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Chen Q, Cheng J, Wang L, Lv X, Hu J. Primary lung cancer in children and adolescents. J Cancer Res Clin Oncol 2024; 150:225. [PMID: 38695944 PMCID: PMC11065912 DOI: 10.1007/s00432-024-05750-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/11/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE Primary lung cancer is extremely rare in children and adolescents. The aim of this study is to clarify clinical features and outcomes of primary lung cancer in children and adolescents. METHODS Young patients (aged ≤ 20 years) diagnosed as primary lung cancer between 2012 and 2023 were retrospective reviewed. According to radiological appearance of the nodules, they were divided into solid nodule (SN) group and ground glass opacity (GGO) group. RESULTS A total of 74 patients were identified, with a median age at diagnosis of 18 years old (range: 11-20), including 7 patients in SN group and 67 patients in GGO group. In the GGO group, none of the nodules enlarged or changed during an average surveillance period of 10.8 months before surgery, except one. Wedge resection was the most common procedure (82.1%), followed by segmentectomy (16.4%) and lobectomy (1.5%). Histopathological analysis revealed that 64.2% of GGO nodules were adenocarcinoma in situ and minimally invasive adenocarcinomas, while the remaining 35.8% were invasive adenocarcinomas. Mutational analysis was performed in nine patients, with mutations identified in all cases. After a mean follow-up period of 1.73 ± 1.62 years, two patients in the SN group died due to multiple distant metastases, while all patients in the GGO group survived without recurrence. The overall survival (100%) of the GGO group was significantly higher than SN group (66.7%). CONCLUSIONS Primary lung cancer in children and adolescents are rare and histopathological heterogeneous. Persistent GGO nodules may indicate early-stage lung adenocarcinoma in children and adolescents.
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Affiliation(s)
- Qiuming Chen
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Jun Cheng
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Luming Wang
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiayi Lv
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jian Hu
- Department of Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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2
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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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3
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Cardillo G, Petersen RH, Ricciardi S, Patel A, Lodhia JV, Gooseman MR, Brunelli A, Dunning J, Fang W, Gossot D, Licht PB, Lim E, Roessner ED, Scarci M, Milojevic M. European guidelines for the surgical management of pure ground-glass opacities and part-solid nodules: Task Force of the European Association of Cardio-Thoracic Surgery and the European Society of Thoracic Surgeons. Eur J Cardiothorac Surg 2023; 64:ezad222. [PMID: 37243746 DOI: 10.1093/ejcts/ezad222] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/10/2023] [Accepted: 05/26/2023] [Indexed: 05/29/2023] Open
Affiliation(s)
- Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Unicamillus-Saint Camillus University of Health Sciences, Rome, Italy
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Sara Ricciardi
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
- Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Akshay Patel
- Department of Thoracic Surgery, University Hospitals Birmingham, England, United Kingdom
- Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom
| | - Joshil V Lodhia
- Department of Thoracic Surgery, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Michael R Gooseman
- Department of Thoracic Surgery, Hull University Teaching Hospitals NHS Trust, and Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Alessandro Brunelli
- Department of Thoracic Surgery, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Joel Dunning
- James Cook University Hospital Middlesbrough, United Kingdom
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shangai, China
| | - Dominique Gossot
- Department of Thoracic Surgery, Curie-Montsouris Thoracic Institute, Paris, France
| | - Peter B Licht
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Eric Lim
- Academic Division of Thoracic Surgery, The Royal Brompton Hospital and Imperial College London, United Kingdom
| | - Eric Dominic Roessner
- Department of Thoracic Surgery, Center for Thoracic Diseases, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Marco Scarci
- Division of Thoracic Surgery, Imperial College NHS Healthcare Trust and National Heart and Lung Institute, Hammersmith Hospital, London, United Kingdom
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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4
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Liu YC, Liang CH, Wu YJ, Chen CS, Tang EK, Wu FZ. Managing Persistent Subsolid Nodules in Lung Cancer: Education, Decision Making, and Impact of Interval Growth Patterns. Diagnostics (Basel) 2023; 13:2674. [PMID: 37627933 PMCID: PMC10453827 DOI: 10.3390/diagnostics13162674] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
With the popularization of lung cancer screening, many persistent subsolid nodules (SSNs) have been identified clinically, especially in Asian non-smokers. However, many studies have found that SSNs exhibit heterogeneous growth trends during long-term follow ups. This article adopted a narrative approach to extensively review the available literature on the topic to explore the definitions, rationale, and clinical application of different interval growths of subsolid pulmonary nodule management and follow-up strategies. The development of SSN growth thresholds with different growth patterns could support clinical decision making with follow-up guidelines to reduce over- and delayed diagnoses. In conclusion, using different SSN growth thresholds could optimize the follow-up management and clinical decision making of SSNs in lung cancer screening programs. This could further reduce the lung cancer mortality rate and potential harm from overdiagnosis and over management.
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Affiliation(s)
- Yung-Chi Liu
- Department of Radiology, Xiamen Chang Gung Hospital, Xiamen 361028, China;
- Department of Imaging Technology Division, Xiamen Chang Gung Hospital, Xiamen 361028, China
- Department of Healthcare Administration Department, Xiamen Chang Gung Hospital, Xiamen 361028, China
| | - Chia-Hao Liang
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei 112304, Taiwan;
| | - Yun-Ju Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
- Department of Software Engineering and Management, National Kaohsiung Normal University, Kaohsiung 80201, Taiwan
| | - Chi-Shen Chen
- Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
| | - En-Kuei Tang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan;
| | - Fu-Zong Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Institute of Education, National Sun Yat-Sen University, Kaohsiung 804241, Taiwan
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5
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Mascalchi M, Picozzi G, Puliti D, Diciotti S, Deliperi A, Romei C, Falaschi F, Pistelli F, Grazzini M, Vannucchi L, Bisanzi S, Zappa M, Gorini G, Carozzi FM, Carrozzi L, Paci E. Lung Cancer Screening with Low-Dose CT: What We Have Learned in Two Decades of ITALUNG and What Is Yet to Be Addressed. Diagnostics (Basel) 2023; 13:2197. [PMID: 37443590 DOI: 10.3390/diagnostics13132197] [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: 04/26/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
The ITALUNG trial started in 2004 and compared lung cancer (LC) and other-causes mortality in 55-69 years-aged smokers and ex-smokers who were randomized to four annual chest low-dose CT (LDCT) or usual care. ITALUNG showed a lower LC and cardiovascular mortality in the screened subjects after 13 years of follow-up, especially in women, and produced many ancillary studies. They included recruitment results of a population-based mimicking approach, development of software for computer-aided diagnosis (CAD) and lung nodules volumetry, LDCT assessment of pulmonary emphysema and coronary artery calcifications (CAC) and their relevance to long-term mortality, results of a smoking-cessation intervention, assessment of the radiations dose associated with screening LDCT, and the results of biomarkers assays. Moreover, ITALUNG data indicated that screen-detected LCs are mostly already present at baseline LDCT, can present as lung cancer associated with cystic airspaces, and can be multiple. However, several issues of LC screening are still unaddressed. They include the annual vs. biennial pace of LDCT, choice between opportunistic or population-based recruitment. and between uni or multi-centre screening, implementation of CAD-assisted reading, containment of false positive and negative LDCT results, incorporation of emphysema. and CAC quantification in models of personalized LC and mortality risk, validation of ultra-LDCT acquisitions, optimization of the smoking-cessation intervention. and prospective validation of the biomarkers.
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Affiliation(s)
- Mario Mascalchi
- Department of Clinical and Experimental Biomedical Sciences "Mario Serio", University of Florence, 50121 Florence, Italy
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Giulia Picozzi
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Donella Puliti
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 47521 Cesena, Italy
| | - Annalisa Deliperi
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Chiara Romei
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Fabio Falaschi
- Radiodiagnostic Unit 2, Department of Diagnostic Imaging, Cisanello University Hospital of Pisa, 56124 Pisa, Italy
| | - Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Michela Grazzini
- Division of Pneumonology, San Jacopo Hospital Pistoia, 51100 Pistoia, Italy
| | - Letizia Vannucchi
- Division of Radiology, San Jacopo Hospital Pistoia, 51100 Pistoia, Italy
| | - Simonetta Bisanzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Marco Zappa
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Giuseppe Gorini
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Francesca Maria Carozzi
- Regional Laboratory of Cancer Prevention, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
| | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, 56124 Pisa, Italy
| | - Eugenio Paci
- Division of Epidemiology and Clinical Governance, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), 50100 Florence, Italy
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6
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Borghesi A, Coviello FL, Scrimieri A, Ciolli P, Ravanelli M, Farina D. Software-based quantitative CT analysis to predict the growth trend of persistent nonsolid pulmonary nodules: a retrospective study. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01648-z. [PMID: 37227661 DOI: 10.1007/s11547-023-01648-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Persistent nonsolid nodules (NSNs) usually exhibit an indolent course and may remain stable for several years; however, some NSNs grow quickly and require surgical excision. Therefore, identifying quantitative features capable of early discrimination between growing and nongrowing NSNs is becoming a crucial aspect of radiological analysis. The main purpose of this study was to evaluate the performance of an open-source software (ImageJ) to predict the future growth of NSNs detected in a Caucasian (Italian) population. MATERIAL AND METHODS We retrospectively selected 60 NSNs with an axial diameter of 6-30 mm scanned with the same acquisition-reconstruction parameters and the same computed tomography (CT) scanner. Software-based analysis was performed on thin-section CT images using ImageJ. For each NSNs, several quantitative features were extracted from the baseline CT images. The relationships of NSN growth with quantitative CT features and other categorical variables were analyzed using univariate and multivariable logistic regression analyses. RESULTS In multivariable analysis, only the skewness and linear mass density (LMD) were significantly associated with NSN growth, and the skewness was the strongest predictor of growth. In receiver operating characteristic curve analyses, the optimal cutoff values of skewness and LMD were 0.90 and 19.16 mg/mm, respectively. The two predictive models that included the skewness, with or without LMD, exhibited an excellent power for predicting NSN growth. CONCLUSION According to our results, NSNs with a skewness value > 0.90, specifically those with a LMD > 19.16 mg/mm, should require closer follow-up due to their higher growth potential, and higher risk of becoming an active cancer.
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Affiliation(s)
- Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
| | - Felice Leopoldo Coviello
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Alessandra Scrimieri
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Pietro Ciolli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
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7
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Liu S, Sun Q, Ren X. Novel strategies for cancer immunotherapy: counter-immunoediting therapy. J Hematol Oncol 2023; 16:38. [PMID: 37055849 PMCID: PMC10099030 DOI: 10.1186/s13045-023-01430-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/21/2023] [Indexed: 04/15/2023] Open
Abstract
The advent of immunotherapy has made an indelible mark on the field of cancer therapy, especially the application of immune checkpoint inhibitors in clinical practice. Although immunotherapy has proven its efficacy and safety in some tumors, many patients still have innate or acquired resistance to immunotherapy. The emergence of this phenomenon is closely related to the highly heterogeneous immune microenvironment formed by tumor cells after undergoing cancer immunoediting. The process of cancer immunoediting refers to the cooperative interaction between tumor cells and the immune system that involves three phases: elimination, equilibrium, and escape. During these phases, conflicting interactions between the immune system and tumor cells result in the formation of a complex immune microenvironment, which contributes to the acquisition of different levels of immunotherapy resistance in tumor cells. In this review, we summarize the characteristics of different phases of cancer immunoediting and the corresponding therapeutic tools, and we propose normalized therapeutic strategies based on immunophenotyping. The process of cancer immunoediting is retrograded through targeted interventions in different phases of cancer immunoediting, making immunotherapy in the context of precision therapy the most promising therapy to cure cancer.
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Affiliation(s)
- Shaochuan Liu
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, 300060, Tianjin, China
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 300060, Tianjin, China
- Key Laboratory of Cancer Immunology and Biotherapy, 300060, Tianjin, China
- Key Laboratory of Cancer Prevention and Therapy, 300060, Tianjin, China
- Tianjin's Clinical Research Center for Cancer, 300060, Tianjin, China
- Department of Biotherapy, Tianjin Medical University Cancer Institute and Hospital, 300060, Tianjin, China
| | - Qian Sun
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, 300060, Tianjin, China.
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 300060, Tianjin, China.
- Key Laboratory of Cancer Immunology and Biotherapy, 300060, Tianjin, China.
- Key Laboratory of Cancer Prevention and Therapy, 300060, Tianjin, China.
- Tianjin's Clinical Research Center for Cancer, 300060, Tianjin, China.
- Department of Biotherapy, Tianjin Medical University Cancer Institute and Hospital, 300060, Tianjin, China.
| | - Xiubao Ren
- Department of Immunology, Tianjin Medical University Cancer Institute and Hospital, 300060, Tianjin, China.
- Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 300060, Tianjin, China.
- Key Laboratory of Cancer Immunology and Biotherapy, 300060, Tianjin, China.
- Key Laboratory of Cancer Prevention and Therapy, 300060, Tianjin, China.
- Tianjin's Clinical Research Center for Cancer, 300060, Tianjin, China.
- Department of Biotherapy, Tianjin Medical University Cancer Institute and Hospital, 300060, Tianjin, China.
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8
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Zhang J, Tang K, Liu L, Guo C, Zhao K, Li S. Management of pulmonary nodules in women with pregnant intention: A review with perspective. Ann Thorac Med 2023; 18:61-69. [PMID: 37323371 PMCID: PMC10263075 DOI: 10.4103/atm.atm_270_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 06/17/2023] Open
Abstract
The process for the management of pulmonary nodules in women with pregnant intention remains a challenge. There was a certain proportion of targeted female patients with high-risk lung cancer, and anxiety for suspicious lung cancer in early stage also exists. A comprehensive review of hereditary of lung cancer, effects of sexual hormone on lung cancer, natural history of pulmonary nodules, and computed tomography imaging with radiation exposure based on PubMed search was completed. The heredity of lung cancer and effects of sexual hormone on lung cancer are not the decisive factors, and the natural history of pulmonary nodules and the radiation exposure of imaging should be the main concerns. The management of incidental pulmonary nodules in young women with pregnant intention is an intricate and indecisive problem we have to encounter. The balance between the natural history of pulmonary nodules and the radiation exposure of imaging should be weighed.
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Affiliation(s)
- Jiaqi Zhang
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kun Tang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
- Institute of Respiratory Disease of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Lei Liu
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Guo
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ke Zhao
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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9
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Milanese G, Ledda RE, Sabia F, Ruggirello M, Sestini S, Silva M, Sverzellati N, Marchianò AV, Pastorino U. Ultra-low dose computed tomography protocols using spectral shaping for lung cancer screening: Comparison with low-dose for volumetric LungRADS classification. Eur J Radiol 2023; 161:110760. [PMID: 36878153 DOI: 10.1016/j.ejrad.2023.110760] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE To compare Low-Dose Computed Tomography (LDCT) with four different Ultra-Low-Dose Computed Tomography (ULDCT) protocols for PN classification according to the Lung Reporting and Data System (LungRADS). METHODS Three hundred sixty-one participants of an ongoing lung cancer screening (LCS) underwent single-breath-hold double chest Computed Tomography (CT), including LDCT (120kVp, 25mAs; CTDIvol 1,62 mGy) and one ULDCT among: fully automated exposure control ("ULDCT1"); fixed tube-voltage and current according to patient size ("ULDCT2"); hybrid approach with fixed tube-voltage ("ULDCT3") and tube current automated exposure control ("ULDCT4"). Two radiologists (R1, R2) assessed LungRADS 2022 categories on LDCT, and then after 2 weeks on ULDCT using two different kernels (R1: Qr49ADMIRE 4; R2: Br49ADMIRE 3). Intra-subject agreement for LungRADS categories between LDCT and ULDCT was measured by the k-Cohen Index with Fleiss-Cohen weights. RESULTS LDCT-dominant PNs were detected in ULDCT in 87 % of cases on Qr49ADMIRE 4 and 88 % on Br49ADMIRE 3. The intra-subject agreement was: κULDCT1 = 0.89 [95 %CI 0.82-0.96]; κULDCT2 = 0.90 [0.81-0.98]; κULDCT3 = 0.91 [0.84-0.99]; κULDCT4 = 0.88 [0.78-0.97] on Qr49ADMIRE 4, and κULDCT1 = 0.88 [0.80-0.95]; κULDCT2 = 0.91 [0.86-0.96]; κULDCT3 = 0.87 [0.78-0.95]; and κULDCT4 = 0.88 [0.82-0.94] on Br49ADMIRE 3. LDCT classified as LungRADS 4B were correctly identified as LungRADS 4B at ULDCT3, with the lowest radiation exposure among the tested protocols (median effective doses were 0.31, 0.36, 0.27 and 0.37 mSv for ULDCT1, ULDCT2, ULDCT3, and ULDCT4, respectively). CONCLUSIONS ULDCT by spectral shaping allows the detection and characterization of PNs with an excellent agreement with LDCT and can be proposed as a feasible approach in LCS.
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Affiliation(s)
- Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Roberta Eufrasia Ledda
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy; Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Federica Sabia
- Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Margherita Ruggirello
- Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Diagnostic Imaging and Radiotherapy, Milan, Italy.
| | - Stefano Sestini
- Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Alfonso Vittorio Marchianò
- Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Diagnostic Imaging and Radiotherapy, Milan, Italy.
| | - Ugo Pastorino
- Fondazione IRCCS Istituto Nazionale dei Tumori, Thoracic Surgery, Milan, Lombardia, Italy.
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10
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Kanne JP. Lung Cancer Screening in Never Smokers: Point-Might Reduce Mortality With Comprehensive Risk Assessment and Conservative Nodule Management. AJR Am J Roentgenol 2023; 220:486-487. [PMID: 36321983 DOI: 10.2214/ajr.22.28627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, MC 3252, Madison, WI 53792-3252
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11
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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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12
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Bartlett EC, Rahman S, Ridge CA. Percutaneous image-guided thermal ablation of lung cancer: What is the evidence? Lung Cancer 2023; 176:14-23. [PMID: 36571982 DOI: 10.1016/j.lungcan.2022.12.010] [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: 10/13/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
Thermal ablation techniques have now been used for more than twenty years in the treatment of primary lung tumours, predominantly non-small cell lung cancer (NSCLC). Although primarily used for the treatment of early-stage disease in non-surgical patients, thermal ablation is now also being used in selected patients with oligometastatic and oligoprogressive disease. This review discusses the techniques available for thermal ablation, the evidence for use of thermal ablation in primary lung tumours in early- and advanced-stage disease and compares thermal ablation to alternative treatment strategies.
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Affiliation(s)
- E C Bartlett
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Department of Radiology, Sydney Street, London SW3 6NP, United Kingdom.
| | - S Rahman
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Department of Radiology, Sydney Street, London SW3 6NP, United Kingdom
| | - C A Ridge
- Royal Brompton Hospital (Guy's and St Thomas' NHS Foundation Trust), Department of Radiology, Sydney Street, London SW3 6NP, United Kingdom; National Heart and Lung Institute, Imperial College, London SW3 6LY, United Kingdom
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13
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Zhang Z, Zhou L, Yang F, Li X. The natural growth history of persistent pulmonary subsolid nodules: Radiology, genetics, and clinical management. Front Oncol 2022; 12:1011712. [PMID: 36568242 PMCID: PMC9772280 DOI: 10.3389/fonc.2022.1011712] [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: 08/04/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
The high detection rate of pulmonary subsolid nodules (SSN) is an increasingly crucial clinical issue due to the increased number of screening tests and the growing popularity of low-dose computed tomography (LDCT). The persistence of SSN strongly suggests the possibility of malignancy. Guidelines have been published over the past few years and guide the optimal management of SSNs, but many remain controversial and confusing for clinicians. Therefore, in-depth research on the natural growth history of persistent pulmonary SSN can help provide evidence-based medical recommendations for nodule management. In this review, we briefly describe the differential diagnosis, growth patterns and rates, genetic characteristics, and factors that influence the growth of persistent SSN. With the advancement of radiomics and artificial intelligence (AI) technology, individualized evaluation of SSN becomes possible. These technologies together with liquid biopsy, will promote the transformation of current diagnosis and follow-up strategies and provide significant progress in the precise management of subsolid nodules in the early stage of lung cancer.
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14
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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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15
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Li R, Luo L, Tao W, Huang W, Bao T. Level of knowledge on low-dose CT lung cancer screening in Sichuan province, China: a cross-sectional study. BMJ Open 2022; 12:e061987. [PMID: 36127104 PMCID: PMC9490565 DOI: 10.1136/bmjopen-2022-061987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Low-dose CT (LDCT) can help determine the early stage of lung cancer and reduce mortality. However, knowledge of lung cancer and lung cancer screening among community residents and medical workers, and potential factors that may affect medical institutions to set up LDCT are limited. DESIGN A cross-sectional study was conducted in Sichuan province, China, in 2021. Community residents, medical workers and medical institutions were randomly selected, and participants responded to related questionnaires. Knowledge of lung cancer and LDCT lung cancer screening was evaluated. Data analyses were performed using SAS V.9.4. RESULTS A total of 35 692 residents, 6350 medical workers and 81 medical institutions were recruited; 4.05% of the residents were very familiar with lung cancer and 37.89% were (completely) unfamiliar. Characteristics, such as age and level of education, were significantly related to residents who were very familiar with lung cancer. Furthermore, 22.87% of the residents knew that LDCT can effectively screen for early-stage lung cancer, which was correlated with smoking (OR 1.1300; 95% CI 1.0540 to 1.2110; p=0.006) and family history of cancer (OR 1.2210; 95% CI 1.1400 to 1.3080; p<0.0001); 66.06% of medical workers believed that LDCT can detect early-stage lung cancer. Technicians and nurses were less knowledgeable than doctors about whether LDCT can effectively screen for early-stage lung cancer (OR 0.6976; 95% CI 0.5399 to 0.9015; p=0.0059 and OR 0.6970; 95% CI 0.5718 to 0.8496; p=0.0004, respectively). Setting up LDCT in medical institutions was related to grade, administrative rank, number of hospital beds that opened and total number of medical workers. CONCLUSIONS The knowledge of lung cancer in residents is relatively low, and the knowledge of LDCT in screening (early-stage) lung cancer needs to be improved both in residents and medical workers. Possible factors that affect medical institutions to set up LDCT may need to be incorporated.
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Affiliation(s)
- Ruicen Li
- Department of Industrial Engineering and Engineering Management, Sichuan University, Chengdu, Sichuan, China
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
| | - Li Luo
- Department of Industrial Engineering and Engineering Management, Sichuan University, Chengdu, Sichuan, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
| | - Wenxia Huang
- Department of Healthcare, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Bao
- Health Management Center, West China Hospital, Sichuan University, Chengdu, China
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16
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Bonney A, Malouf R, Marchal C, Manners D, Fong KM, Marshall HM, Irving LB, Manser R. Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. Cochrane Database Syst Rev 2022; 8:CD013829. [PMID: 35921047 PMCID: PMC9347663 DOI: 10.1002/14651858.cd013829.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lung cancer is the most common cause of cancer-related death in the world, however lung cancer screening has not been implemented in most countries at a population level. A previous Cochrane Review found limited evidence for the effectiveness of lung cancer screening with chest radiography (CXR) or sputum cytology in reducing lung cancer-related mortality, however there has been increasing evidence supporting screening with low-dose computed tomography (LDCT). OBJECTIVES: To determine whether screening for lung cancer using LDCT of the chest reduces lung cancer-related mortality and to evaluate the possible harms of LDCT screening. SEARCH METHODS We performed the search in collaboration with the Information Specialist of the Cochrane Lung Cancer Group and included the Cochrane Lung Cancer Group Trial Register, Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, current issue), MEDLINE (accessed via PubMed) and Embase in our search. We also searched the clinical trial registries to identify unpublished and ongoing trials. We did not impose any restriction on language of publication. The search was performed up to 31 July 2021. SELECTION CRITERIA: Randomised controlled trials (RCTs) of lung cancer screening using LDCT and reporting mortality or harm outcomes. DATA COLLECTION AND ANALYSIS: Two review authors were involved in independently assessing trials for eligibility, extraction of trial data and characteristics, and assessing risk of bias of the included trials using the Cochrane RoB 1 tool. We assessed the certainty of evidence using GRADE. Primary outcomes were lung cancer-related mortality and harms of screening. We performed a meta-analysis, where appropriate, for all outcomes using a random-effects model. We only included trials in the analysis of mortality outcomes if they had at least 5 years of follow-up. We reported risk ratios (RRs) and hazard ratios (HRs), with 95% confidence intervals (CIs) and used the I2 statistic to investigate heterogeneity. MAIN RESULTS: We included 11 trials in this review with a total of 94,445 participants. Trials were conducted in Europe and the USA in people aged 40 years or older, with most trials having an entry requirement of ≥ 20 pack-year smoking history (e.g. 1 pack of cigarettes/day for 20 years or 2 packs/day for 10 years etc.). One trial included male participants only. Eight trials were phase three RCTs, with two feasibility RCTs and one pilot RCT. Seven of the included trials had no screening as a comparison, and four trials had CXR screening as a comparator. Screening frequency included annual, biennial and incrementing intervals. The duration of screening ranged from 1 year to 10 years. Mortality follow-up was from 5 years to approximately 12 years. None of the included trials were at low risk of bias across all domains. The certainty of evidence was moderate to low across different outcomes, as assessed by GRADE. In the meta-analysis of trials assessing lung cancer-related mortality, we included eight trials (91,122 participants), and there was a reduction in mortality of 21% with LDCT screening compared to control groups of no screening or CXR screening (RR 0.79, 95% CI 0.72 to 0.87; 8 trials, 91,122 participants; moderate-certainty evidence). There were probably no differences in subgroups for analyses by control type, sex, geographical region, and nodule management algorithm. Females appeared to have a larger lung cancer-related mortality benefit compared to males with LDCT screening. There was also a reduction in all-cause mortality (including lung cancer-related) of 5% (RR 0.95, 95% CI 0.91 to 0.99; 8 trials, 91,107 participants; moderate-certainty evidence). Invasive tests occurred more frequently in the LDCT group (RR 2.60, 95% CI 2.41 to 2.80; 3 trials, 60,003 participants; moderate-certainty evidence). However, analysis of 60-day postoperative mortality was not significant between groups (RR 0.68, 95% CI 0.24 to 1.94; 2 trials, 409 participants; moderate-certainty evidence). False-positive results and recall rates were higher with LDCT screening compared to screening with CXR, however there was low-certainty evidence in the meta-analyses due to heterogeneity and risk of bias concerns. Estimated overdiagnosis with LDCT screening was 18%, however the 95% CI was 0 to 36% (risk difference (RD) 0.18, 95% CI -0.00 to 0.36; 5 trials, 28,656 participants; low-certainty evidence). Four trials compared different aspects of health-related quality of life (HRQoL) using various measures. Anxiety was pooled from three trials, with participants in LDCT screening reporting lower anxiety scores than in the control group (standardised mean difference (SMD) -0.43, 95% CI -0.59 to -0.27; 3 trials, 8153 participants; low-certainty evidence). There were insufficient data to comment on the impact of LDCT screening on smoking behaviour. AUTHORS' CONCLUSIONS: The current evidence supports a reduction in lung cancer-related mortality with the use of LDCT for lung cancer screening in high-risk populations (those over the age of 40 with a significant smoking exposure). However, there are limited data on harms and further trials are required to determine participant selection and optimal frequency and duration of screening, with potential for significant overdiagnosis of lung cancer. Trials are ongoing for lung cancer screening in non-smokers.
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Affiliation(s)
- Asha Bonney
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Reem Malouf
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | | | - David Manners
- Respiratory Medicine, Midland St John of God Public and Private Hospital, Midland, Australia
| | - Kwun M Fong
- Thoracic Medicine Program, The Prince Charles Hospital, Brisbane, Australia
- UQ Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Henry M Marshall
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Louis B Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Renée Manser
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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17
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Liang X, Liu M, Li M, Zhang L. Clinical and CT Features of Subsolid Pulmonary Nodules With Interval Growth: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:929174. [PMID: 35860567 PMCID: PMC9289285 DOI: 10.3389/fonc.2022.929174] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEstablishing risk-based follow-up management strategies is crucial to the surveillance of subsolid pulmonary nodules (SSNs). However, the risk factors for SSN growth are not currently clear. This study aimed to perform a systematic review and meta-analysis to identify clinical and CT features correlated with SSN growth.MethodsRelevant studies were retrieved from Web of Science, PubMed, Cochrane Library, and EMBASE. The correlations of clinical and CT features with SSN growth were pooled using a random-effects model or fixed-effects model depending on heterogeneity, which was examined by the Q test and I2 test. Pooled odds ratio (OR) or pooled standardized mean differences (SMD) based on univariate analyses were calculated to assess the correlation of clinical and CT features with SSN growth. Pooled ORs based on multivariate analyses were calculated to find out independent risk factors to SSN growth. Subgroup meta-analysis was performed based on nodule consistency (pure ground-glass nodule (pGGN) and part-solid nodule (PSN). Publication bias was examined using funnel plots.ResultsNineteen original studies were included, consisting of 2444 patients and 3012 SSNs. The median/mean follow-up duration of these studies ranged from 24.2 months to 112 months. Significant correlations were observed between SSN growth and eighteen features. Male sex, history of lung cancer, nodule size > 10 mm, nodule consistency, and age > 65 years were identified as independent risk factors for SSN growth based on multivariate analyses results. Eight features, including male sex, smoking history, nodule size > 10 mm, larger nodule size, air bronchogram, higher mean CT attenuation, well-defined border, and lobulated margin were detected to be significantly correlated with pGGNs growth. Smoking history showed no significant correlation with pGGN growth based on the multivariate analysis results.ConclusionsEighteen clinical and CT features were identified to be correlated with SSN growth, among which male sex, history of lung cancer, nodule size > 10 mm, nodule consistency and age > 65 years were independent risk factors while history of lung cancer was not correlated with pGGN growth. These factors should be considered when making risk-based follow-up plans for SSN patients.
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18
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Shu J, Wen D, Xu Z, Meng X, Zhang Z, Lin S, Zheng M. Improved interobserver agreement on nodule type and Lung-RADS classification of subsolid nodules using computer-aided solid component measurement. Eur J Radiol 2022; 152:110339. [DOI: 10.1016/j.ejrad.2022.110339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/06/2022] [Accepted: 05/01/2022] [Indexed: 11/16/2022]
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19
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Silva M, Milanese G, Ledda RE, Nayak SM, Pastorino U, Sverzellati N. European lung cancer screening: valuable trial evidence for optimal practice implementation. Br J Radiol 2022; 95:20200260. [PMID: 34995141 PMCID: PMC10993986 DOI: 10.1259/bjr.20200260] [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: 03/18/2020] [Revised: 11/25/2021] [Accepted: 12/07/2021] [Indexed: 11/05/2022] Open
Abstract
Lung cancer screening (LCS) by low-dose computed tomography is a strategy for secondary prevention of lung cancer. In the last two decades, LCS trials showed several options to practice secondary prevention in association with primary prevention, however, the translation from trial to practice is everything but simple. In 2020, the European Society of Radiology and European Respiratory Society published their joint statement paper on LCS. This commentary aims to provide the readership with detailed description about hurdles and potential solutions that could be encountered in the practice of LCS.
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Affiliation(s)
- Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
| | - Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
| | - Roberta E Ledda
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
| | - Sundeep M Nayak
- Department of Radiology, Kaiser Permanente Northern
California, San Leandro,
California, USA
| | - Ugo Pastorino
- Section of Thoracic Surgery, IRCCS Istituto Nazionale
Tumori, Milano,
Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery
(DiMeC), University of Parma,
Parma, Italy
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20
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Silva M, Picozzi G, Sverzellati N, Anglesio S, Bartolucci M, Cavigli E, Deliperi A, Falchini M, Falaschi F, Ghio D, Gollini P, Larici AR, Marchianò AV, Palmucci S, Preda L, Romei C, Tessa C, Rampinelli C, Mascalchi M. Low-dose CT for lung cancer screening: position paper from the Italian college of thoracic radiology. Radiol Med 2022; 127:543-559. [PMID: 35306638 PMCID: PMC8934407 DOI: 10.1007/s11547-022-01471-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/18/2022] [Indexed: 12/24/2022]
Abstract
Smoking is the main risk factor for lung cancer (LC), which is the leading cause of cancer-related death worldwide. Independent randomized controlled trials, governmental and inter-governmental task forces, and meta-analyses established that LC screening (LCS) with chest low dose computed tomography (LDCT) decreases the mortality of LC in smokers and former smokers, compared to no-screening, especially in women. Accordingly, several Italian initiatives are offering LCS by LDCT and smoking cessation to about 10,000 high-risk subjects, supported by Private or Public Health Institutions, envisaging a possible population-based screening program. Because LDCT is the backbone of LCS, Italian radiologists with LCS expertise are presenting this position paper that encompasses recommendations for LDCT scan protocol and its reading. Moreover, fundamentals for classification of lung nodules and other findings at LDCT test are detailed along with international guidelines, from the European Society of Thoracic Imaging, the British Thoracic Society, and the American College of Radiology, for their reporting and management in LCS. The Italian College of Thoracic Radiologists produced this document to provide the basics for radiologists who plan to set up or to be involved in LCS, thus fostering homogenous evidence-based approach to the LDCT test over the Italian territory and warrant comparison and analyses throughout National and International practices.
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Affiliation(s)
- Mario Silva
- Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, Parma, Italy.
- Unit of "Scienze Radiologiche", University Hospital of Parma, Pad. Barbieri, Via Gramsci 14, 43126, Parma, Italy.
| | - Giulia Picozzi
- Istituto Di Studio Prevenzione E Rete Oncologica, Firenze, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, Parma, Italy
- Unit of "Scienze Radiologiche", University Hospital of Parma, Pad. Barbieri, Via Gramsci 14, 43126, Parma, Italy
| | | | | | | | | | | | | | - Domenico Ghio
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Anna Rita Larici
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore Di Roma, Roma, Italy
| | - Alfonso V Marchianò
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, MI, Italy
| | - Stefano Palmucci
- UOC Radiologia 1, Dipartimento Scienze Mediche Chirurgiche E Tecnologie Avanzate "GF Ingrassia", Università Di Catania, AOU Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Lorenzo Preda
- IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Dipartimento Di Scienze Clinico-Chirurgiche, Diagnostiche E Pediatriche, Università Degli Studi Di Pavia, Pavia, Italy
| | | | - Carlo Tessa
- Radiologia Apuane E Lunigiana, Azienda USL Toscana Nord Ovest, Pisa, Italy
| | | | - Mario Mascalchi
- Istituto Di Studio Prevenzione E Rete Oncologica, Firenze, Italy
- Università Di Firenze, Firenze, Italy
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21
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Payne RG, Anker CJ, Sprague BL, No HJ, Lin SH, Lester-Coll NH. Active Surveillance for Early Stage Lung Cancer. Clin Lung Cancer 2022; 23:226-235. [DOI: 10.1016/j.cllc.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/30/2021] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
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22
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Management of Ground-Glass Nodules: When and How to Operate? Cancers (Basel) 2022; 14:cancers14030715. [PMID: 35158981 PMCID: PMC8833330 DOI: 10.3390/cancers14030715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/23/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary An increasing number of lung cancer screening programs have detected the frequent occurrence of small pulmonary ground-glass nodules (GGNs). If GGN is an incidental finding, it should be followed according to the guidelines. A multidisciplinary team discussion should be initiated if a new solid component develops or the solid portion grows on follow-up CT. Preoperative attempts to biopsy solid components in part-solid GGNs are often not feasible and not helpful. If malignancy is suspected, a surgical biopsy with the guidance of various localization methods is recommended. Once the GGN is confirmed to be malignant, sub-lobar resection may be reasonable in the majority of cases, and the extent of lung resection should be determined based on the CT finding or intraoperative frozen section examination using special inflation technique. Although rare, the recurrence in the remaining lobe can occur especially in patients with high risk histologic features, which currently cannot accurately diagnosed either pre- or intra-operatively. Abstract With the increased popularity of low-dose computed tomography (LDCT), many patients present with pulmonary ground-glass nodules (GGNs), and the appropriate diagnostic and management strategy of those lesions make physicians be on the horn of the clinical dilemma. As there is not enough data available to set universally acceptable guidelines, the management of GGNs may be different. If GGN is an incidental finding through LDCT, the lesion should be followed according to the current guidelines. We recommend a multidisciplinary team discussion to be initiated if a new solid component develops or the solid portion size grows on follow-up CT as the risk of malignancy is high. Attempts to preoperatively biopsy solid components in part-solid GGNs are often not feasible and not helpful in clinical settings. Currently, if malignancy is suspected, a surgical biopsy with the guidance of various localization methods is recommended. If malignancy is confirmed, sub-lobar resection may provide an excellent oncologic outcome.
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23
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Wu FZ, Wu YJ, Chen CS, Yang SC. Impact of Smoking Status on Lung Cancer Characteristics and Mortality Rates between Screened and Non-Screened Lung Cancer Cohorts: Real-World Knowledge Translation and Education. J Pers Med 2022; 12:jpm12010026. [PMID: 35055341 PMCID: PMC8780024 DOI: 10.3390/jpm12010026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
This was a retrospective hospital-based cohort study of participants diagnosed with lung cancer in the lung cancer register database, and our goal was to evaluate the impact of smoking and screening status on lung cancer characteristics and clinical outcomes. According to the hospital-based lung cancer register database, a total of 2883 lung cancers were diagnosed in 2883 patients between January 2007 and September 2017, which were divided into four groups according to smoking and screening status. A comparison was performed in terms of clinical characteristics and outcomes of lung cancer between the four groups. For non-smokers, age, gender, screened status, tumor size, targeted therapy, and curative surgery were independent prognostic factors of overall survival for lung cancer subjects. However, screened status and gender were not significant prognostic factors for lung cancer survival in smokers with lung cancer. For the non-smoker group, about 4.9% of lung cancer subjects (N = 81) were detected by screening. However, only 0.97% of lung cancer subjects (N = 12) were detected by screening in smokers. This could be attributed to smokers' negative attitudes and low socioeconomic status preventing LDCT lung cancer screening. In summary, our real-world data suggest that effectively encouraging smokers to be more willing to participate in lung cancer screening programs with screening allowance and educational training in the future is an important issue.
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Affiliation(s)
- Fu-Zong Wu
- Institute of Education, National Sun Yat-sen University, 70, Lien-Hai Road, Kaohsiung 80424, Taiwan;
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
- Department of Medical Research and Education, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Faculty of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Yun-Ju Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
| | - Chi-Shen Chen
- Physical Examination Center, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
| | - Shu-Ching Yang
- Institute of Education, National Sun Yat-sen University, 70, Lien-Hai Road, Kaohsiung 80424, Taiwan;
- Correspondence:
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Bocchialini G, Lagrasta C, Madeddu D, Mazzaschi G, Marturano D, Sogni F, Silini EM, Gnetti L, Becchi G, Rusca M, Carbognani P, Ventura L, Braggio C, Tiseo M, Quaini F, Ampollini L. Spatial architecture of tumour-infiltrating lymphocytes as a prognostic parameter in resected non-small-cell lung cancer. Eur J Cardiothorac Surg 2021; 58:619-628. [PMID: 32267920 DOI: 10.1093/ejcts/ezaa098] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/14/2020] [Accepted: 02/21/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Tumour-infiltrating lymphocytes (TILs) are critically implicated in the clinical outcome and response to immunotherapy in non-small-cell lung cancer (NSCLC) patients. The functional competence of lymphocyte subpopulations is strongly conditioned by their spatial arrangement within the tumour immune microenvironment. The aim of this study was to determine whether the tissue localization of specific TIL subpopulations might have an impact on the risk of recurrence in surgically resected NSCLC. METHODS High-speed scanning of whole slide images was performed on immunohistochemically stained tissue sections from 97 NSCLC patients to assess the number and ratio of CD3+, CD8+ and PD-1+ T-lymphocytes. TIL distribution was computed considering the intratumoural (proximal or distal) and peripheral (invasive margin) localization as well as their location within the fibrotic tissue (immune excluded). The tumour proliferative index was assessed by Ki67 labelling. The impact of TILs number and distribution on clinical-pathological characteristics and outcomes were statistically analysed. RESULTS High density and percentage of proximal CD8+ TILs and low PD-1-to-CD8 ratio had a positive impact on disease-free-survival (P = 0.03) and overall survival (P = 0.003). An inverse correlation was observed between the abundance of intratumoural CD8+ TILs carrying PD-1 inhibitory receptor and cancer cell proliferation. Cases with high compared to low fraction of immune excluded CD8+ TILs had significantly reduced 5-year overall survival (n events: 22 vs 12; P = 0.04) and disease-free survival (n events: 24 vs 16; P = 0.03) rates while the amount of CD3+ and CD8+ TILs located at the invasive margin had a favourable effect on the clinical course. CONCLUSIONS Mapping TIL subpopulations may implement the definition of prognostic parameters in surgically resected NSCLC.
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Affiliation(s)
- Giovanni Bocchialini
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Costanza Lagrasta
- Department of Medicine and Surgery, Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Denise Madeddu
- Department of Medicine and Surgery, Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Giulia Mazzaschi
- Medical Oncology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Davide Marturano
- Department of Medicine and Surgery, Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Francesco Sogni
- Department of Medicine and Surgery, Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Enrico Maria Silini
- Department of Medicine and Surgery, Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Letizia Gnetti
- Department of Medicine and Surgery, Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Gabriella Becchi
- Department of Medicine and Surgery, Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Michele Rusca
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Paolo Carbognani
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Luigi Ventura
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Cesare Braggio
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Federico Quaini
- Haematology and Bone Marrow Transplantation, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Luca Ampollini
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
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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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Ricciardi S, Booton R, Petersen RH, Infante M, Scarci M, Veronesi G, Cardillo G. Managing of screening-detected sub-solid nodules-a European perspective. Transl Lung Cancer Res 2021; 10:2368-2377. [PMID: 34164284 PMCID: PMC8182699 DOI: 10.21037/tlcr.2020.03.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since the National Lung Screening Trial in 2011 showed a 20% reduction in lung cancer mortality using annual low-dose computed tomography (LDCT), several randomised controlled trials and studies have been started in Europe. These include the Italian lung study (ITALUNG), the Dutch-Belgian lung cancer screening trial (NELSON), the UK lung cancer screening trial (UKLS), the Detection and screening of early lung cancer with novel imaging technology (DANTE), the Danish lung cancer screening trial (DLCST), the German lung cancer screening intervention trial (LUSI), the Multicentric Italian lung detection trial (MILD) and the CT screening for lung cancer study (COSMOS). As a result of the increasing number of screening trials and the growing utilization of LDCT, the high detection of subsolid nodules is an increasingly important clinical problem. In the last few years, several guidelines have been published and providing guidance on the optimal management of subsolid nodules, but many controversies still exist. Follow-up imaging plays an important role in clinical assessment and subsequent management of this particular type of lung nodules, since they can be transient inflammatory lesions, and if persistent they can be both benign lesions or lung cancers of variable clinical behaviour. However, the vast majority of subsolid nodules retain an indolent course over many years. The aim of this review is to present a European perspective in management of screening detected subsolid nodules.
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Affiliation(s)
- Sara Ricciardi
- Division of Thoracic Surgery, Department of Surgical, Medical, Molecular, Pathology and Critical Care, University Hospital of Pisa, Pisa, Italy
| | - Richard Booton
- North West Lung Centre, Wythenshawe Hospital, Manchester University Foundation Trust & School of Biological Sciences, The University of Manchester, Manchester UK
| | - Renè Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University, Rigshospitalet, Copenhagen, Denmark
| | - Maurizio Infante
- Department of Thoracic Surgery, University and Hospital Trust, Verona, Italy
| | - Marco Scarci
- Department of Thoracic Surgery, S. Gerardo Hospital, Monza, Italy
| | - Giulia Veronesi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University Milan, Milan, Italy.,IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
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Martini K, Chassagnon G, Frauenfelder T, Revel MP. Ongoing challenges in implementation of lung cancer screening. Transl Lung Cancer Res 2021; 10:2347-2355. [PMID: 34164282 PMCID: PMC8182720 DOI: 10.21037/tlcr-2021-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is the leading cause of cancer deaths in Europe and around the world. Although available therapies have undergone considerable development in the past decades, the five-year survival rate for lung cancer remains low. This sobering outlook results mainly from the advanced stages of cancer most patients are diagnosed with. As the population at risk is relatively well defined and early stage disease is potentially curable, lung cancer outcomes may be improved by screening. Several studies already show that lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality. However, for a successful implementation of LCS programmes, several challenges have to be overcome: selection of high-risk individuals, standardization of nodule classification and measurement, specific training of radiologists, optimization of screening intervals and screening duration, handling of ancillary findings are some of the major points which should be addressed. Last but not least, the psychological impact of screening on screened individuals and the impact of potential false positive findings should not be neglected. The aim of this review is to discuss the different challenges of implementing LCS programmes and to give some hints on how to overcome them. Finally, we will also discuss the psychological impact of screening on quality of life and the importance of smoking cessation.
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Affiliation(s)
- Katharina Martini
- Radiology Department, Hôpital Cochin, APHP.Centre-Université de Paris, Paris, France.,Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Guillaume Chassagnon
- Radiology Department, Hôpital Cochin, APHP.Centre-Université de Paris, Paris, France
| | - Thomas Frauenfelder
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Marie-Pierre Revel
- Radiology Department, Hôpital Cochin, APHP.Centre-Université de Paris, Paris, France
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Silva M, Milanese G, Ledda RE, Pastorino U, Sverzellati N. Screen-detected solid nodules: from detection of nodule to structured reporting. Transl Lung Cancer Res 2021; 10:2335-2346. [PMID: 34164281 PMCID: PMC8182712 DOI: 10.21037/tlcr-20-296] [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] [Indexed: 12/18/2022]
Abstract
Lung cancer screening (LCS) is gaining some interest worldwide after positive results from International trials. Unlike other screening practices, LCS is performed by an extremely sensitive test, namely low-dose computed tomography (LDCT) that can detect the smallest nodules in lung parenchyma. Up-to-date detection approaches, such as computer aided detection systems, have been increasingly employed for lung nodule automatic identification and are largely used in most LCS programs as a complementary tool to visual reading. Solid nodules of any size are represented in the vast majority of subjects undergoing LDCT. However, less than 1% of solid nodules will be diagnosed lung cancer. This fact calls for specific characterization of nodules to avoid false positives, overinvestigation, and reduce the risks associated with nodule work up. Recent research has been exploring the potential of artificial intelligence, including deep learning techniques, to enhance the accuracy of both detection and characterisation of lung nodule. Computer aided detection and diagnosis algorithms based on artificial intelligence approaches have demonstrated the ability to accurately detect and characterize parenchymal nodules, reducing the number of false positives, and to outperform some of the currently used risk models for prediction of lung cancer risk, potentially reducing the proportion of surveillance CT scans. These forthcoming approaches will eventually integrate a new reasoning for development of future guidelines, which are expected to evolve into precision and personalized stratification of lung cancer risk stratification by continuous fashion, as opposed to the current format with a limited number of risk classes within fixed thresholds of nodule size. This review aims to detail the standard of reference for optimal management of solid nodules by low-dose computed and its projection into the fine selection of candidates for work up.
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Affiliation(s)
- Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Roberta E Ledda
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Ugo Pastorino
- Section of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
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Jiang B, Zhang Y, Zhang L, H de Bock G, Vliegenthart R, Xie X. Human-recognizable CT image features of subsolid lung nodules associated with diagnosis and classification by convolutional neural networks. Eur Radiol 2021; 31:7303-7315. [PMID: 33847813 DOI: 10.1007/s00330-021-07901-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/03/2021] [Accepted: 03/16/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The interpretability of convolutional neural networks (CNNs) for classifying subsolid nodules (SSNs) is insufficient for clinicians. Our purpose was to develop CNN models to classify SSNs on CT images and to investigate image features associated with the CNN classification. METHODS CT images containing SSNs with a diameter of ≤ 3 cm were retrospectively collected. We trained and validated CNNs by a 5-fold cross-validation method for classifying SSNs into three categories (benign and preinvasive lesions [PL], minimally invasive adenocarcinoma [MIA], and invasive adenocarcinoma [IA]) that were histologically confirmed or followed up for 6.4 years. The mechanism of CNNs on human-recognizable CT image features was investigated and visualized by gradient-weighted class activation map (Grad-CAM), separated activation channels and areas, and DeepDream algorithm. RESULTS The accuracy was 93% for classifying 586 SSNs from 569 patients into three categories (346 benign and PL, 144 MIA, and 96 IA in 5-fold cross-validation). The Grad-CAM successfully located the entire region of image features that determined the final classification. Activated areas in the benign and PL group were primarily smooth margins (p < 0.001) and ground-glass components (p = 0.033), whereas in the IA group, the activated areas were mainly part-solid (p < 0.001) and solid components (p < 0.001), lobulated shapes (p < 0.001), and air bronchograms (p < 0.001). However, the activated areas for MIA were variable. The DeepDream algorithm showed the image features in a human-recognizable pattern that the CNN learned from a training dataset. CONCLUSION This study provides medical evidence to interpret the mechanism of CNNs that helps support the clinical application of artificial intelligence. KEY POINTS • CNN achieved high accuracy (93%) in classifying subsolid nodules on CT images into three categories: benign and preinvasive lesions, MIA, and IA. • The gradient-weighted class activation map (Grad-CAM) located the entire region of image features that determined the final classification, and the visualization of the separated activated areas was consistent with radiologists' expertise for diagnosing subsolid nodules. • DeepDream showed the image features that CNN learned from a training dataset in a human-recognizable pattern.
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Affiliation(s)
- Beibei Jiang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China
| | - Yaping Zhang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China
| | - Lu Zhang
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Xueqian Xie
- Radiology Department, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Haining Rd.100, Shanghai, 200080, China.
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30
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Tringali G, Milanese G, Ledda RE, Pastorino U, Sverzellati N, Silva M. Lung Cancer Screening: Evidence, Risks, and Opportunities for Implementation. ROFO-FORTSCHR RONTG 2021; 193:1153-1161. [PMID: 33772489 DOI: 10.1055/a-1382-8648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer is the most common cause of cancer death worldwide. Several trials with different screening approaches have recognized the role of lung cancer screening with low-dose CT for reducing lung cancer mortality. The efficacy of lung cancer screening depends on many factors and implementation is still pending in most European countries. METHODS This review aims to portray current evidence on lung cancer screening with a focus on the potential for opportunities for implementation strategies. Pillars of lung cancer screening practice will be discussed according to the most updated literature (PubMed search until November 16, 2020). RESULTS AND CONCLUSION The NELSON trial showed reduction of lung cancer mortality, thus confirming previous results of independent European studies, notably by volume of lung nodules. Heterogeneity in patient recruitment could influence screening efficacy, hence the importance of risk models and community-based screening. Recruitment strategies develop and adapt continuously to address the specific needs of the heterogeneous population of potential participants, the most updated evidence comes from the UK. The future of lung cancer screening is a tailored approach with personalized continuous stratification of risk, aimed at reducing costs and risks. KEY POINTS · Secondary prevention of lung cancer by low-dose computed tomography showed a reduction of lung cancer mortality.. · Semi-automated volume measurement and use of volume doubling time should be the reference method for optimization of risks, namely controlling measurement variability and the false-positive rate.. · A conservative approach with surveillance of subsolid nodules can be one of the strategies to reduce the risk of overdiagnosis and overtreatment.. · The goal of a tailored approach with personalized risk stratification aims to reduce costs and risks. A longer interval between rounds is one option for participants at lower risk.. CITATION FORMAT · Tringali G, Milanese G, Ledda RE et al. Lung Cancer Screening: Evidence, Risks, and Opportunities for Implementation. Fortschr Röntgenstr 2021; 193: 1153 - 1161.
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Affiliation(s)
- Giulia Tringali
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Gianluca Milanese
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Roberta Eufrasia Ledda
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
| | - Mario Silva
- Department of Medicine and Surgery (DiMeC - Scienze Radiologiche), University of Parma, Italy
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Bartlett EC, Silva M, Callister ME, Devaraj A. False-Negative Results in Lung Cancer Screening-Evidence and Controversies. J Thorac Oncol 2021; 16:912-921. [PMID: 33545386 DOI: 10.1016/j.jtho.2021.01.1607] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/22/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022]
Abstract
Identifying false-negative cases is an important quality metric in lung cancer screening, but it has been infrequently and variably reported in previous studies. Although as a proportion of all screening participants, false-negative cases are uncommon, such cases may constitute a substantial proportion of all lung cancers diagnosed (up to 15%) within a screening program. This article reviews the impact and causes of false-negative lung cancer screening tests, including those related to radiologic evaluation, nodule management protocols, and management decisions made by multidisciplinary teams. Following a review of data from international screening studies, this article discusses the controversies within the screening literature surrounding the definition and classification of a false-negative lung cancer screening test and how data on false-negative rates should be captured and recorded. Challenges, such as avoiding overly cautious surveillance of lung nodules while minimizing overdiagnosis and investigation of indolent or benign lesions, are considered. Finally, the advantages and disadvantages of different approaches to dealing with false-negative results in lung cancer screening are discussed.
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Affiliation(s)
- Emily C Bartlett
- Department of Radiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Mario Silva
- Section of "Scienze Radiologiche," Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Matthew E Callister
- St James's University Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom.
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Delorme S, Kaaks R. Lung Cancer Screening by Low-Dose Computed Tomography: Part 2 - Key Elements for Programmatic Implementation of Lung Cancer Screening. ROFO-FORTSCHR RONTG 2020; 193:644-651. [PMID: 33212539 DOI: 10.1055/a-1290-7817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE For screening with low-dose CT (LDCT) to be effective, the benefits must outweigh the potential risks. In large lung cancer screening studies, a mortality reduction of approx. 20 % has been reported, which requires several organizational elements to be achieved in practice. MATERIALS AND METHODS The elements to be set up are an effective invitation strategy, uniform and quality-assured assessment criteria, and computer-assisted evaluation tools resulting in a nodule management algorithm to assign each nodule the needed workup intensity. For patients with confirmed lung cancer, immediate counseling and guideline-compliant treatment in tightly integrated regional expert centers with expert skills are required. First, pulmonology contacts as well as CT facilities should be available in the participant's neighborhood. IT infrastructure, linkage to clinical cancer registries, quality management as well as epidemiologic surveillance are also required. RESULTS An effective organization of screening will result in an articulated structure of both widely distributed pulmonology offices as the participants' primary contacts and CT facilities as well as central expert facilities for supervision of screening activities, individual clarification of suspicious findings, and treatment of proven cancer. CONCLUSION In order to ensure that the benefits of screening more than outweigh the potential harms and that it will be accepted by the public, a tightly organized structure is needed to ensure wide availability of pulmonologists as first contacts and CT facilities with expert skills and high-level equipment concentrated in central facilities. KEY POINTS · For lung cancer screening, elements must function optimally and be tightly organized.. · Lung cancer screening requires a network of expert centers and collaborating facilities.. · IT infrastructure, QM, epidemiological surveillance, and linkage to cancer registries are essential.. CITATION FORMAT · Delorme S, Kaaks R: Lung Cancer Screening by Low-Dose Computed Tomography: Part 2 - Key Elements for Programmatic Implementation of Lung Cancer Screening. Fortschr Röntgenstr 2021; 193: 644 - 651.
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Affiliation(s)
- Stefan Delorme
- Division of Radiology, German Cancer Research Centre, Heidelberg, Germany
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany.,Translational Lung Research Center (TLRC) Heidelberg, Member of the German Center for Lung Research (DZL), Germany
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33
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Infante MV, Cardillo G. Lung cancer screening in never-smokers: facts and remaining issues. Eur Respir J 2020; 56:56/5/2002949. [DOI: 10.1183/13993003.02949-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 12/12/2022]
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34
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Silva M, Milanese G, Kauczor HU, Revel MP, Sverzellati N. Milestones towards lung cancer screening implementation. Clin Radiol 2020; 75:881-885. [PMID: 32863024 DOI: 10.1016/j.crad.2020.07.028] [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: 04/30/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023]
Abstract
The European Society of Radiology (ESR) and European Respiratory Society (ERS) published their joint statement paper on lung cancer screening (LCS), on 12 February 2020. This document joins and completes previous recommendations on LCS with specific emphasis on the analysis of issues encountered in the practical implementation of LCS in the community. Major milestones to enable the most efficient and equal dissemination of LCS are recognised as engagement of all stakeholders (e.g. candidate/participant, general practitioners, up to the specialised LCS facility), quality assurance, and primary prevention in the form of provision of counselling for smoking cessation.
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Affiliation(s)
- M Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Italy.
| | - G Milanese
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Italy
| | - H-U Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - M-P Revel
- Radiology Department, Cochin Hospital, APHP, Paris, France
| | - N Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Italy
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35
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Dezube AR, Jaklitsch MT. New evidence supporting lung cancer screening with low dose CT & surgical implications. Eur J Surg Oncol 2020; 46:982-990. [DOI: 10.1016/j.ejso.2020.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Nardi Agmon I, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Respir J 2020; 55:13993003.00506-2019. [PMID: 32051182 DOI: 10.1183/13993003.00506-2019] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Dept of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, CH Lyon Sud, Pierre Bénite, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Dept of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Dept of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Dept of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Dept of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital Sotiria, Athens, Greece
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37
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Agmon IN, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Radiol 2020; 30:3277-3294. [PMID: 32052170 DOI: 10.1007/s00330-020-06727-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany.
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Department of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, Sud, Pierre Bénite, Lyon, CH, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Department of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Department of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
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Borghesi A, Michelini S, Golemi S, Scrimieri A, Maroldi R. What's New on Quantitative CT Analysis as a Tool to Predict Growth in Persistent Pulmonary Subsolid Nodules? A Literature Review. Diagnostics (Basel) 2020; 10:E55. [PMID: 31973010 PMCID: PMC7168253 DOI: 10.3390/diagnostics10020055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 12/23/2022] Open
Abstract
Pulmonary subsolid nodules (SSNs) are observed not infrequently on thin-section chest computed tomography (CT) images. SSNs persisting after a follow-up period of three to six months have a high likelihood of being pre-malignant or malignant lesions. Malignant SSNs usually represent the histologic spectrum of pulmonary adenocarcinomas, and pulmonary adenocarcinomas presenting as SSNs exhibit quite heterogeneous behavior. In fact, while most lesions show an indolent course and may grow very slowly or remain stable for many years, others may exhibit significant growth in a relatively short time. Therefore, it is not yet clear which persistent SSNs should be surgically removed and for how many years stable SSNs should be monitored. In order to solve these two open issues, the use of quantitative analysis has been proposed to define the "tailored" management of persistent SSNs. The main purpose of this review was to summarize recent results about quantitative CT analysis as a diagnostic tool for predicting the behavior of persistent SSNs. Thus, a literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science databases to find original articles published from January 2014 to October 2019. The results of the selected studies are presented and compared in a narrative way.
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Affiliation(s)
- Andrea Borghesi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
| | - Silvia Michelini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124 Brescia, Italy;
| | - Salvatore Golemi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
| | - Alessandra Scrimieri
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
| | - Roberto Maroldi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
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Wang Y, Wu B, Zhang N, Liu J, Ren F, Zhao L. Research progress of computer aided diagnosis system for pulmonary nodules in CT images. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:1-16. [PMID: 31815727 DOI: 10.3233/xst-190581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Since CAD (Computer Aided Diagnosis) system can make it easier and more efficient to interpret CT (Computer Tomography) images, it has gained much attention and developed rapidly in recent years. This article reviews recent CAD techniques for pulmonary nodule detection and diagnosis in CT Images. METHODS CAD systems can be classified into computer-aided detection (CADe) and computer-aided diagnosis (CADx) systems. This review reports recent researches of both systems, including the database, technique, innovation and experimental results of each work. Multi-task CAD systems, which can handle segmentation, false positive reduction, malignancy prediction and other tasks at the same time. The commercial CAD systems are also briefly introduced. RESULTS We have found that deep learning based CAD is the mainstream of current research. The reported sensitivity of deep learning based CADe systems ranged between 80.06% and 94.1% with an average 4.3 false-positive (FP) per scan when using LIDC-IDRI dataset, and between 94.4% and 97.9% with an average 4 FP/scan when using LUNA16 dataset, respectively. The overall accuracy of deep learning based CADx systems ranged between 86.84% and 92.3% with an average AUC of 0.956 reported when using LIDC-IDRI dataset. CONCLUSIONS We summarized the current tendency and limitations as well as future challenges in this field. The development of CAD needs to meet the rigid clinical requirements, such as high accuracy, strong robustness, high efficiency, fine-grained analysis and classification, and to provide practical clinical functions. This review provides helpful information for both engineering researchers and radiologists to learn the latest development of CAD systems.
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Affiliation(s)
- Yu Wang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Bo Wu
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Nan Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Jiabao Liu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Fei Ren
- Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China
| | - Liqin Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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40
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Fernandez C, Grills IS, Ye H, Hope AJ, Guckenberger M, Mantel F, Kestin LL, Belderbos J, Werner-Wasik M. Stereotactic Image Guided Lung Radiation Therapy for Clinical Early Stage Non-Small Cell Lung Cancer: A Long-Term Report From a Multi-Institutional Database of Patients Treated With or Without a Pathologic Diagnosis. Pract Radiat Oncol 2019; 10:e227-e237. [PMID: 31837478 DOI: 10.1016/j.prro.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/07/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Early stage lung cancer is treated with stereotactic body radiation therapy (SBRT) in patients who are unable or unwilling to undergo surgical resection. Some patients' comorbidities are so severe that they are unable to even undergo a biopsy. A clinical diagnosis without biopsy before SBRT has been used, but there are limited data on its efficacy. METHODS AND MATERIALS Data on patients treated with SBRT for non-small cell lung cancer, with and without tissue confirmation, were collected from multiple institutions across Europe, Canada, and the United States. Patients with a minimum of 2 years of comprehensive follow up were selected for analysis. Treatment and patient characteristics were compared. Overall survival (OS), disease-free survival (DFS), cause-specific survival (CSS), and rates of local recurrence (LR), regional recurrence (RR), and distant metastasis (DM) were calculated and analyzed. RESULTS A total of 701 patients were identified, of which 67% had tissue confirmation of their tumors. The 3- and 5-year outcomes for OS, CSS, and DFS were 83.8%, 93.1%, 69%, and 60.6%, 86.7%, 45.5%, respectively. The rates for LR, RR, and DM at 3 and 5 years were 6.4%, 9.3%, 14.3%, and 10.5%, 14.3%, 19.7%, respectively. There were no statistically significant differences in survival outcomes or recurrences between the biopsy and no-biopsy cohorts. CONCLUSIONS SBRT for clinically diagnosed lung cancers is efficacious in appropriately selected patients, with similar outcomes as those with a pathologic diagnosis. Thorough clinical and radiographic evaluations in a multidisciplinary setting are critical to the management of these patients.
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Affiliation(s)
- Christian Fernandez
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Inga S Grills
- Department of Radiation Oncology, William Beaumont Health, Royal Oak, Michigan
| | - Hong Ye
- Department of Radiation Oncology, William Beaumont Health, Royal Oak, Michigan
| | - Andrew J Hope
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Frederick Mantel
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Larry L Kestin
- Michigan Health Professionals, Radiation Oncology Institute, Farmington Hills, Michigan
| | - Jose Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
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41
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Heidinger BH, Silva M, de Margerie-Mellon C, VanderLaan PA, Bankier AA. The natural course of incidentally detected, small, subsolid lung nodules-is follow-up needed beyond current guideline recommendations? Transl Lung Cancer Res 2019; 8:S412-S417. [PMID: 32038927 DOI: 10.21037/tlcr.2019.11.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Benedikt H Heidinger
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Mario Silva
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy.,Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Paul A VanderLaan
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alexander A Bankier
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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42
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Evolving the pulmonary nodules diagnosis from classical approaches to deep learning-aided decision support: three decades' development course and future prospect. J Cancer Res Clin Oncol 2019; 146:153-185. [PMID: 31786740 DOI: 10.1007/s00432-019-03098-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Lung cancer is the commonest cause of cancer deaths worldwide, and its mortality can be reduced significantly by performing early diagnosis and screening. Since the 1960s, driven by the pressing needs to accurately and effectively interpret the massive volume of chest images generated daily, computer-assisted diagnosis of pulmonary nodule has opened up new opportunities to relax the limitation from physicians' subjectivity, experiences and fatigue. And the fair access to the reliable and affordable computer-assisted diagnosis will fight the inequalities in incidence and mortality between populations. It has been witnessed that significant and remarkable advances have been achieved since the 1980s, and consistent endeavors have been exerted to deal with the grand challenges on how to accurately detect the pulmonary nodules with high sensitivity at low false-positive rate as well as on how to precisely differentiate between benign and malignant nodules. There is a lack of comprehensive examination of the techniques' development which is evolving the pulmonary nodules diagnosis from classical approaches to machine learning-assisted decision support. The main goal of this investigation is to provide a comprehensive state-of-the-art review of the computer-assisted nodules detection and benign-malignant classification techniques developed over three decades, which have evolved from the complicated ad hoc analysis pipeline of conventional approaches to the simplified seamlessly integrated deep learning techniques. This review also identifies challenges and highlights opportunities for future work in learning models, learning algorithms and enhancement schemes for bridging current state to future prospect and satisfying future demand. CONCLUSION It is the first literature review of the past 30 years' development in computer-assisted diagnosis of lung nodules. The challenges indentified and the research opportunities highlighted in this survey are significant for bridging current state to future prospect and satisfying future demand. The values of multifaceted driving forces and multidisciplinary researches are acknowledged that will make the computer-assisted diagnosis of pulmonary nodules enter into the main stream of clinical medicine and raise the state-of-the-art clinical applications as well as increase both welfares of physicians and patients. We firmly hold the vision that fair access to the reliable, faithful, and affordable computer-assisted diagnosis for early cancer diagnosis would fight the inequalities in incidence and mortality between populations, and save more lives.
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43
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Pastorino U, Sverzellati N, Sestini S, Silva M, Sabia F, Boeri M, Cantarutti A, Sozzi G, Corrao G, Marchianò A. Ten-year results of the Multicentric Italian Lung Detection trial demonstrate the safety and efficacy of biennial lung cancer screening. Eur J Cancer 2019; 118:142-148. [PMID: 31336289 DOI: 10.1016/j.ejca.2019.06.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Multicentric Italian Lung Detection (MILD) trial demonstrated that prolonged low-dose computed tomography (LDCT) screening could achieve a 39% reduction in lung cancer (LC) mortality. We have here evaluated the long-term results of annual vs. biennial LDCT and the impact of screening intensity on overall and LC-specific mortality at 10 years. PATIENTS AND METHODS Between 2005 and 2018, the MILD trial prospectively randomised the 2376 screening arm participants to annual (n = 1190) or biennial (n = 1186) LDCT, for a median screening period of 6.2 years and 23,083 person-years of follow-up. The primary outcomes were 10-year overall and LC-specific mortality, and the secondary end-points were the frequency of advanced-stage and interval LCs. RESULTS The biennial LDCT arm showed a similar overall mortality (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.57-1.12) and LC-specific mortality at 10 years (HR 1.10, 95% CI 0.59-2.05), as compared with the annual LDCT arm. Biennial screening saved 44% of follow-up LDCTs in subjects with negative baseline LDCT, and 38% of LDCTs in all participants, with no increase in the occurrence of stage II-IV or interval LCs. CONCLUSIONS The MILD trial provides original evidence that prolonged screening beyond five years with biennial LDCT can achieve an LC mortality reduction comparable to annual LDCT, in subjects with a negative baseline examination.
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Affiliation(s)
- U Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
| | - N Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - S Sestini
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Silva
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - F Sabia
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - M Boeri
- Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - A Cantarutti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - G Sozzi
- Tumor Genomics Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - G Corrao
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - A Marchianò
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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Pastorino U, Silva M, Sestini S, Sabia F, Boeri M, Cantarutti A, Sverzellati N, Sozzi G, Corrao G, Marchianò A. Prolonged lung cancer screening reduced 10-year mortality in the MILD trial: new confirmation of lung cancer screening efficacy. Ann Oncol 2019; 30:1162-1169. [PMID: 30937431 PMCID: PMC6637372 DOI: 10.1093/annonc/mdz117] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The National Lung Screening Trial showed that lung cancer (LC) screening by three annual rounds of low-dose computed tomography (LDCT) reduces LC mortality. We evaluated the benefit of prolonged LDCT screening beyond 5 years, and its impact on overall and LC specific mortality at 10 years. DESIGN The Multicentric Italian Lung Detection (MILD) trial prospectively randomized 4099 participants, to a screening arm (n = 2376), with further randomization to annual (n = 1190) or biennial (n = 1186) LDCT for a median period of 6 years, or control arm (n = 1723) without intervention. Between 2005 and 2018, 39 293 person-years of follow-up were accumulated. The primary outcomes were 10-year overall and LC specific mortality. Landmark analysis was used to test the long-term effect of LC screening, beyond 5 years by exclusion of LCs and deaths that occurred in the first 5 years. RESULTS The LDCT arm showed a 39% reduced risk of LC mortality at 10 years [hazard ratio (HR) 0.61; 95% confidence interval (CI) 0.39-0.95], compared with control arm, and a 20% reduction of overall mortality (HR 0.80; 95% CI 0.62-1.03). LDCT benefit improved beyond the 5th year of screening, with a 58% reduced risk of LC mortality (HR 0.42; 95% CI 0.22-0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49-0.94). CONCLUSIONS The MILD trial provides additional evidence that prolonged screening beyond 5 years can enhance the benefit of early detection and achieve a greater overall and LC mortality reduction compared with NLST trial. CLINICALTRIALS.GOV IDENTIFIER NCT02837809.
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Affiliation(s)
- U Pastorino
- Unit of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan.
| | - M Silva
- Unit of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan; Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma
| | - S Sestini
- Unit of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - F Sabia
- Unit of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - M Boeri
- Tumour Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - A Cantarutti
- Division of Biostatistics, Department of Statistics and Quantitative Methods, Epidemiology and Public Health, University of Milano-Bicocca, Milan
| | - N Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma
| | - G Sozzi
- Tumour Genomics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - G Corrao
- Division of Biostatistics, Department of Statistics and Quantitative Methods, Epidemiology and Public Health, University of Milano-Bicocca, Milan
| | - A Marchianò
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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45
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Milanese G, Silva M, Frauenfelder T, Eberhard M, Sabia F, Martini C, Marchianò A, Prokop M, Sverzellati N, Pastorino U. Comparison of ultra-low dose chest CT scanning protocols for the detection of pulmonary nodules: a phantom study. TUMORI JOURNAL 2019; 105:394-403. [PMID: 31041885 DOI: 10.1177/0300891619847271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To test ultra-low-dose computed tomography (ULDCT) scanning protocols for the detection of pulmonary nodules (PN). METHODS A chest phantom containing 19 solid and 11 subsolid PNs was scanned on a third-generation dual-source computed tomography (CT) scanner. Five ULDCT scans (Sn100kVp and 120, 70, 50, 30, and 20 reference mAs, using tube current modulation), reconstructed with iterative reconstruction (IR) algorithm at strength levels 2, 3, 4, and 5, were compared with standard CT (120kVp, 150 reference mAs, using tube current modulation). PNs were subjectively assessed according to a 4-point scale: 0, nondetectable nodule; 1, detectable nodule, very unlikely to be correctly measured; 2, detectable nodule, likely to be correctly measured; 3, PN quality equal to standard of reference. PN scores were analysed according to the Lung Imaging Reporting and Data System (Lung-RADS), simulating detection of nodules at baseline and incidence screening round. RESULTS For the baseline round, there were 17 Lung-RADS 2, 4 Lung-RADS 3, 8 Lung-RADS 4A, and 1 Lung-RADS 4B PNs. They were detectable in any ULDCT protocol, with the exception of 1 nondetectable part-solid nodule in 1 scanning protocol (120 reference mAs; IR strength: 3). For the incidence round, there were 4 Lung-RADS 2, 14 Lung-RADS 3, 2 Lung-RADS 4A, and 10 Lung-RADS 4B PNs. Ten were nondetectable in at least one ULDCT dataset; however, they were at least detectable in ULDCT with 70 reference mAs (IR strength: 4 and 5). CONCLUSIONS ULDCT scanning protocols allowing the detection of PNs can be proposed for the purpose of lung cancer screening.
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Affiliation(s)
- Gianluca Milanese
- Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mario Silva
- Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Thomas Frauenfelder
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Federica Sabia
- Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alfonso Marchianò
- Department of Radiology, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mathias Prokop
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicola Sverzellati
- Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
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Ledda RE, Milanese G, Gnetti L, Borghesi A, Sverzellati N, Silva M. Spread through air spaces in lung adenocarcinoma: is radiology reliable yet? J Thorac Dis 2019; 11:S256-S261. [PMID: 30997191 DOI: 10.21037/jtd.2019.01.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Roberta E Ledda
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Letizia Gnetti
- Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Andrea Borghesi
- Department of Radiology, University and Spedali Civili of Brescia, Brescia, Italy
| | - Nicola Sverzellati
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
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Papapietro VR, Milanese G, Borghesi A, Sverzellati N, Silva M. Look around your target: a new approach to early diagnosis of lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S77. [PMID: 30613652 DOI: 10.21037/atm.2018.10.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Vito R Papapietro
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gianluca Milanese
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Borghesi
- Department of Radiology, University and Spedali Civili of Brescia, Brescia, Italy
| | - Nicola Sverzellati
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
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