1
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Zhang Y, Qu L, Zhang H, Wang Y, Gao G, Wang X, Zhang T. Construction of a predictive model of 2-3 cm ground-glass nodules developing into invasive lung adenocarcinoma using high-resolution CT. Front Med (Lausanne) 2024; 11:1403020. [PMID: 38975053 PMCID: PMC11224554 DOI: 10.3389/fmed.2024.1403020] [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: 03/18/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Background The purpose of this study was to analyze the imaging risk factors for the development of 2-3 cm ground-glass nodules (GGN) for invasive lung adenocarcinoma and to establish a nomogram prediction model to provide a reference for the pathological prediction of 2-3 cm GGN and the selection of surgical procedures. Methods We reviewed the demographic, imaging, and pathological information of 596 adult patients who underwent 2-3 cm GGN resection, between 2018 and 2022, in the Department of Thoracic Surgery, Second Affiliated Hospital of the Air Force Medical University. Based on single factor analysis, the regression method was used to analyze multiple factors, and a nomogram prediction model for 2-3 cm GGN was established. Results (1) The risk factors for the development of 2-3 cm GGN during the invasion stage of the lung adenocarcinoma were pleural depression sign (OR = 1.687, 95%CI: 1.010-2.820), vacuole (OR = 2.334, 95%CI: 1.222-4.460), burr sign (OR = 2.617, 95%CI: 1.008-6.795), lobulated sign (OR = 3.006, 95%CI: 1.098-8.227), bronchial sign (OR = 3.134, 95%CI: 1.556-6.310), diameter of GGN (OR = 3.118, 95%CI: 1.151-8.445), and CTR (OR = 172.517, 95%CI: 48.023-619.745). (2) The 2-3 cm GGN risk prediction model was developed based on the risk factors with an AUC of 0.839; the calibration curve Y was close to the X-line, and the decision curve was drawn in the range of 0.0-1.0. Conclusion We analyzed the risk factors for the development of 2-3 cm GGN during the invasion stage of the lung adenocarcinoma. The predictive model developed based on the above factors had some clinical significance.
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Affiliation(s)
- Yifan Zhang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Lin Qu
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Haihua Zhang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Ying Wang
- Department of Respiratory Medicine, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Guizhou Gao
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Xiaodong Wang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Tao Zhang
- Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi’an, China
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2
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Werner R, Steinmann N, Decaluwe H, Date H, De Ruysscher D, Opitz I. Complex situations in lung cancer: multifocal disease, oligoprogression and oligorecurrence. Eur Respir Rev 2024; 33:230200. [PMID: 38811031 PMCID: PMC11134198 DOI: 10.1183/16000617.0200-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/23/2024] [Indexed: 05/31/2024] Open
Abstract
With the emergence of lung cancer screening programmes and newly detected localised and multifocal disease, novel treatment compounds and multimodal treatment approaches, the treatment landscape of non-small cell lung cancer is becoming increasingly complex. In parallel, in-depth molecular analyses and clonality studies are revealing more information about tumorigenesis, potential therapeutical targets and the origin of lesions. All can play an important role in cases with multifocal disease, oligoprogression and oligorecurrence. In multifocal disease, it is essential to understand the relatedness of separate lesions for treatment decisions, because this information distinguishes separate early-stage tumours from locally advanced or metastatic cancer. Clonality studies suggest that a majority of same-histology lesions represent multiple primary tumours. With the current standard of systemic treatment, oligoprogression after an initial treatment response is a common scenario. In this state of induced oligoprogressive disease, local ablative therapy by either surgery or radiotherapy is becoming increasingly important. Another scenario involves the emergence of a limited number of metastases after radical treatment of the primary tumour, referred to as oligorecurrence, for which the use of local ablative therapy holds promise in improving survival. Our review addresses these complex situations in lung cancer by discussing current evidence, knowledge gaps and treatment recommendations.
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Affiliation(s)
- Raphael Werner
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nina Steinmann
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Herbert Decaluwe
- Department of Thoracovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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3
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Sadeghi JK, Reza JA, Miller C, Cooke DT, Erkmen C. Death by a thousand delays. JTCVS OPEN 2024; 18:353-359. [PMID: 38690410 PMCID: PMC11056460 DOI: 10.1016/j.xjon.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 10/25/2023] [Accepted: 12/04/2023] [Indexed: 05/02/2024]
Affiliation(s)
- John K. Sadeghi
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pa
| | - Joseph A. Reza
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pa
| | - Claire Miller
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pa
| | - David T. Cooke
- Division of General Thoracic Surgery, University of California, Davis, Davis, Calif
| | - Cherie Erkmen
- Department of Thoracic Medicine and Surgery, Temple University, Philadelphia, Pa
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De Intinis C, Izzo P, Codacci-Pisanelli M, Izzo L, Messineo D, Sibio S, Campagnol M, Lai S, Molle M, Izzo S. A Rare Case of Complete-Immunotherapy-Responsive Metastatic Non-Small Cell Lung Cancer with Long Lasting Progression-Free Survival: A Case Report. Curr Oncol 2024; 31:723-732. [PMID: 38392047 PMCID: PMC10888175 DOI: 10.3390/curroncol31020053] [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: 12/07/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND INTRODUCTION Lung cancer is a prevalent and deadly disease globally. Non-small cell lung cancer (NSCLC) is the most common subtype, comprising 85% of cases. CASE REPORT A 65-year-old male ex-smoker presented to our facility with a nocturnal cough. Various investigations revealed that he had metastatic NSCLC, for which he underwent chemotherapy with cisplatin and gemcitabine, followed by immunotherapy with Nivolumab. He achieved a complete response to the therapy and has remained free from recurrence for over 7 years since the initial diagnosis. DISCUSSION AND CONCLUSIONS The treatment of metastatic NSCLC remains a significant therapeutic challenge, but the implementation of new therapeutic techniques has expanded the possibilities of achieving complete and durable eradication of the disease.
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Affiliation(s)
- Claudia De Intinis
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.D.I.); (P.I.); (M.C.-P.); (S.S.); (M.C.)
| | - Paolo Izzo
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.D.I.); (P.I.); (M.C.-P.); (S.S.); (M.C.)
| | - Massimo Codacci-Pisanelli
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.D.I.); (P.I.); (M.C.-P.); (S.S.); (M.C.)
| | - Luciano Izzo
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.D.I.); (P.I.); (M.C.-P.); (S.S.); (M.C.)
| | - Daniela Messineo
- Department of Radiological Sciences, Oncology and Anatomo-Pathological Science, “Sapienza” University of Rome, Viale dell’Universitá 31/33, 00161 Rome, Italy;
| | - Simone Sibio
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.D.I.); (P.I.); (M.C.-P.); (S.S.); (M.C.)
| | - Monica Campagnol
- Department of Surgery “Pietro Valdoni”, Policlinico “Umberto I”, “Sapienza” University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (C.D.I.); (P.I.); (M.C.-P.); (S.S.); (M.C.)
| | - Silvia Lai
- Department of Translational and Precision Medicine, Nephrology Unit, “Sapienza” University of Rome, Viale dell’Universitá 31/33, 00161 Rome, Italy;
| | - Marcello Molle
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 1, 80138 Naples, Italy; (M.M.); (S.I.)
| | - Sara Izzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Plastic Surgery Unit, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 1, 80138 Naples, Italy; (M.M.); (S.I.)
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5
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Catarata MJ, Creamer AW, Dias M, Toland S, Chaabouni M, Verbeke K, Vieira Naia J, Hassan M, Naidu SB, Lynch GA, Blyth KG, Rahman NM, Hardavella G. ERS International Congress 2023: highlights from the Thoracic Oncology Assembly. ERJ Open Res 2024; 10:00860-2023. [PMID: 38410708 PMCID: PMC10895436 DOI: 10.1183/23120541.00860-2023] [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: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 02/28/2024] Open
Abstract
Lung cancer is the leading cause of cancer mortality in the world. It greatly affects the patients' quality of life, and is thus a challenge for the daily practice in respiratory medicine. Advances in the genetic knowledge of thoracic tumours' mutational landscape, and the development of targeted therapies and immune checkpoint inhibitors, have led to a paradigm shift in the treatment of lung cancer and pleural mesothelioma. During the 2023 European Respiratory Society Congress in Milan, Italy, experts from all over the world presented their high-quality research and reviewed best clinical practices. Lung cancer screening, management of early stages of lung cancer, application of artificial intelligence and biomarkers were discussed and they will be summarised here.
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Affiliation(s)
- Maria Joana Catarata
- Pulmonology Department, Hospital de Braga, Braga, Portugal
- Tumour and Microenvironment Interactions Group, I3S – Institute for Health Research and Innovation, University of Porto, Porto, Portugal
| | | | - Margarida Dias
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sile Toland
- Department of Medicine, Letterkenny University Hospital, Letterkenny, Ireland
| | - Malek Chaabouni
- Asklepios Klinik Altona, Department of Internal Medicine II, Pulmonology and Thoracic Oncology Section, Hamburg, Germany
| | - Koen Verbeke
- Department of Respiratory Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Maged Hassan
- Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | | | - Geraldine A. Lynch
- Academic Respiratory Unit, University of Bristol Medical School, Bristol, UK
| | - Kevin G. Blyth
- Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Najib M. Rahman
- Oxford University Hospitals NHS Foundation Trust, Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Headington, UK
| | - Georgia Hardavella
- 9th Department of Respiratory Medicine, Sotiria Athens Chest Diseases Hospital, Athens, Greece
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6
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Huang W, Zhang H, Ge Y, Duan S, Ma Y, Wang X, Zhou X, Zhou T, Tu W, Wang Y, Liu S, Dong P, Fan L. Radiomics-based Machine Learning Methods for Volume Doubling Time Prediction of Pulmonary Ground-glass Nodules With Baseline Chest Computed Tomography. J Thorac Imaging 2023; 38:304-314. [PMID: 37423615 DOI: 10.1097/rti.0000000000000725] [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: 07/11/2023]
Abstract
PURPOSE Reliable prediction of volume doubling time (VDT) is essential for the personalized management of pulmonary ground-glass nodules (GGNs). We aimed to determine the optimal VDT prediction method by comparing different machine learning methods only based on the baseline chest computed tomography (CT) images. MATERIALS AND METHODS Seven classical machine learning methods were evaluated in terms of their stability and performance for VDT prediction. The VDT, calculated by the preoperative and baseline CT, was divided into 2 groups with a cutoff value of 400 days. A total of 90 GGNs from 3 hospitals constituted the training set, and 86 GGNs from the fourth hospital served as the external validation set. The training set was used for feature selection and model training, and the validation set was used to evaluate the predictive performance of the model independently. RESULTS The eXtreme Gradient Boosting showed the highest predictive performance (accuracy: 0.890±0.128 and area under the ROC curve (AUC): 0.896±0.134), followed by the neural network (NNet) (accuracy: 0.865±0.103 and AUC: 0.886±0.097). While regarding stability, the NNet showed the highest robustness against data perturbation (relative SDs [%] of mean AUC: 10.9%). Therefore, the NNet was chosen as the final model, achieving high accuracy of 0.756 in the external validation set. CONCLUSION The NNet is a promising machine learning method to predict the VDT of GGNs, which would assist in the personalized follow-up and treatment strategies for GGNs reducing unnecessary follow-up and radiation dose.
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Affiliation(s)
- Wenjun Huang
- School of Medical Imaging, Weifang Medical University
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Hanxiao Zhang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu
| | - Yanming Ge
- School of Medical Imaging, Weifang Medical University
- Medical Imaging Center, Affiliated Hospital of Weifang Medical University, Weifang
| | - Shaofeng Duan
- GE Healthcare, Precision Health Institution, Shanghai
| | - Yanqing Ma
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province
| | - Xiaoling Wang
- Department of Radiology, Deyang People's Hospital, Deyang, Sichuan Province, China
| | - Xiuxiu Zhou
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Taohu Zhou
- School of Medical Imaging, Weifang Medical University
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Wenting Tu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Yun Wang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Shiyuan Liu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
| | - Peng Dong
- School of Medical Imaging, Weifang Medical University
| | - Li Fan
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai
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7
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Huang W, Deng H, Li Z, Xiong Z, Zhou T, Ge Y, Zhang J, Jing W, Geng Y, Wang X, Tu W, Dong P, Liu S, Fan L. Baseline whole-lung CT features deriving from deep learning and radiomics: prediction of benign and malignant pulmonary ground-glass nodules. Front Oncol 2023; 13:1255007. [PMID: 37664069 PMCID: PMC10470826 DOI: 10.3389/fonc.2023.1255007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Objective To develop and validate the model for predicting benign and malignant ground-glass nodules (GGNs) based on the whole-lung baseline CT features deriving from deep learning and radiomics. Methods This retrospective study included 385 GGNs from 3 hospitals, confirmed by pathology. We used 239 GGNs from Hospital 1 as the training and internal validation set; 115 and 31 GGNs from Hospital 2 and Hospital 3 as the external test sets 1 and 2, respectively. An additional 32 stable GGNs from Hospital 3 with more than five years of follow-up were used as the external test set 3. We evaluated clinical and morphological features of GGNs at baseline chest CT and extracted the whole-lung radiomics features simultaneously. Besides, baseline whole-lung CT image features are further assisted and extracted using the convolutional neural network. We used the back-propagation neural network to construct five prediction models based on different collocations of the features used for training. The area under the receiver operator characteristic curve (AUC) was used to compare the prediction performance among the five models. The Delong test was used to compare the differences in AUC between models pairwise. Results The model integrated clinical-morphological features, whole-lung radiomic features, and whole-lung image features (CMRI) performed best among the five models, and achieved the highest AUC in the internal validation set, external test set 1, and external test set 2, which were 0.886 (95% CI: 0.841-0.921), 0.830 (95%CI: 0.749-0.893) and 0.879 (95%CI: 0.712-0.968), respectively. In the above three sets, the differences in AUC between the CMRI model and other models were significant (all P < 0.05). Moreover, the accuracy of the CMRI model in the external test set 3 was 96.88%. Conclusion The baseline whole-lung CT features were feasible to predict the benign and malignant of GGNs, which is helpful for more refined management of GGNs.
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Affiliation(s)
- Wenjun Huang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
- School of Medical Imaging, Weifang Medical University, Weifang, Shandong, China
- Department of Radiology, The Second People’s hospital of Deyang, Deyang, Sichuan, China
| | - Heng Deng
- School of Medicine, Shanghai University, Shanghai, China
| | - Zhaobin Li
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhanda Xiong
- Department of Artificial Intelligence Medical Imaging, Tron Technology, Shanghai, China
| | - Taohu Zhou
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
- School of Medical Imaging, Weifang Medical University, Weifang, Shandong, China
| | - Yanming Ge
- School of Medical Imaging, Weifang Medical University, Weifang, Shandong, China
- Medical Imaging Center, Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China
| | - Jing Zhang
- Department of Radiology, The Second People’s hospital of Deyang, Deyang, Sichuan, China
| | - Wenbin Jing
- Department of Radiology, The Second People’s hospital of Deyang, Deyang, Sichuan, China
| | - Yayuan Geng
- Clinical Research Institute, Shukun (Beijing) Technology Co., Ltd., Beijing, China
| | - Xiang Wang
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Wenting Tu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Peng Dong
- School of Medical Imaging, Weifang Medical University, Weifang, Shandong, China
| | - Shiyuan Liu
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Li Fan
- Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China
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8
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Lancaster HL, Heuvelmans MA, de Bock GH, Du Y, Mohamed Hoesein FAA, Nackaerts K, Walter JE, Vliegenthart R, Oudkerk M. Influenza season influence on outcome of new nodules in the NELSON study. Sci Rep 2023; 13:6589. [PMID: 37085595 PMCID: PMC10121576 DOI: 10.1038/s41598-023-33672-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 04/17/2023] [Indexed: 04/23/2023] Open
Abstract
We evaluated the impact of the influenza season on outcome of new lung nodules in a LDCT lung cancer screening trial population. NELSON-trial participants with ≥ 1 new nodule detected in screening rounds two and three were included. Outcome (resolution or persistence) of new nodules detected per season was calculated and compared. Winter (influenza season) was defined as 1st October to 31st March, and compared to the summer (hay-fever season), 1st April to 30th September. Overall, 820 new nodules were reported in 529 participants. Of the total new nodules, 482 (59%) were reported during winter. When considering the outcome of all new nodules, there was no statistically significant association between summer and resolving nodules (OR 1.07 [CI 1.00-1.15], p = 0.066), also when looking at the largest nodule per participant (OR 1.37 [CI 0.95-1.98], p = 0.094). Similarly, there was no statistically significant association between season and screen detected cancers (OR 0.47 [CI 0.18-1.23], p = 0.123). To conclude, in this lung cancer screening population, there was no statistically significant association between influenza season and outcome of new lung nodules. Hence, we recommend new nodule management strategy is not influenced by the season in which the nodule is detected.
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Affiliation(s)
- H L Lancaster
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A Heuvelmans
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Y Du
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - F A A Mohamed Hoesein
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - K Nackaerts
- Department of Pneumology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - J E Walter
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - R Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Oudkerk
- Faculty of Medical Sciences, University of Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
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9
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Abstract
Pulmonary nodules are a common finding on CT scans of the chest. In the United Kingdom, management should follow British Thoracic Society Guidelines, which were published in 2015. This review covers key aspects of nodule management also looks at new and emerging evidence since then.
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Affiliation(s)
- Emma L O’Dowd
- Department of Respiratory Medicine, David Evans Building, Nottingham City Hospital, Nottingham, United Kingdom
| | - David R Baldwin
- Department of Respiratory Medicine, David Evans Building, Nottingham City Hospital, Nottingham, United Kingdom
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10
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Borg M, Nederby L, Wen SWC, Hansen TF, Jakobsen A, Andersen RF, Weinreich UM, Hilberg O. Assessment of circulating biomarkers for detection of lung cancer in a high-risk cohort. Cancer Biomark 2023; 36:63-69. [PMID: 36404535 DOI: 10.3233/cbm-210543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is an urgent need for early detection of lung cancer. Screening with low-dose computed tomography (LDCT) is now implemented in the US. Supplementary use of a lung cancer biomarker with high specificity is desirable. OBJECTIVE To assess the diagnostic properties of a biomarker panel consisting of cytokeratin 19 fragment (CYFRA 21-1), carcinoembryonic antigen (CEA) and cancer antigen 125 (CA125). METHODS A cohort of 250 high-risk patients was investigated on suspicion of lung cancer. Ahead of diagnostic work-up, blood samples taken. Cross-validated prediction models were computed to assess lung cancer detection properties. RESULTS In total 32% (79/250) of patients were diagnosed with lung cancer. Area under the curve (AUC) for the three biomarkers was of 0.795, with sensitivity/specificity of 57%/93% and negative predictive value of 83%. When combining the biomarkers with US screening criteria, the AUC was 0.809, while applying only US screening criteria on the cohort, yielded an AUC of 0.62. The ability of the biomarkers to detect stage I-II lung cancer was substantially lower; AUC 0.54. CONCLUSIONS In a high-risk cohort, the detection properties of the three biomarkers were acceptable compared to current LDCT screening criteria. However, the ability to detect early stage lung cancer was low.
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Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - Line Nederby
- Department of Clinical Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - Sara Witting Christensen Wen
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Torben Frøstrup Hansen
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anders Jakobsen
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Rikke Fredslund Andersen
- Department of Clinical Biochemistry, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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11
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Wu Q, Zhao S, Huang Y, Wang J, Tang W, Zhou L, Qi L, Zhang Z, Xie Y, Zhang J, Li H, Wu N. Correlation between lung cancer probability and number of pulmonary nodules in baseline computed tomography lung cancer screening: A retrospective study based on the Chinese population. Front Oncol 2023; 12:1061242. [PMID: 36686791 PMCID: PMC9846312 DOI: 10.3389/fonc.2022.1061242] [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: 10/04/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
Background Screening for lung cancer with LDCT detects a large number of nodules. However, it is unclear whether nodule number influences lung cancer probability. This study aimed to acquire deeply insight into the distribution characteristics of nodule number in the Chinese population and to reveal the association between the nodule number and the probability of lung cancer (LC). Methods 10,167 asymptomatic participants who underwent LDCT LC screening were collected. Noncalcified nodules larger than 4 mm were included. The nodule number per participant was determined. We defined five categories according to the number of nodules (based on nodule type and size): one, two, three, four, and more than four nodules. We stratified the nodules as groups A, B, and C and participants as Amax, Bmax, and Cmax groups, and explored the association between nodule number and the probability of LC on nodule and participant levels. Results 97 participants were confirmed to have LC. The probabilities of LC were 49/1719, 22/689, 11/327, 6/166, and 9/175 in participants with one, two, three, four, and more than four nodules (p>0.05), respectively. In the Bmax group, the probability of LC was significantly higher in participants with one nodule than those with >4 nodules (p<0.05), and the probability of LC showed a negative linear trend with increasing nodule numbers (p<0.05). Based on the nodule-level analyses, in Group B, LC probability was significantly higher when participants had a solitary nodule than when they had >4 nodules (p<0.05). Conclusion LC probability does not significantly change with the number of nodules. However, when stratified by the nodule size, the effect of nodule number on LC probability was nodule-size dependent, and greater attention and active follow-up are required for solitary nodules especially SNs/solid component of PSNs measuring 6-15 mm or NSNs measuring 8-15 mm. Assessing the nodule number in conjunction with nodule size in baseline LDCT LC screening is considered beneficial.
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Affiliation(s)
- Quanyang Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shijun Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yao Huang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianwei Wang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Tang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lina Zhou
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Linlin Qi
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zewei Zhang
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuting Xie
- Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaxing Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongjia Li
- PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Wu
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, China,*Correspondence: Ning Wu,
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12
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Hattori A, Matsunaga T, Fukui M, Suzuki K, Takamochi K, Suzuki K. Prognostic Impact of Very Small Ground-Glass Opacity Component in Stage IA Solid Predominant Non-small Cell Lung Cancer. Semin Thorac Cardiovasc Surg 2022; 36:251-260. [PMID: 36180013 DOI: 10.1053/j.semtcvs.2022.09.006] [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: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/11/2022]
Abstract
We evaluated the prognostic role of the presence of a very small ground glass opacity (GGO) component in stage IA solid-predominant non-small cell lung cancer (NSCLC). We evaluated surgically resected 1471 patients diagnosed with stage IA solid-predominant NSCLC. They were classified into 3 groups; that is, GGO group (0.5
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Affiliation(s)
- Aritoshi Hattori
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Mariko Fukui
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuhiro Suzuki
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
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13
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[Low-dose Spiral Computed Tomography in Lung Cancer Screening]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:678-683. [PMID: 36172733 PMCID: PMC9549430 DOI: 10.3779/j.issn.1009-3419.2022.101.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lung cancer is one of the malignant tumors with the highest morbidity and mortality in the world. The low early diagnosis rate and poor prognosis of patients have caused serious social burden. Regular screening of high-risk population by low-dose spiral computed tomography (LDCT) can significantly improve the early diagnosis rate of lung cancer and bring new opportunities for the diagnosis and treatment of lung cancer. In recent years, LDCT lung cancer screening programs have been carried out in many countries around the world and achieved good results, but there are still some controversies in the selection of screening subjects, screening frequency, cost effectiveness and other aspects. In this paper, the key factors of LDCT lung cancer screening, screening effect, pulmonary nodule management and artificial intelligence contribution to the development of LDCT will be reviewed, and the application progress of LDCT in lung cancer screening will be discussed.
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Liu Z, Liu X, Ni L. Analysis of pulmonary nodules detected by annual low-dose computed tomography in the elderly during a 10-year follow-up. Geriatr Gerontol Int 2022; 22:865-869. [PMID: 36065163 DOI: 10.1111/ggi.14479] [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: 04/11/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Abstract
AIM To describe pulmonary nodules detected by annual low-dose computed tomography (LDCT) in the elderly during a 10-year follow-up, and to provide a basis for clinical decision-making in the elderly. METHODS In this retrospective study, patients who completed at least a 3-year follow-up visit with annual LDCT imaging data were eligible for inclusion. The evolution of pulmonary nodules was evaluated, including malignant, suspicious malignant, benign and undetermined nodules. Additionally, the nature and outcome of new nodules during the follow-up were analyzed. RESULTS For the 365 subjects included, 899 positive pulmonary nodules were detected in 286 patients. Among these there were 788 solid nodules, 20 part-solid nodules and 91 nonsolid nodules. The detection rate of positive nodules and of lung cancer was 78.4% and 5.5%, respectively. 99.7% (786/788) of solid nodules were benign, and 75% (15/20) of part-solid nodules and 28.6% (26/91) of nonsolid nodules were malignant or suspected malignant. 124 new positive nodules appeared during the annual follow-up, but 58.9% of them subsequently disappeared. Significant higher detection rates of 10-20-mm nodules (P = 0.0485) and suspicious malignant nodules (P = 0.017) were observed in subjects over 75 years old as compared with those under 75 years old. CONCLUSIONS Solid nodules accounted for the highest proportion of lung nodules screened at baseline, and most of them were benign. The malignant probability of part-solid nodules was the highest. Most newly appeared nodules disappeared during subsequent follow-up. The proportions of suspicious malignant nodules and 10-20-mm nodules in subjects over 75 years old were higher than in those under 75 years old. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Zhonghui Liu
- The Geriatrics Department, Peking University First Hospital, Beijing, China
| | - Xinmin Liu
- The Geriatrics Department, Peking University First Hospital, Beijing, China
| | - Lianfang Ni
- The Geriatrics Department, Peking University First Hospital, Beijing, China
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Lancaster HL, Heuvelmans MA, Oudkerk M. Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research. J Intern Med 2022; 292:68-80. [PMID: 35253286 PMCID: PMC9311401 DOI: 10.1111/joim.13480] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lung cancer causes more deaths than breast, cervical, and colorectal cancer combined. Nevertheless, population-based lung cancer screening is still not considered standard practice in most countries worldwide. Early lung cancer detection leads to better survival outcomes: patients diagnosed with stage 1A lung cancer have a >75% 5-year survival rate, compared to <5% at stage 4. Low-dose computed tomography (LDCT) thorax imaging for the secondary prevention of lung cancer has been studied at length, and has been shown to significantly reduce lung cancer mortality in high-risk populations. The US National Lung Screening Trial reported a 20% overall reduction in lung cancer mortality when comparing LDCT to chest X-ray, and the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial more recently reported a 24% reduction when comparing LDCT to no screening. Hence, the focus has now shifted to implementation research. Consequently, the 4-IN-THE-LUNG-RUN consortium based in five European countries, has set up a large-scale multicenter implementation trial. Successful implementation of and accessibility to LDCT lung cancer screening are dependent on many factors, not limited to population selection, recruitment strategy, computed tomography screening frequency, lung-nodule management, participant compliance, and cost effectiveness. This review provides an overview of current evidence for LDCT lung cancer screening, and draws attention to major factors that need to be addressed to successfully implement standardized, effective, and accessible screening throughout Europe. Evidence shows that through the appropriate use of risk-prediction models and a more personalized approach to screening, efficacy could be improved. Furthermore, extending the screening interval for low-risk individuals to reduce costs and associated harms is a possibility, and through the use of volumetric-based measurement and follow-up, false positive results can be greatly reduced. Finally, smoking cessation programs could be a valuable addition to screening programs and artificial intelligence could offer a solution to the added workload pressures radiologists are facing.
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Affiliation(s)
- Harriet L Lancaster
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Marjolein A Heuvelmans
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Institute for Diagnostic Accuracy, Groningen, The Netherlands.,Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
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Xu L, Chang N, Yang T, Lang Y, Zhang Y, Che Y, Xi H, Zhang W, Song Q, Zhou Y, Yang X, Yang J, Qu S, Zhang J. Development of Diagnosis Model for Early Lung Nodules Based on a Seven Autoantibodies Panel and Imaging Features. Front Oncol 2022; 12:883543. [PMID: 35530343 PMCID: PMC9069812 DOI: 10.3389/fonc.2022.883543] [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: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background There is increasing incidence of pulmonary nodules due to the promotion and popularization of low-dose computed tomography (LDCT) screening for potential populations with suspected lung cancer. However, a high rate of false-positive and concern of radiation-related cancer risk of repeated CT scanning remains a major obstacle to its wide application. Here, we aimed to investigate the clinical value of a non-invasive and simple test, named the seven autoantibodies (7-AABs) assay (P53, PGP9.5, SOX2, GAGE7, GUB4-5, MAGEA1, and CAGE), in distinguishing malignant pulmonary diseases from benign ones in routine clinical practice, and construct a neural network diagnostic model with the development of machine learning methods. Method A total of 933 patients with lung diseases and 744 with lung nodules were identified. The serum levels of the 7-AABs were tested by an enzyme-linked Immunosorbent assay (ELISA). The primary goal was to assess the sensitivity and specificity of the 7-AABs panel in the detection of lung cancer. ROC curves were used to estimate the diagnosis potential of the 7-AABs in different groups. Next, we constructed a machine learning model based on the 7-AABs and imaging features to evaluate the diagnostic efficacy in lung nodules. Results The serum levels of all 7-AABs in the malignant lung diseases group were significantly higher than that in the benign group. The sensitivity and specificity of the 7-AABs panel test were 60.7% and 81.5% in the whole group, and 59.7% and 81.1% in cases with early lung nodules. Comparing to the 7-AABs panel test alone, the neural network model improved the AUC from 0.748 to 0.96 in patients with pulmonary nodules. Conclusion The 7-AABs panel may be a promising method for early detection of lung cancer, and we constructed a new diagnostic model with better efficiency to distinguish malignant lung nodules from benign nodules which could be used in clinical practice.
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Affiliation(s)
- Leidi Xu
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Ning Chang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Tingyi Yang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yuxiang Lang
- National Science Library, Chinese Academy of Sciences, Beijing, China
| | - Yong Zhang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yinggang Che
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Hangtian Xi
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Weiqi Zhang
- Department of Radiology, Xijing Hospital, Air Force Medical University, Xi'an, China
| | | | - Ying Zhou
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Xuemin Yang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Juanli Yang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Shuoyao Qu
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jian Zhang
- Department of Pulmonary Medicine, Xijing Hospital, Air Force Medical University, Xi'an, China
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Kim YW, Kwon BS, Lim SY, Lee YJ, Park JS, Cho YJ, Yoon HI, Lee KW, Lee JH, Chung JH, Ji E, Lee CT. Lung cancer probability and clinical outcomes of baseline and new subsolid nodules detected on low-dose CT screening. Thorax 2021; 76:980-988. [PMID: 33859050 PMCID: PMC8461405 DOI: 10.1136/thoraxjnl-2020-215107] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Limited data are available regarding the management of subsolid nodules detected on lung cancer screening with low-dose CT (LDCT). We aimed to determine the characteristics of screen-detected subsolid nodules, and to evaluate the probability of lung cancer and the clinical course of subsolid nodules detected at baseline and during follow-up screening. METHODS We evaluated 50 132 asymptomatic adults (22 631 never-smokers and 27 501 ever-smokers) who underwent LDCT screening for lung cancer between May 2003 and June 2019 at a tertiary centre in South Korea. The incidence, characteristics and clinical outcomes of the baseline and new screen-detected subsolid nodules were determined. RESULTS A total of 6725 subsolid nodules (5116 pure ground glass opacity nodules and 1609 part-solid nodules) were detected in 4545 participants (1484 new subsolid nodules detected in 937 (1.9%) participants; the overall incidence of subsolid nodules: 10.7% in never-smokers and 7.7% in ever-smokers, p<0.001). Among 4918 subsolid nodules that underwent follow-up with CT scans (the mean number of CT scans, including the baseline LDCT scan: 4.6), 2116 nodules (30.0% of baseline subsolid nodules and 78.9% of new subsolid nodules) resolved spontaneously. Among 293 biopsied subsolid nodules, 227 (77.5%) nodules were diagnosed as lung cancer, of which 226 (99.6%) were adenocarcinomas. No significant difference was observed in pathological invasiveness or the initial stage between the baseline and new cancerous subsolid nodules. Multivariable analyses revealed that new detection at follow-up screening was significantly associated with a lower probability of lung cancer (OR 0.26, 95% CI 0.14 to 0.49) and overall growth (OR 0.39, 95% CI 0.26 to 0.59), but with a higher probability of resolution (OR 6.30, 95% CI 5.09 to 7.81). CONCLUSIONS LDCT screening led to a considerably high rate of subsolid nodule detection, particularly in never-smokers. Compared with the baseline subsolid nodules, the new subsolid nodules were associated with a lower probability of lung cancer and higher probability of spontaneous resolution, indicating their more inflammatory nature. Less aggressive follow-up may be allowed for new subsolid nodules, particularly in screening programmes for Asian populations.
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Affiliation(s)
- Yeon Wook Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byoung Soo Kwon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung Yoon Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yeon Joo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jong Sun Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Jae Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ho Il Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Ho Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin-Haeng Chung
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eunjeong Ji
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Choon-Taek Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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Borg M, Wen SWC, Nederby L, Hansen TF, Jakobsen A, Andersen RF, Weinreich UM, Hilberg O. Performance of the EarlyCDT® Lung test in detection of lung cancer and pulmonary metastases in a high-risk cohort. Lung Cancer 2021; 158:85-90. [PMID: 34130044 DOI: 10.1016/j.lungcan.2021.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Early detection of lung cancer is pivotal for an optimal prognosis. CT screening is currently implemented in USA. To decrease the amount of CT scans, the application of a blood-based biomarker as part of screening criteria is desirable. MATERIALS AND METHODS The EarlyCDT® Lung test was performed in a high-risk cohort composed 246 patients referred from their GP on suspicion of lung cancer. Blood samples were taken at first visit and patients underwent diagnostic workup on suspicion of lung cancer resulting in either a malignant diagnosis or ruled out cancer. Sensitivity and specificity of the EarlyCDT® Lung were calculated in the cohort and subgroups based on age, smoking history, sex and lung cancer stage. RESULTS Overall sensitivity in the cohort was 33 % for lung cancer and 31 % for primary lung cancer and lung metastases combined. Sensitivity in age groups was 11 % (60 years or below), 31 % (61-75 years) and 55 % (>75 years). In patients with at least 10 tobacco pack years, sensitivity was 33 % while the sensitivity in patients with at least 50 tobacco pack years was 44 %. The assay sensitivity in stage I-II lung cancer patients was 21 %, while this was 40 % in stage III-IV lung cancer patients. In a subgroup of patients that met current CT screening criteria (age 55-80 years and minimum 30 tobacco pack years) the sensitivity was 37 %. CONCLUSION The rationale of screening for lung cancer is to find patients in an early and resectable stage. However, the EarlyCDT® Lung test performed best in elderly, late stage lung cancer patients with a heavy smoking history. Based on these results, the current study finds insufficient sensitivity of the EarlyCDT® Lung test to be used as part of inclusion criteria in a low-dose CT program for detection of lung cancer.
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Affiliation(s)
- Morten Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
| | - Sara W C Wen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark.
| | - Line Nederby
- Department of Clinical Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark.
| | - Anders Jakobsen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark.
| | - Rikke Fredslund Andersen
- Department of Clinical Biochemistry, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
| | - Ulla Møller Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Mølleparkvej 4, 9000 Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000 Aalborg, Denmark.
| | - Ole Hilberg
- Institute of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, 3, 5000 Odense C, Denmark; Department of Internal Medicine, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
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Schreuder A, Prokop M, Scholten ET, Mets OM, Chung K, Mohamed Hoesein FAA, Jacobs C, Schaefer-Prokop CM. CT-Detected Subsolid Nodules: A Predictor of Lung Cancer Development at Another Location? Cancers (Basel) 2021; 13:cancers13112812. [PMID: 34200018 PMCID: PMC8200192 DOI: 10.3390/cancers13112812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this case-cohort study was to investigate whether the frequency and computed tomography (CT) features of pulmonary nodules posed a risk for the future development of lung cancer (LC) at a different location. Patients scanned between 2004 and 2012 at two Dutch academic hospitals were cross-linked with the Dutch Cancer Registry. All patients who were diagnosed with LC by 2014 and a random selection of LC-free patients were considered. LC patients who were determined to be LC-free at the time of the scan and all LC-free patients with an adequate scan were included. The nodule count and types (solid, part-solid, ground-glass, and perifissural) were recorded per scan. Age, sex, and other CT measures were included to control for confounding factors. The cohort included 163 LC patients and 1178 LC-free patients. Cox regression revealed that the number of ground-glass nodules and part-solid nodules present were positively correlated to future LC risk. The area under the receiver operating curve of parsimonious models with and without nodule type information were 0.827 and 0.802, respectively. The presence of subsolid nodules in a clinical setting may be a risk factor for future LC development in another pulmonary location in a dose-dependent manner. Replication of the results in screening cohorts is required for maximum utility of these findings.
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Affiliation(s)
- Anton Schreuder
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (M.P.); (E.T.S.); (K.C.); (C.J.); (C.M.S.-P.)
- Correspondence:
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (M.P.); (E.T.S.); (K.C.); (C.J.); (C.M.S.-P.)
| | - Ernst T. Scholten
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (M.P.); (E.T.S.); (K.C.); (C.J.); (C.M.S.-P.)
| | - Onno M. Mets
- Department of Radiology and Nuclear Medicine, Academic Medical Center, 1105 AZ Amsterdam, The Netherlands;
| | - Kaman Chung
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (M.P.); (E.T.S.); (K.C.); (C.J.); (C.M.S.-P.)
- Department of Radiology, Meander Medisch Centrum, 3813 TZ Amersfoort, The Netherlands
| | | | - Colin Jacobs
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (M.P.); (E.T.S.); (K.C.); (C.J.); (C.M.S.-P.)
| | - Cornelia M. Schaefer-Prokop
- Department of Medical Imaging, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (M.P.); (E.T.S.); (K.C.); (C.J.); (C.M.S.-P.)
- Department of Radiology, Meander Medisch Centrum, 3813 TZ Amersfoort, The Netherlands
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Van Haren RM, Delman AM, Turner KM, Waits B, Hemingway M, Shah SA, Starnes SL. Impact of the COVID-19 Pandemic on Lung Cancer Screening Program and Subsequent Lung Cancer. J Am Coll Surg 2021; 232:600-605. [PMID: 33346080 PMCID: PMC7947221 DOI: 10.1016/j.jamcollsurg.2020.12.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Low-dose CT (LDCT) screening reduces lung cancer mortality by at least 20%. The COVID-19 pandemic required an unprecedented shutdown in our institutional LDCT program. The purpose of this study was to examine the impact of COVID-19 on lung cancer screening and subsequent cancer diagnosis. STUDY DESIGN We analyzed our prospective institutional LDCT screening database, which began in 2012. In all, 2,153 patients have participated. Monthly mean number of LDCTs were compared between baseline (January 2017 to February 2020) and COVID-19 periods (March 2020 to July 2020). RESULTS LDCT was suspended on March 13, 2020 and 818 screening visits were cancelled. Phased reopening began on May 5, 2020 and full opening on June 1, 2020. Total monthly mean ± SD LDCTs (146 ± 31 vs 39 ± 40; p < 0.01) and new patient monthly LDCTs (56 ± 14 vs 15 ± 17; p < 0.01) were significantly decreased during the COVID-19 period. New patient monthly LDCTs have remained low despite resuming full operations. Three- and 6-month interval follow-up LDCTs were prioritized and were significantly increased compared with baseline (11 ± 4 vs 30 ± 4; p < 0.01). The "no-show" rate was significantly increased from baseline (15% vs 40%; p < 0.04). Most concerning, the percentage of patients with lung nodules suspicious for malignancy (Lung-RADS 4) were significantly increased after screenings resumed (8% vs 29%; p < 0.01). CONCLUSIONS COVID-19 caused significant disruption in lung cancer screening, leading to a decrease in new patients screened and an increased proportion of nodules suspicious for malignancy once screening resumed. Using lung cancer and the LDCT screening program as a model, this early analysis showed the unrecognized consequences related to the pandemic for screening programs and cancer care.
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Affiliation(s)
- Robert M Van Haren
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Thoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Aaron M Delman
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kevin M Turner
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Brandy Waits
- Division of Thoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Mona Hemingway
- Division of Thoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Shimul A Shah
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sandra L Starnes
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Thoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
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21
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Couraud S, Ferretti G, Milleron B, Cortot A, Girard N, Gounant V, Laurent F, Leleu O, Quoix E, Revel MP, Wislez M, Westeel V, Zalcman G, Scherpereel A, Khalil A. [Recommendations of French specialists on screening for lung cancer]. Rev Mal Respir 2021; 38:310-325. [PMID: 33637394 DOI: 10.1016/j.rmr.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 01/25/2021] [Indexed: 12/17/2022]
Affiliation(s)
- S Couraud
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, hospices civils de Lyon, hôpital Lyon Sud, Pierre-Bénite, France; Intergroupe francophone de cancérologie thoracique, Paris, France.
| | - G Ferretti
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de radiologie diagnostique et interventionnel, CHU de Grenoble-Alpes, Grenoble, France
| | - B Milleron
- Intergroupe francophone de cancérologie thoracique, Paris, France
| | - A Cortot
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie et oncologie thoracique, CHU de Lille, Lille, France
| | - N Girard
- Intergroupe francophone de cancérologie thoracique, Paris, France; Unité d'oncologie thoracique, institut Curie, Paris, France
| | - V Gounant
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service d'oncologie thoracique, groupe hospitalier Bichat-Claude-Bernard, AP-HP, Paris, France
| | - F Laurent
- Service de radiologie, CHU de Bordeaux, Pessac, France
| | - O Leleu
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie, centre hospitalier Abbeville, Abbeville, France
| | - E Quoix
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie, CHRU Strasbourg, Strasbourg, France
| | - M-P Revel
- Service de radiologie, hôpital Cochin, Paris, France
| | - M Wislez
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service d'oncologie thoracique, hôpital Cochin, Paris, France
| | - V Westeel
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie et cancérologie thoracique, CHU de Besançon, Besançon, France
| | - G Zalcman
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service d'oncologie thoracique, groupe hospitalier Bichat-Claude-Bernard, AP-HP, Paris, France
| | - A Scherpereel
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie et oncologie thoracique, CHU de Lille, Lille, France
| | - A Khalil
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de radiologie, groupe hospitalier Bichat-Claude-Bernard, AP-HP, Paris, France
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22
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Intergroupe francophone de cancérologie thoracique, Société de pneumologie de langue française, and Société d'imagerie thoracique statement paper on lung cancer screening. Diagn Interv Imaging 2021; 102:199-211. [PMID: 33648872 DOI: 10.1016/j.diii.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 12/17/2022]
Abstract
Following the American National Lung Screening Trial results in 2011 a consortium of French experts met to edit a statement. Recent results of other randomized trials gave the opportunity for our group to meet again in order to edit updated guidelines. After literature review, we provide here a new update on lung cancer screening in France. Notably, in accordance with all international guidelines, the experts renew their recommendation in favor of individual screening for lung cancer in France as per the conditions laid out in this document. In addition, the experts recommend the very rapid organization and funding of prospective studies, which, if conclusive, will enable the deployment of lung cancer screening organized at the national level.
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23
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Lambert L, Janouskova L, Novak M, Bircakova B, Meckova Z, Votruba J, Michalek P, Burgetova A. Early detection of lung cancer in Czech high-risk asymptomatic individuals (ELEGANCE): A study protocol. Medicine (Baltimore) 2021; 100:e23878. [PMID: 33592843 PMCID: PMC7870244 DOI: 10.1097/md.0000000000023878] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Lung cancer screening in high-risk population increases the proportion of patients diagnosed at a resectable stage. AIMS To optimize the selection criteria and quality indicators for lung cancer screening by low-dose CT (LDCT) in the Czech population of high-risk individuals. To compare the influence of screening on the stage of lung cancer at the time of the diagnosis with the stage distribution in an unscreened population. To estimate the impact on life-years lost according to the stage-specific cancer survival and stage distribution in the screened population. To calculate the cost-effectiveness of the screening program. METHODS Based on the evidence from large national trials - the National Lung Screening Trial in the USA (NLST), the NELSON study, the recent recommendations of the Fleischner society, the American College of Radiology, and I-ELCAP action group, we developed a protocol for a single-arm prospective study in the Czech Republic for the screening of high-risk asymptomatic individuals. The study commenced in August 2020. RESULTS The inclusion criteria are: age 55 to 74 years; smoking: ≥30 pack-years; smoker or ex-smoker <15 years; performance status (0-1). The screening timepoints are at baseline and 1 year. The LDCT acquisition has a target CTDIvol ≤0.5mGy and effective dose ≤0.2mSv for a standard-size patient. The interpretation of findings is primarily based on nodule volumetry, volume doubling time (and related risk of malignancy). The management includes follow-up LDCT, contrast enhanced CT, PET/CT, tissue sampling. The primary outcome is the number of cancers detected at a resectable stage, secondary outcomes include the average cost per diagnosis of lung cancer, the number, cost, complications of secondary examinations, and the number of potentially important secondary findings. CONCLUSIONS A study protocol for early detection of lung cancer in Czech high-risk asymptomatic individuals (ELEGANCE) study using LDCT has been described.
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Affiliation(s)
| | | | | | | | | | - Jiri Votruba
- 1st Department of Tuberculosis and Respiratory Diseases
| | - Pavel Michalek
- Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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24
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Xing X, Yang F, Huang Q, Guo H, Li J, Qiu M, Bai F, Wang J. Decoding the multicellular ecosystem of lung adenocarcinoma manifested as pulmonary subsolid nodules by single-cell RNA sequencing. SCIENCE ADVANCES 2021; 7:7/5/eabd9738. [PMID: 33571124 PMCID: PMC7840134 DOI: 10.1126/sciadv.abd9738] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/08/2020] [Indexed: 05/11/2023]
Abstract
Lung adenocarcinomas (LUAD) that radiologically display as subsolid nodules (SSNs) exhibit more indolent biological behavior than solid LUAD. The transcriptomic features and tumor microenvironment (TME) of SSN remain poorly understood. Here, we performed single-cell RNA sequencing analyses of 16 SSN samples, 6 adjacent normal lung tissues (nLung), and 9 primary LUAD with lymph node metastasis (mLUAD). Approximately 0.6 billion unique transcripts were obtained from 118,293 cells. We found that cytotoxic natural killer/T cells were dominant in the TME of SSN, and malignant cells in SSN undergo a strong metabolic reprogram and immune stress. In SSN, the subtype composition of endothelial cells was similar to that in mLUAD, while the subtype distribution of fibroblasts was more like that in nLung. Our study provides single-cell transcriptomic profiling of SSN and their TME. This resource provides deeper insight into the indolent nature of SSN and will be helpful in advancing lung cancer immunotherapy.
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Affiliation(s)
- Xudong Xing
- School of Life Sciences, Tsinghua University, Beijing 100084, China
- Peking University-Tsinghua University-National Institute of Biological Sciences Joint Graduate Program, Tsinghua University, Beijing 100084, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Qi Huang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450003, China
| | - Haifa Guo
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Jiawei Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Mantang Qiu
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China.
| | - Fan Bai
- Biomedical Pioneering Innovation Center (BIOPIC), School of Life Sciences, Peking University, Beijing 100871, China.
- Beijing Advanced Innovation Center for Genomics (ICG), Peking University, Beijing 100871, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China.
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25
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Dyer SC, Bartholmai BJ, Koo CW. Implications of the updated Lung CT Screening Reporting and Data System (Lung-RADS version 1.1) for lung cancer screening. J Thorac Dis 2020; 12:6966-6977. [PMID: 33282402 PMCID: PMC7711402 DOI: 10.21037/jtd-2019-cptn-02] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Lung cancer remains the leading cause of cancer death in the United States. Screening with low-dose computed tomography (LDCT) has been proven to aid in early detection of lung cancer and reduce disease specific mortality. In 2014, the American College of Radiology (ACR) released version 1.0 of the Lung CT Screening Reporting and Data System (Lung-RADS) as a quality tool to standardize the reporting of lung cancer screening LDCT. In 2019, 5 years after the implementation of Lung-RADS version 1.0 the ACR released the updated Lung-RADS version 1.1 which incorporates initial experience with lung cancer screening. In this review, we outline the implications of the changes and additions in Lung-RADS version 1.1 and examine relevant literature for many of the updates. We also highlight several challenges and opportunities as Lung-RADS version 1.1 is implemented in lung cancer screening programs.
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Affiliation(s)
- Spencer C Dyer
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Chi Wan Koo
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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26
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韦 梦, 乔 友. [Progress of Lung Cancer Screening with Low Dose Helical Computed Tomography]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:875-882. [PMID: 32791651 PMCID: PMC7583869 DOI: 10.3779/j.issn.1009-3419.2020.101.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 12/19/2022]
Abstract
Lung cancer which represents characteristics of a heavy disease burden, a large proportion of advanced lung cancer and a low five-year survival rate is a threat to human health. It is essential to implement population-based lung cancer screening to improve early detection and early treatment. The National Lung Screening Trial (NLST) demonstrated that screening with low dose helical computed tomography (LDCT) may decrease lung cancer mortality, which brings hope for the early diagnosis and treatment of lung cancer. In recent years, great progresses have been made on research of lung cancer screening with LDCT. However, whether LDCT could be applied to large population-based lung cancer screening projects is still under debate. In this paper, we review the recent progresses on history of lung cancer screening with LDCT, selection of high-risk individuals, management of pulmonary nodules, performance of screening, acceptance of LDCT and cost-effectiveness.
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Affiliation(s)
- 梦娜 韦
- />100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院流行病学室Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - 友林 乔
- />100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院流行病学室Department of Cancer Epidemiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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27
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Lam S, Bryant H, Donahoe L, Domingo A, Earle C, Finley C, Gonzalez AV, Hergott C, Hung RJ, Ireland AM, Lovas M, Manos D, Mayo J, Maziak DE, McInnis M, Myers R, Nicholson E, Politis C, Schmidt H, Sekhon HS, Soprovich M, Stewart A, Tammemagi M, Taylor JL, Tsao MS, Warkentin MT, Yasufuku K. Management of screen-detected lung nodules: A Canadian partnership against cancer guidance document. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2020. [DOI: 10.1080/24745332.2020.1819175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Stephen Lam
- British Columbia Cancer Agency & the University of British Columbia, Vancouver, British Columbia, Canada
| | - Heather Bryant
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Laura Donahoe
- Division of Thoracic Surgery, Department of Surgery, University Health Network, Toronto, Ontario, Canada
| | - Ashleigh Domingo
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Craig Earle
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Christian Finley
- Department of Thoracic Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada
| | - Anne V. Gonzalez
- Division of Respiratory Medicine, McGill University, Montreal, Quebec, Canada
| | - Christopher Hergott
- Division of Respiratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rayjean J. Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Anne Marie Ireland
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Michael Lovas
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Mayo
- Department of Radiology, Vancouver Coastal Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna E. Maziak
- Surgical Oncology Division of Thoracic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Micheal McInnis
- Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Renelle Myers
- British Columbia Cancer Agency & the University of British Columbia, Vancouver, British Columbia, Canada
| | - Erika Nicholson
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Christopher Politis
- Screening and Early Detection, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Heidi Schmidt
- University Health Network and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Harman S. Sekhon
- Department of Pathology and Laboratory Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marie Soprovich
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Archie Stewart
- Patient and Family Advocate, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Martin Tammemagi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Jana L. Taylor
- Department of Radiology, McGill University, Montreal, Quebec, Canada
| | - Ming-Sound Tsao
- Department of Laboratory Medicine and Pathobiology, University Health Network and Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matthew T. Warkentin
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Department of Surgery and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Lung cancer LDCT screening and mortality reduction - evidence, pitfalls and future perspectives. Nat Rev Clin Oncol 2020; 18:135-151. [PMID: 33046839 DOI: 10.1038/s41571-020-00432-6] [Citation(s) in RCA: 221] [Impact Index Per Article: 55.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/17/2022]
Abstract
In the past decade, the introduction of molecularly targeted agents and immune-checkpoint inhibitors has led to improved survival outcomes for patients with advanced-stage lung cancer; however, this disease remains the leading cause of cancer-related mortality worldwide. Two large randomized controlled trials of low-dose CT (LDCT)-based lung cancer screening in high-risk populations - the US National Lung Screening Trial (NLST) and NELSON - have provided evidence of a statistically significant mortality reduction in patients. LDCT-based screening programmes for individuals at a high risk of lung cancer have already been implemented in the USA. Furthermore, implementation programmes are currently underway in the UK following the success of the UK Lung Cancer Screening (UKLS) trial, which included the Liverpool Health Lung Project, Manchester Lung Health Check, the Lung Screen Uptake Trial, the West London Lung Cancer Screening pilot and the Yorkshire Lung Screening trial. In this Review, we focus on the current evidence on LDCT-based lung cancer screening and discuss the clinical developments in high-risk populations worldwide; additionally, we address aspects such as cost-effectiveness. We present a framework to define the scope of future implementation research on lung cancer screening programmes referred to as Screening Planning and Implementation RAtionale for Lung cancer (SPIRAL).
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29
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Azour L, Ko JP, Naidich DP, Moore WH. Shades of Gray: Subsolid Nodule Considerations and Management. Chest 2020; 159:2072-2089. [PMID: 33031828 PMCID: PMC7534873 DOI: 10.1016/j.chest.2020.09.252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 12/15/2022] Open
Abstract
Subsolid nodules are common on chest CT imaging and may be either benign or malignant. Their varied features and broad differential diagnoses present management challenges. Although subsolid nodules often represent lung adenocarcinomas, other possibilities are common and influence management. Practice guidelines exist for subsolid nodule management for both incidentally and screening-detected nodules, incorporating patient and nodule characteristics. This review highlights the similarities and differences among these algorithms, with the intent of providing a resource for comparison and aid in choosing management options.
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Affiliation(s)
- Lea Azour
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY.
| | - Jane P Ko
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - David P Naidich
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
| | - William H Moore
- Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY
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30
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Abstract
Lung cancer is the most common cause of cancer death in the world. However, recent studies have found that patients with pulmonary ground-glass opacity (GGO) have a better prognosis. Considering its low invasiveness, sublobar resection may be an appropriate treatment of choice. Low-dose computed tomography (CT) is recommended for the high-risk groups of lung cancer. Patients with nonsolid nodule are suggested to take annual low dose CT following-up. For part-solid or solid nodules, the solid component size less or more than 8 mm is the watershed of surgical treatment. Increasing tumor size is a hint of malignancy. Biopsy can be performed for clinically highly suspected malignant nodules. The endobronchial ultrasound biopsy, CT-guide biopsy, or surgical excision are the mainstream for the diagnosis of lung nodules. But for treatment, the sublobar resection is the mainstream of pulmonary GGO. A precise localization technique makes surgeons get enough resection margin and preserve more pulmonary function of the patients. The different localization technique is suitable for different kind nodular position. For patients with pure pulmonary GGO, annual low dose CT checkup is suitable. If the tumor size or solid part of the tumors increased gradually, adequate sublobar resection after tumor localization technique may provide good prognosis and preserve more pulmonary function of the patients.
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Affiliation(s)
- Yi-Han Lin
- Division of Thoracic Surgery, Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan, ROC
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Han-Shui Hsu
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Address correspondence. Dr. Han-Shui Hsu, Department of Surgery, Division of Thoracic Surgery, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail address: (H.-S. Hsu)
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31
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Chandrika S, Yarmus L. Recent developments in advanced diagnostic bronchoscopy. Eur Respir Rev 2020; 29:29/157/190184. [PMID: 32878972 DOI: 10.1183/16000617.0184-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/24/2020] [Indexed: 12/25/2022] Open
Abstract
The field of bronchoscopy is advancing rapidly. Minimally invasive diagnostic approaches are replacing more aggressive surgical ones for the diagnosis and staging of lung cancer. Evolving diagnostic modalities allow early detection and serve as an adjunct to early treatment, ideally influencing patient outcomes. In this review, we will elaborate on recent bronchoscopic developments as well as some promising investigational tools and approaches in development. We aim to offer a concise overview of the significant advances in the field of advanced bronchoscopy and to put them into clinical context. We will also address potential complications and current diagnostic challenges associated with sampling central and peripheral lung lesions.
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Affiliation(s)
- Sharad Chandrika
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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32
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Age-different extent of resection for clinical IA non-small cell lung cancer: analysis of nodal metastasis. Sci Rep 2020; 10:9587. [PMID: 32533050 PMCID: PMC7293256 DOI: 10.1038/s41598-020-66509-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/19/2020] [Indexed: 02/08/2023] Open
Abstract
Whether age has any impact on the risk of lymph node (LN) metastasis in patients with early-stage non-small cell lung cancer (NSCLC) remains controversial. Therefore, we aimed to objectively compare the risk of LN metastasis between elderly and young patients so as to justify for age-different extent of surgical resection for treating these patients. We retrospectively collected clinical data of patients undergoing lobectomy or segmentectomy with systematic hilar and mediastinal LN dissection for clinical stage IA peripheral NSCLC from January 2015 to December 2018. Both multivariate logistic regression analysis and propensity score-matched (PSM) analysis were applied to compare the risk of LN metastasis between elderly (>65 years old) and young (≤65 years old) patients. We finally included a total of 590 patients for analysis (142 elderly patients and 448 young patients). In the analysis of unmatched cohorts, young patients tended to have higher rates of hilar/intrapulmonary LN (13.4% VS 9.2%) and mediastinal LN metastasis (10.5% VS 6.3%) than elderly patients. In the multivariate analysis, age was found to be an independent predictor of both hilar/intrapulmonary (Odds ratio(OR) = 2.065, 95%confidence interval(CI): 1.049–4.064, P = 0.036) and mediastinal (OR = 2.400, 95%CI: 1.083–5.316, P = 0.031) LN metastasis. Moreover, in the analysis of well-matched cohorts generated by PSM analysis, young patients had significantly higher rates of hilar/intrapulmonary (18.8% VS 9.4%, P = 0.039) and mediastinal LN metastasis (17.1% VS 6.0%, P = 0.008) than elderly patients. Therefore, age remains to be an independent predictor of LN metastasis in early-stage NSCLC and age-different extent of surgical resection may be justified for these patients.
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Lymphadenectomy is Unnecessary for Pure Ground-Glass Opacity Pulmonary Nodules. J Clin Med 2020; 9:jcm9030672. [PMID: 32131524 PMCID: PMC7141214 DOI: 10.3390/jcm9030672] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Lobectomy plus lymph node dissection is the standard treatment of early-stage lung cancer, but the low lymph node metastasis rate with ground-glass opacity (GGO) makes surgeons not perform lymphadenectomy. This study aimed to re-evaluate the lymph node metastasis rate of GGO to help make a clinical judgment. METHODS We performed this retrospective study to enroll patients who received lung cancer surgery from 2011 to 2016. Patient characteristics collected included tumor size, solid part size and lymph node metastasis rate. These patients were categorized into pure GGO and part solid GGO groups to undergo analysis. RESULTS Lymph node metastasis rates were 0%, 3.8% and 6.9% in order of the pure GGO group, the GGO predominant group and the solid predominant group. In the lobectomy patients, the solid predominant group still showed to have the highest lymph node metastasis rate and recurrence rate (8.3% and 10.1%). CONCLUSION It is unnecessary to perform lymphadenectomy for patients with pure GGO in view of the 0% lymph node metastasis rate. The higher lymph node metastasis rate in the patients with the solid predominant group, 6.9%, suggested that surgeons should choose a rational lymphadenectomy method according to their GGO property and clinical judgment.
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Cui X, Han D, Heuvelmans MA, Du Y, Zhao Y, Zhang L, Groen HJ, de Bock GH, Dorrius MD, Oudkerk M, Vliegenthart R, Ye Z. Clinical characteristics and work-up of small to intermediate-sized pulmonary nodules in a Chinese dedicated cancer hospital. Cancer Biol Med 2020; 17:199-207. [PMID: 32296586 PMCID: PMC7142837 DOI: 10.20892/j.issn.2095-3941.2019.0028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/30/2019] [Indexed: 12/23/2022] Open
Abstract
Objectives: To evaluate the characteristics and work-up of small to intermediate-sized pulmonary nodules in a Chinese dedicated cancer hospital. Methods: Patients with pulmonary nodules 4-25 mm in diameter detected via computed tomography (CT) in 2013 were consecutively included. The analysis was restricted to patients with a histological nodule diagnosis or a 2-year follow-up period without nodule growth confirming benign disease. Patient information was collected from hospital records. Results: Among the 314 nodules examined in 299 patients, 212 (67.5%) nodules in 206 (68.9%) patients were malignant. Compared to benign nodules, malignant nodules were larger (18.0 mm vs. 12.5 mm, P < 0.001), more often partly solid (16.0% vs. 4.7%, P < 0.001) and more often spiculated (72.2% vs. 41.2%, P < 0.001), with higher density in contrast-enhanced CT (67.0 HU vs. 57.5 HU, P = 0.015). Final diagnosis was based on surgery in 232 out of 314 (73.9%) nodules, 166 of which were identified as malignant [30 (18.1%) stage III or IV] and 66 as benign. In 36 nodules (11.5%), diagnosis was confirmed by biopsy and the remainder verified based on stability of nodule size at follow-up imaging (n = 46, 14.6%). Among 65 nodules subjected to gene (EGFR) mutation analyses, 28 (43.1%) cases (EGFR19 n = 13; EGFR21 n = 15) were identified as EGFR mutant and 37 (56.9%) as EGFR wild-type. Prior to surgery, the majority of patients [n = 194 (83.6%)] received a contrast-enhanced CT scan for staging of both malignant [n = 140 (84.3%)] and benign [n = 54 (81.8%)] nodules. Usage of positron emission tomography (PET)-CT was relatively uncommon [n = 38 (16.4%)]. Conclusions: CT-derived nodule assessment assists in diagnosis of small to intermediate- sized malignant pulmonary nodules. Currently, contrast-enhanced CT is commonly used as the sole diagnostic confirmation technique for pre-surgical staging, often resulting in surgery for late-stage disease and unnecessary surgery in cases of benign nodules.
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Affiliation(s)
- Xiaonan Cui
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Daiwei Han
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Marjolein A. Heuvelmans
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
- Medisch Spectrum Twente, Department of Pulmonology, Enschede 7512 KZ, The Netherlands
| | - Yihui Du
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Yingru Zhao
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Lei Zhang
- Department of Thoracic Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Harry J.M. Groen
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Monique D. Dorrius
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
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Duma N, Santana-Davila R, Molina JR. Non-Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment. Mayo Clin Proc 2019; 94:1623-1640. [PMID: 31378236 DOI: 10.1016/j.mayocp.2019.01.013] [Citation(s) in RCA: 1132] [Impact Index Per Article: 226.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 01/04/2019] [Accepted: 01/21/2019] [Indexed: 02/08/2023]
Abstract
Lung cancer remains the leading cause of cancer deaths in the United States. In the past decade, significant advances have been made in the science of non-small cell lung cancer (NSCLC). Screening has been introduced with the goal of early detection. The National Lung Screening Trial found a lung cancer mortality benefit of 20% and a 6.7% decrease in all-cause mortality with the use of low-dose chest computed tomography in high-risk individuals. The treatment of lung cancer has also evolved with the introduction of several lines of tyrosine kinase inhibitors in patients with EGFR, ALK, ROS1, and NTRK mutations. Similarly, immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of NSCLC treatment. Furthermore, the results of new trials continue to help us understand the role of these novel agents and which patients are more likely to benefit; ICIs are now part of the first-line NSCLC treatment armamentarium as monotherapy, combined with chemotherapy, or after definite chemoradiotherapy in patients with stage III unresectable NSCLC. Expression of programmed cell death protein-ligand 1 in malignant cells has been studied as a potential biomarker for response to ICIs. However, important drawbacks exist that limit its discriminatory potential. Identification of accurate predictive biomarkers beyond programmed cell death protein-ligand 1 expression remains essential to select the most appropriate candidates for ICI therapy. Many questions remain unanswered regarding the proper sequence and combinations of these new agents; however, the field is moving rapidly, and the overall direction is optimistic.
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Affiliation(s)
- Narjust Duma
- Division of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Rafael Santana-Davila
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle
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Walter JE, Heuvelmans MA, Ten Haaf K, Vliegenthart R, van der Aalst CM, Yousaf-Khan U, van Ooijen PMA, Nackaerts K, Groen HJM, De Bock GH, de Koning HJ, Oudkerk M. Persisting new nodules in incidence rounds of the NELSON CT lung cancer screening study. Thorax 2018; 74:247-253. [PMID: 30591535 DOI: 10.1136/thoraxjnl-2018-212152] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/23/2018] [Accepted: 10/29/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND The US guidelines recommend low-dose CT (LDCT) lung cancer screening for high-risk individuals. New solid nodules after baseline screening are common and have a high lung cancer probability. Currently, no evidence exists concerning the risk stratification of non-resolving new solid nodules at first LDCT screening after initial detection. METHODS In the Dutch-Belgian Randomized Lung Cancer Screening (NELSON) trial, 7295 participants underwent the second and 6922 participants the third screening round. We included participants with solid nodules that were registered as new or <15 mm³ (study detection limit) at previous screens and received additional screening after initial detection, thereby excluding high-risk nodules according to the NELSON management protocol (nodules ≥500 mm3). RESULTS Overall, 680 participants with 1020 low-risk and intermediate-risk new solid nodules were included. A total of 562 (55%) new solid nodules were resolving, leaving 356 (52%) participants with a non-resolving new solid nodule, of whom 25 (7%) were diagnosed with lung cancer. At first screening after initial detection, volume doubling time (VDT), volume, and VDT combined with a predefined ≥200 mm3 volume cut-off had high discrimination for lung cancer (VDT, area under the curve (AUC): 0.913; volume, AUC: 0.875; VDT and ≥200 mm3 combination, AUC: 0.939). Classifying a new solid nodule with either ≤590 days VDT or ≥200 mm3 volume positive provided 100% sensitivity, 84% specificity and 27% positive predictive value for lung cancer. CONCLUSIONS More than half of new low-risk and intermediate-risk solid nodules in LDCT lung cancer screening resolve. At follow-up, growth assessment potentially combined with a volume limit can be used for risk stratification. TRIAL REGISTRATION NUMBER ISRCTN63545820; pre-results.
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Affiliation(s)
- Joan E Walter
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjolein A Heuvelmans
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kevin Ten Haaf
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rozemarijn Vliegenthart
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carlijn M van der Aalst
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Uraujh Yousaf-Khan
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter M A van Ooijen
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Kristiaan Nackaerts
- Department of Pulmonary Medicine, KU Leuven, University Hospital Leuven, Leuven, Belgium
| | - Harry J M Groen
- Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Rotterdam, The Netherlands
| | - Geertruida H De Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Matthijs Oudkerk
- Center for Medical Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Roden AC, Mansfield AS. Multifocal Pulmonary Adenocarcinoma with Ground-Glass/Lepidic Features-Exciting Times as the Mystery Is Unfolding. J Thorac Oncol 2018; 13:1616-1618. [PMID: 30368406 DOI: 10.1016/j.jtho.2018.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota.
| | - Aaron S Mansfield
- Division of Medical Oncology, Department of Oncology, Mayo Clinic Rochester, Rochester, Minnesota
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Abstract
A recent position statement by a group of European experts reviewed the current evidence for low-dose computed tomography (LDCT) lung cancer screening, based on the outcomes and screening performance of the published randomized trials and identified actions needed for eventual future implementation. After the National Lung Screening Trial (NLST) outcome publication, guidelines changed in USA and Canada, but there are still problems in real-world screening practice. In Europe any decision was postponed to the publication of the European randomized trial outcomes and recommendations continue to discourage screening for lung cancer in all member countries. The NELSON randomized controlled trial (RCT), the largest one in Europe, outcome results are still waited, whereas the MILD, DANTE, DLSCT and ITALUNG (all with small sample size) RCTs have published mortality and incidence data with adequate follow up. The implementation of an organized screening in Europe is conditioned by a health technology assessment process at European level. According with the European policy, confirmed in the recent European Cancer Code [2015], screening is transferred in current public-health practice according with evidence-based recommendations and based on organized, usually population-based, programs. Guidelines, standard indicators of performance, training of dedicated radiologists and professionals and a comprehensive quality assurance system is requested in European countries to implement nationally a public health screening program. Waiting the NELSON randomized trial results, key issues as modality for selection of high risk subjects and recruitment, integration of screening and smoking cessation, optimal screening regimen and related research on biomarkers should be assessed, discussed and reviewed. Informed decision making, promotion of primary prevention and integration of screening and smoking cessation are all essential components of a comprehensive risk reduction policy. The path to an Evidence-based screening practice is narrow and, in the absence of a well-established decision-making process, the risk of a spontaneous, uncontrolled use of LDCT screening or, on the other side, an oversight of the screening opportunity is high.
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Affiliation(s)
- Eugenio Paci
- Epidemiologist, ISPO - Cancer Prevention and Research Institute, Florence, Italy
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