - Michael Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (M.G.)
| | - Ella A Kazerooni
- Departments of Radiology and Internal Medicine, University of Michigan/Michigan Medicine, Ann Arbor, Michigan (E.A.K.)
| | - Peter J Mazzone
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio (P.J.M.)
| | - M Patricia Rivera
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina (M.P.R.)
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (V.P.D.)
| | - Lauren S Rosenthal
- Cancer Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia (L.S.R., R.A.S.)
| | | | - Robert A Smith
- Cancer Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia (L.S.R., R.A.S.)
| | - Nichole T Tanner
- Division of Pulmonary Medicine, Thoracic Oncology Research Group, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (G.A.S., N.T.T.)
| | - Stacey Fedewa
- Intramural Research Department, American Cancer Society, Atlanta, Georgia (S.F.)
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Clark SD, Reuland DS, Brenner AT, Jonas DE. Effect of Incidental Findings Information on Lung Cancer Screening Intent: a Randomized Controlled Trial. J Gen Intern Med 2022; 37:3676-3683. [PMID: 35113322 PMCID: PMC9585131 DOI: 10.1007/s11606-022-07409-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Centers for Medicare & Medicaid Services requires decision aid use for lung cancer screening (LCS) shared decision-making. However, it does not require information about incidental findings, a potential harm of screening. OBJECTIVE To assess the effect of incidental findings information in an LCS decision aid on screening intent as well as knowledge and valuing of screening benefits and harms. DESIGN Randomized controlled trial conducted online between July 16, 2020, and August 22, 2020. PARTICIPANTS Adults 55-80 years, eligible for LCS. INTERVENTION LCS video decision aid including information on incidental findings or a control video decision aid. MAIN MEASURES Intent to undergo LCS; knowledge regarding the benefit and harms of LCS using six knowledge questions; and valuing of six benefits and harms using rating (1-5 scale, 5 most important) and ranking (ranked 1-6) exercises. KEY RESULTS Of 427 eligible individuals approached, 348 (83.1%) completed the study (173 intervention, 175 control). Mean age was 64.5 years, 48.6% were male, 73.0% white, 76.3% with less than a college degree, and 64.1% with income < $50,000. There was no difference between the intervention and controls in percentage intending to pursue screening (70/173, 40.5% vs 73/175, 41.7%, diff 1.2%, 95% CI - 9.1 to 11.5%, p = 0.81). Intervention participants had a higher percentage of correct answers for the incidental findings knowledge than controls (164/173, 94.8% vs 129/175, 73.7%, 95% CI - 28.4 to - 13.8%, p < 0.01). Incidental findings had the fifth highest mean importance rating (4.0 ± 1.1) and the third highest mean ranking (3.6 ± 1.5). There was no difference in mean rating or ranking of incidental findings between intervention and control groups (rating 4.0 vs 3.9, diff 0.1, 95% CI - 0.2, 0.3, p = 0.51; ranking 3.6 vs 3.6, diff 0.02, 95% CI - 0.3, 0.3, p = 0.89). CONCLUSIONS Incidental findings information in a LCS decision aid did not affect LCS intent, but it resulted in more informed individuals regarding these findings. In formulating screening preferences, incidental findings were less important than other benefits and harms. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04432753.
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Affiliation(s)
- Stephen D Clark
- Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, 1101 East Marshall St., Sanger Hall 1-010, Box, Richmond, VA, 980102, USA.
| | - Daniel S Reuland
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alison T Brenner
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Daniel E Jonas
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Division of General Internal Medicine and Geriatrics, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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Kamineni A, Doria-Rose VP, Chubak J, Inadomi JM, Corley DA, Haas JS, Kobrin SC, Winer RL, Lafata JE, Beaber EF, Yudkin JS, Zheng Y, Skinner CS, Schottinger JE, Ritzwoller DP, Croswell JM, Burnett-Hartman AN. Evaluation of Harms Reporting in U.S. Cancer Screening Guidelines. Ann Intern Med 2022; 175:1582-1590. [PMID: 36162112 PMCID: PMC9903969 DOI: 10.7326/m22-1139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cancer screening should be recommended only when the balance between benefits and harms is favorable. This review evaluated how U.S. cancer screening guidelines reported harms, within and across organ-specific processes to screen for cancer. OBJECTIVE To describe current reporting practices and identify opportunities for improvement. DESIGN Review of guidelines. SETTING United States. PATIENTS Patients eligible for screening for breast, cervical, colorectal, lung, or prostate cancer according to U.S. guidelines. MEASUREMENTS Information was abstracted on reporting of patient-level harms associated with screening, diagnostic follow-up, and treatment. The authors classified harms reporting as not mentioned, conceptual, qualitative, or quantitative and noted whether literature was cited when harms were described. Frequency of harms reporting was summarized by organ type. RESULTS Harms reporting was inconsistent across organ types and at each step of the cancer screening process. Guidelines did not report all harms for any specific organ type or for any category of harm across organ types. The most complete harms reporting was for prostate cancer screening guidelines and the least complete for colorectal cancer screening guidelines. Conceptualization of harms and use of quantitative evidence also differed by organ type. LIMITATIONS This review considers only patient-level harms. The authors did not verify accuracy of harms information presented in the guidelines. CONCLUSION The review identified opportunities for improving conceptualization, assessment, and reporting of screening process-related harms in guidelines. Future work should consider nuances associated with each organ-specific process to screen for cancer, including which harms are most salient and where evidence gaps exist, and explicitly explore how to optimally weigh available evidence in determining net screening benefit. Improved harms reporting could aid informed decision making, ultimately improving cancer screening delivery. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - John M. Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jennifer S. Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Sarah C. Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Rachel L. Winer
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy and UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Henry Ford Health System, Detroit, MI
| | - Elisabeth F. Beaber
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Joshua S. Yudkin
- University of Texas Health Science Center at Houston, Houston, TX
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Celette Sugg Skinner
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX; Simmons Comprehensive Cancer Center, Dallas, TX
| | | | | | - Jennifer M. Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Older Patients with Lung Cancer: a Summary of Seminal Contributions to Optimal Patient Care. Curr Oncol Rep 2022; 24:1607-1618. [PMID: 35900716 DOI: 10.1007/s11912-022-01307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW This review aspires to summarize the landmark advancements in the management of the non-small cell lung cancer (NSCLC), both historically and contemporarily with special focus in older adults. RECENT FINDINGS The past two decades have witnessed remarkable improvements in the diagnosis and management of lung cancer. Screening recommendations now facilitate earlier diagnosis in high-risk individuals, PET/CT scans have improved radiologic accuracy in identifying sites of disease, and surgical management with minimally invasive techniques has rendered surgery safer in those with limited physiologic reserve. Radiation enhancements, especially radiosurgery, have extended the reach and safety of radiation among high-risk populations. Finally, the revolution in precision medicine with identification of numerous actionable mutations, the advent of immunotherapy, and enhanced supportive care have revolutionized the outcomes in patients with advanced lung cancer. Older adults who represent a majority of patients battling lung cancer have not benefitted to the same extent as their younger counterparts. This special population is only expected to grow in coming days. Hence, addressing major gaps in the management of older adults with NSCLC and optimizing the care are much needed.
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Evaluating Characteristics in Lung Cancer Screening Program Participants and Non-Small Cell Lung Cancer (NSCLC) Patient Populations. Dela J Public Health 2022; 8:26-28. [PMID: 36340946 PMCID: PMC9621579 DOI: 10.32481/djph.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To assess and compare specific characteristics and identify any differences, gaps, and/or disparities among two population groups; Bayhealth Lung screening program participants and newly diagnosed non-small cell lung cancer patients. Methods This study was conducted with 2019 data from the American College of Radiology (ACR) registry, 1st time Low Dose CT screenings (Group 1) and the Bayhealth Cancer registry, newly diagnosed non-small cell lung cancer patients (Group 2). Results Group 1 has 615 participants and Group 2 has 140 participants. The groups are separated based upon who is a first-time participant in the Bayhealth Lung Screening program in 2019 compared to patients who were newly diagnosed with Non-small Cell Lung Cancer at Bayhealth Medical Center-Cancer Center in 2019. Groups 1 and 2 had a statistical difference in the number of packs per year of cigarettes smoked. In group 2 there is no association between smoking status and clinical stage of diagnosis. There is however an association between smoking experience and pathological stage. Conclusion Smoking continues to be the main contributing factor in patients diagnosed with non-small cell lung cancer. In addition to prevention efforts, early detection through Lung Cancer screenings is vital to identify early stage cancer.
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Golden SE, Schweiger L, Melzer AC, Ono SS, Datta S, Davis JM, Slatore CG. "It's a decision I have to make": Patient perspectives on smoking and cessation after lung cancer screening decisions. Prev Med Rep 2022; 30:102014. [PMID: 36237837 PMCID: PMC9551209 DOI: 10.1016/j.pmedr.2022.102014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/17/2022] [Accepted: 10/02/2022] [Indexed: 11/07/2022] Open
Abstract
Few studies exist showing that involvement in lung cancer screening (LCS) leads to a change in rates of cigarette smoking. We investigated LCS longitudinally to determine whether teachable moments for smoking cessation occur downstream from the initial provider-patient LCS shared decision-making discussion and self-reported effects on smoking behaviors. We performed up to two successive semi-structured interviews to assess the experiences of 39 individuals who formerly or currently smoked cigarettes who underwent LCS decision-making discussions performed during routine care from three established US medical center LCS programs. The majority of those who remembered hearing about the importance of smoking cessation after LCS-related encounters did not report communication about smoking influencing their motivation to quit or abstain from smoking, including patients who were found to have pulmonary nodules. Patients experienced little distress related to LCS discussions. Patients reported that there were other, more significant, reasons for quitting or abstinence. They recommended clinicians continue to ask about smoking at every clinical encounter, provide information comparing the benefits of LCS with those of quitting smoking, and have clinicians help them identify triggers or other motivators for improving smoking behaviors. Our findings suggest that there may be other teachable moment opportunities outside of LCS processes that could be utilized to motivate smoking reduction or cessation, or LCS processes could be improved to integrate cessation resources.
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Affiliation(s)
- Sara E. Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA,Corresponding author at: 3710 SW US Veterans Hospital Rd. R&D 66, Portland, OR 97239, USA.
| | - Liana Schweiger
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
| | - Anne C Melzer
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Division of Pulmonary, Allergy, Critical Care and Sleep, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Sarah S. Ono
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA,Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Santanu Datta
- Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - James M. Davis
- Duke Cancer Institute, Duke University, Durham, NC, USA,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA,Department of Medicine, Oregon Health & Science University, Portland, OR, USA,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, Portland, OR, USA
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Hall H, Ruparel M, Quaife SL, Dickson JL, Horst C, Tisi S, Batty J, Woznitza N, Ahmed A, Burke S, Shaw P, Soo MJ, Taylor M, Navani N, Bhowmik A, Baldwin DR, Duffy SW, Devaraj A, Nair A, Janes SM. The role of computer-assisted radiographer reporting in lung cancer screening programmes. Eur Radiol 2022; 32:6891-6899. [PMID: 35567604 PMCID: PMC9474336 DOI: 10.1007/s00330-022-08824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/11/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Successful lung cancer screening delivery requires sensitive, timely reporting of low-dose computed tomography (LDCT) scans, placing a demand on radiology resources. Trained non-radiologist readers and computer-assisted detection (CADe) software may offer strategies to optimise the use of radiology resources without loss of sensitivity. This report examines the accuracy of trained reporting radiographers using CADe support to report LDCT scans performed as part of the Lung Screen Uptake Trial (LSUT). METHODS In this observational cohort study, two radiographers independently read all LDCT performed within LSUT and reported on the presence of clinically significant nodules and common incidental findings (IFs), including recommendations for management. Reports were compared against a 'reference standard' (RS) derived from nodules identified by study radiologists without CADe, plus consensus radiologist review of any additional nodules identified by the radiographers. RESULTS A total of 716 scans were included, 158 of which had one or more clinically significant pulmonary nodules as per our RS. Radiographer sensitivity against the RS was 68-73.7%, with specificity of 92.1-92.7%. Sensitivity for detection of proven cancers diagnosed from the baseline scan was 83.3-100%. The spectrum of IFs exceeded what could reasonably be covered in radiographer training. CONCLUSION Our findings highlight the complexity of LDCT reporting requirements, including the limitations of CADe and the breadth of IFs. We are unable to recommend CADe-supported radiographers as a sole reader of LDCT scans, but propose potential avenues for further research including initial triage of abnormal LDCT or reporting of follow-up surveillance scans. KEY POINTS • Successful roll-out of mass screening programmes for lung cancer depends on timely, accurate CT scan reporting, placing a demand on existing radiology resources. • This observational cohort study examines the accuracy of trained radiographers using computer-assisted detection (CADe) software to report lung cancer screening CT scans, as a potential means of supporting reporting workflows in LCS programmes. • CADe-supported radiographers were less sensitive than radiologists at identifying clinically significant pulmonary nodules, but had a low false-positive rate and good sensitivity for detection of confirmed cancers.
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Affiliation(s)
- Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
| | - James Batty
- Department of Radiology, University College London Hospital, London, UK
| | | | - Asia Ahmed
- Department of Radiology, University College London Hospital, London, UK
| | - Stephen Burke
- Department of Radiology, Homerton University Hospital, London, UK
| | - Penny Shaw
- Department of Radiology, University College London Hospital, London, UK
| | - May Jan Soo
- Department of Radiology, Homerton University Hospital, London, UK
| | - Magali Taylor
- Department of Radiology, University College London Hospital, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - Angshu Bhowmik
- Department of Thoracic Medicine, Homerton University Hospital, London, UK
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, UK
| | - Stephen W Duffy
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Arjun Nair
- Department of Radiology, University College London Hospital, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK.
- Department of Thoracic Medicine, University College London Hospital, London, UK.
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Parekh A, Deokar K, Verma M, Singhal S, Bhatt ML, Katoch CDS. The 50-Year Journey of Lung Cancer Screening: A Narrative Review. Cureus 2022; 14:e29381. [PMID: 36304365 PMCID: PMC9585290 DOI: 10.7759/cureus.29381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
Early diagnosis and treatment are associated with better outcomes in oncology. We reviewed the existing literature using the search terms “low dose computed tomography” and “lung cancer screening” for systematic reviews, metanalyses, and randomized as well as non-randomized clinical trials in PubMed from January 1, 1963 to April 30, 2022. The studies were heterogeneous and included people with different age groups, smoking histories, and other specific risk scores for lung cancer screening. Based on the available evidence, almost all the guidelines recommend screening for lung cancer by annual low dose CT (LDCT) in populations over 50 to 55 years of age, who are either current smokers or have left smoking less than 15 years back with more than 20 to 30 pack-years of smoking. “LDCT screening” can reduce lung cancer mortality if carried out judiciously in countries with adequate resources and infrastructure.
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Lewis JA, Samuels LR, Denton J, Matheny ME, Maiga A, Slatore CG, Grogan E, Kim J, Sherrier RH, Dittus RS, Massion PP, Keohane L, Roumie CL, Nikpay S. The Association of Health Care System Resources With Lung Cancer Screening Implementation. Chest 2022; 162:701-711. [PMID: 35413280 PMCID: PMC9529611 DOI: 10.1016/j.chest.2022.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/04/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Veterans Health Administration issued policy for lung cancer screening resources at eight Veterans Affairs Medical Centers (VAMCs) in a demonstration project (DP) from 2013 through 2015. Research Question Do policies that provide resources increase lung cancer screening rates? Study Design and Methods Data from eight DP VAMCs (DP group) and 20 comparable VAMCs (comparison group) were divided into before DP (January 2011-June 2013), DP (July 2013-June 2015), and after DP (July 2015-December 2018) periods. Coprimary outcomes were unique veterans screened per 1,000 eligible per month and those with 1-year (9-15 months) follow-up screening. Eligible veterans were estimated using yearly counts and the percentage of those with eligible smoking histories. Controlled interrupted time series and difference-in-differences analyses were performed. Results Of 27,746 veterans screened, the median age was 66.5 years and most were White (77.7%), male (95.6%), and urban dwelling (67.3%). During the DP, the average rate of unique veterans screened at DP VAMCs was 17.7 per 1,000 eligible per month, compared with 0.3 at comparison VAMCs. Adjusted analyses found a higher rate increase at DP VAMCs by 0.93 screening per 1,000 eligible per month (95% CI, 0.25-1.61) during this time, with an average facility-level difference of 17.4 screenings per 1,000 eligible per month (95% CI, 12.6-22.3). Veterans with 1-year follow-up screening also increased more rapidly at DP VAMCs during the DP, by 0.39 screening per 1,000 eligible per month (95% CI, 0.18-0.60), for an average facility-level difference of 7.2 more screenings per 1,000 eligible per month (95% CI, 5.2-9.2). Gains were not maintained after the DP. Interpretation In this cohort, provision of resources for lung cancer screening implementation was associated with an increase in veterans screened and those with 1-year follow-up screening. Screening gains associated with the DP were not maintained.
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Affiliation(s)
- Jennifer A Lewis
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Veterans Health Administration - Tennessee Valley Healthcare System, Medicine Service, Nashville, TN; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.
| | - Lauren R Samuels
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Jason Denton
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Michael E Matheny
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Amelia Maiga
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher G Slatore
- Veterans Health Administration-Portland Health Care System, Center to Improve Veteran Involvement in Care Pulmonary & Critical Care Medicine, Portland, OR
| | - Eric Grogan
- Veterans Health Administration - Tennessee Valley Healthcare System, Thoracic Surgery, Nashville, TN; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jane Kim
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC
| | | | - Robert S Dittus
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Pierre P Massion
- Veterans Health Administration - Tennessee Valley Healthcare System, Medicine Service, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Laura Keohane
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Christianne L Roumie
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Sayeh Nikpay
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
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Kim YW, Kim HJ, Yoon SH, Lee KH, Park YM, Ahn SY, Song MJ, Kwon BS, Lim SY, Lee YJ, Park JS, Cho YJ, Yoon HI, Lee JH, Lee CT. Evaluation of the synergistic impact of needle and forceps biopsy with electromagnetic navigation bronchoscopy: the CONFIDENT-ENB trial design. BMC Pulm Med 2022; 22:319. [PMID: 35986257 PMCID: PMC9392264 DOI: 10.1186/s12890-022-02104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/08/2022] [Indexed: 12/09/2022] Open
Abstract
Background Electromagnetic navigation bronchoscopy (ENB) is an emerging advanced imaging-guided bronchoscopy technique for diagnosing peripheral lung lesions. However, the selection strategy for the optimal biopsy device and whether adopting a multi-tool strategy increases the diagnostic yield remains undetermined. The CONFIDENT-ENB trial (NCT05110131) is a prospective randomized study on ENB, performed in a least-invasive setting. The primary aim is to evaluate whether a combination of needle aspiration and forceps biopsy improves the diagnostic performance, and assess the comparative diagnostic value and discordance of the two devices.
Methods The trial will recruit 142 participants with lung lesions suspected of malignancy who are eligible for an elective ENB procedure under moderate sedation. Participants will undergo ENB-guided needle aspiration and forceps biopsy in a randomized order without the use of any complementary techniques. All participants will be followed up subsequently for up to 12 months to conclude the final diagnosis of the biopsied lesions. Primary outcomes include the diagnostic yield and sensitivity of each biopsy modality and the diagnostic yield of the combined modalities. Discussion The CONFIDENT-ENB trial will prospectively evaluate the synergistic effectiveness and comparative accuracy of ENB-guided needle aspiration and forceps biopsy in a least-invasive setting. The results are expected to improve our understanding of the optimal tool-selection strategy for ENB. Trial registration: ClinicalTrials.gov (NCT05110131). Prospectively registered on 5 November 2021.
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Sputum analysis by flow cytometry; an effective platform to analyze the lung environment. PLoS One 2022; 17:e0272069. [PMID: 35976857 PMCID: PMC9385012 DOI: 10.1371/journal.pone.0272069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/12/2022] [Indexed: 11/19/2022] Open
Abstract
Low dose computed tomography (LDCT) is the standard of care for lung cancer screening in the United States (US). LDCT has a sensitivity of 93.8% but its specificity of 73.4% leads to potentially harmful follow-up procedures in patients without lung cancer. Thus, there is a need for additional assays with high accuracy that can be used as an adjunct to LDCT to diagnose lung cancer. Sputum is a biological fluid that can be obtained non-invasively and can be dissociated to release its cellular contents, providing a snapshot of the lung environment. We obtained sputum from current and former smokers with a 30+ pack-year smoking history and who were either confirmed to have lung cancer or at high risk of developing the disease. Dissociated sputum cells were counted, viability determined, and labeled with a panel of markers to separate leukocytes from non-leukocytes. After excluding debris and dead cells, including squamous epithelial cells, we identified reproducible population signatures and confirmed the samples’ lung origin. In addition to leukocyte and epithelial-specific fluorescent antibodies, we used the highly fluorescent meso-tetra(4-carboxyphenyl) porphyrin (TCPP), known to preferentially stain cancer (associated) cells. We looked for differences in cell characteristics, population size and fluorescence intensity that could be useful in distinguishing cancer samples from high-risk samples. We present our data demonstrating the feasibility of a flow cytometry platform to analyze sputum in a high-throughput and standardized matter for the diagnosis of lung cancer.
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Núñez ER, Caverly TJ, Zhang S, Glickman ME, Qian SX, Boudreau JH, Miller DR, Wiener RS. Invasive Procedures and Associated Complications After Initial Lung Cancer Screening in a National Cohort of Veterans. Chest 2022; 162:475-484. [PMID: 35231480 PMCID: PMC9424329 DOI: 10.1016/j.chest.2022.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/21/2022] [Accepted: 02/13/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Little is known about rates of invasive procedures and associated complications after lung cancer screening (LCS) in nontrial settings. RESEARCH QUESTION What are the frequency of invasive procedures, complication rates, and factors associated with complications in a national sample of veterans screened for lung cancer? STUDY DESIGN AND METHODS We conducted a retrospective cohort analysis of veterans who underwent LCS in any Veterans Health Administration (VA) facility between 2013 and 2019 and identified veterans who underwent invasive procedures within 10 months of initial LCS. The primary outcome was presence of a complication within 10 days after an invasive procedure. We conducted hierarchical mixed-effects logistic regression analyses to determine patient- and facility-level factors associated with complications resulting from an invasive procedure. RESULTS Our cohort of 82,641 veterans who underwent LCS was older, more racially diverse, and had more comorbidities than National Lung Screening Trial (NLST) participants. Overall, 1,741 veterans (2.1%) underwent an invasive procedure after initial screening, including 856 (42.3%) bronchoscopies, 490 (24.2%) transthoracic needle biopsies, and 423 (20.9%) thoracic surgeries. Among veterans who underwent procedures, 151 (8.7%) experienced a major complication (eg, respiratory failure, prolonged hospitalization) and an additional 203 (11.7%) experienced an intermediate complication (eg, pneumothorax, pleural effusion). Veterans who underwent thoracic surgery (OR, 7.70; 95% CI, 5.48-10.81), underwent multiple nonsurgical procedures (OR, 1.49; 95% CI, 1.15-1.92), or carried a dementia diagnosis (OR, 3.91; 95% CI, 1.79-8.52) were more likely to experience complications. Invasive procedures were performed less often than in the NLST (2.1% vs 4.2%), but veterans were more likely to experience complications after each type of procedure. INTERPRETATION These findings may reflect a higher threshold to perform procedures in veteran populations with multiple comorbidities and higher risks of complications. Future work should focus on optimizing the identification of patients whose chance of benefit likely outweighs the complication risks.
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The Chain of Adherence for Incidentally Detected Pulmonary Nodules after an Initial Radiologic Imaging Study: A Multisystem Observational Study. Ann Am Thorac Soc 2022; 19:1379-1389. [PMID: 35167780 DOI: 10.1513/annalsats.202111-1220oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Rationale: Millions of people are diagnosed with incidental pulmonary nodules every year. Although most nodules are benign, it is universally recommended that all patients be assessed to determine appropriate follow-up and ensure that it is obtained. Objectives: To determine the degree of concordance and adherence to 2005 Fleischner Society guidelines among radiologists, clinicians, and patients at two Veterans Affairs healthcare systems with incidental nodule tracking systems. Methods: Trained researchers abstracted data from the electronic health records of patients with incidental pulmonary nodules as identified by interpreting radiologists from 2008 to 2016. We classified radiology reports and patient follow-up into three categories. Radiologist-Fleischner adherence was the agreement between the radiologist's recommendation in the computed tomography (CT) report and the 2005 Fleischner Society guidelines. Clinician/patient-Fleischner concordance was agreement between patient follow-up and the guidelines. Clinician/patient-radiologist adherence was agreement between the radiologist's recommendation and patient follow-up. We evaluated whether the recommendation or follow-up was more (e.g., sooner) or less (e.g., later) aggressive than recommended. Results: After exclusions, 4,586 patients with 7,408 imaging tests (n = 4,586 initial chest CT scans; n = 2,717 follow-up chest CT scans; n = 105 follow-up low-dose CT scans) were included. Among radiology reports that could be classified in terms of Fleischner Society guidelines (n = 3,150), 80% had nonmissing radiologist recommendations. Among those reports, radiologist-Fleischner adherence was 86.6%, with 4.8% more aggressive and 8.6% less aggressive. Among patients whose initial scans could be classified, clinician/patient-Fleischner concordance was 46.0%, 14.5% were more aggressive, and 39.5% were less aggressive. Clinician/patient-radiologist adherence was 54.3%. Veterans whose radiology reports were adherent to Fleischner Society guidelines had a substantially higher proportion of clinician/patient-Fleischner concordance: 52.0% concordance among radiologist-Fleischner adherent versus 11.6% concordance among radiologist-Fleischner nonadherent. Conclusions: In this multi-health system observational study of incidental pulmonary nodule follow-up, we found that radiologist adherence to 2005 Fleischner Society guidelines may be necessary but not sufficient. Our results highlight the many facets of care processes that must occur to achieve guideline-concordant care.
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