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Wang Z, Zhang Q, Wang C, Herth FJF, Guo Z, Zhang X. Multiple primary lung cancer: Updates and perspectives. Int J Cancer 2024; 155:785-799. [PMID: 38783577 DOI: 10.1002/ijc.34994] [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: 10/18/2023] [Revised: 02/14/2024] [Accepted: 03/28/2024] [Indexed: 05/25/2024]
Abstract
Management of multiple primary lung cancer (MPLC) remains challenging, partly due to its increasing incidence, especially with the significant rise in cases of multiple lung nodules caused by low-dose computed tomography screening. Moreover, the indefinite pathogenesis, diagnostic criteria, and treatment selection add to the complexity. In recent years, there have been continuous efforts to dissect the molecular characteristics of MPLC and explore new diagnostic approaches as well as treatment modalities, which will be reviewed here, with a focus on newly emerging evidence and future perspectives, hope to provide new insights into the management of MPLC and serve as inspiration for future research related to MPLC.
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Affiliation(s)
- Ziqi Wang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan International Joint Laboratory of Diagnosis and Treatment for Pulmonary Nodules, Zhengzhou, Henan, China
| | - Quncheng Zhang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan International Joint Laboratory of Diagnosis and Treatment for Pulmonary Nodules, Zhengzhou, Henan, China
| | - Chaoyang Wang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan International Joint Laboratory of Diagnosis and Treatment for Pulmonary Nodules, Zhengzhou, Henan, China
| | - Felix J F Herth
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan International Joint Laboratory of Diagnosis and Treatment for Pulmonary Nodules, Zhengzhou, Henan, China
- Department of Pneumology and Critical Care Medicine Thoraxklinik, University of Heidelberg, Heidelberg, Germany
| | - Zhiping Guo
- Department of Health Management, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan Provincial Key Laboratory of Chronic Diseases and Health Management, Zhengzhou, Henan, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
- Henan International Joint Laboratory of Diagnosis and Treatment for Pulmonary Nodules, Zhengzhou, Henan, China
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Henschke C, Huber R, Jiang L, Yang D, Cavic M, Schmidt H, Kazerooni E, Zulueta JJ, Sales Dos Santos R, Ventura L. Perspective on Management of Low-Dose Computed Tomography Findings on Low-Dose Computed Tomography Examinations for Lung Cancer Screening. From the International Association for the Study of Lung Cancer Early Detection and Screening Committee. J Thorac Oncol 2024; 19:565-580. [PMID: 37979778 DOI: 10.1016/j.jtho.2023.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/24/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
Lung cancer screening using low-dose computed tomography (LDCT) carefully implemented has been found to reduce deaths from lung cancer. Optimal management starts with selection of eligibility criteria, counseling of screenees, smoking cessation, selection of the regimen of screening which specifies the imaging protocol, and workup of LDCT findings. Coordination of clinical, radiologic, and interventional teams and ultimately treatment of diagnosed lung cancers under screening determine the benefit of LDCT screening. Ethical considerations of who should be eligible for LDCT screening programs are important to provide the benefit to as many people at risk of lung cancer as possible. Unanticipated diseases identified on LDCT may offer important benefits through early detection of leading global causes of death, such as cardiovascular diseases and chronic obstructive pulmonary disease, as the latter may result from conditions such as emphysema and bronchiectasis, which can be identified early on LDCT. This report identifies the key components of the regimen of LDCT screening for lung cancer which include the need for a management system to provide data for continuous updating of the regimen and provides quality assurance assessment of actual screenings. Multidisciplinary clinical management is needed to maximize the benefit of early detection, diagnosis, and treatment of lung cancer. Different regimens have been evolving throughout the world as the resources and needs may be different, for countries with limited resources. Sharing of results, further knowledge, and incorporation of technologic advances will continue to accelerate worldwide improvements in the diagnostic and treatment approaches.
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Affiliation(s)
- Claudia Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Rudolf Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine, University of Munich - Campus Innenstadt, Ziemssenstrabe, Munich, Germany
| | - Long Jiang
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dawei Yang
- Department of Pulmonary Medicine and Critical Care, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Milena Cavic
- Department of Experimental Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Heidi Schmidt
- Department of Medical Imaging, Toronto General Hospital, Toronto, Canada
| | - Ella Kazerooni
- Division of Cardiothoracic Radiology and Internal Medicine, University of Michigan Medical School, Frankel Cardiovascular Center, Ann Arbor, Michigan
| | - Javier J Zulueta
- Department of Medicine, Mount Sinai Morningside, New York, New York
| | - Ricardo Sales Dos Santos
- Department of Minimally Invasive Thoracic and Robotic Surgery, Albert Einstein Israeli Hospital, Sao Paulo, Brazil
| | - Luigi Ventura
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
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Grenier PA. Cure Rate of Lung Cancer Diagnosed at Annual CT Screening. Radiology 2023; 309:e232698. [PMID: 37934092 DOI: 10.1148/radiol.232698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Philippe A Grenier
- From the Department of Clinical Research and Innovation, Hôpital Foch, 40 rue Worth, 92150 Suresnes, France
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Henschke CI, Yip R, Shaham D, Markowitz S, Cervera Deval J, Zulueta JJ, Seijo LM, Aylesworth C, Klingler K, Andaz S, Chin C, Smith JP, Taioli E, Altorki N, Flores RM, Yankelevitz DF. A 20-year Follow-up of the International Early Lung Cancer Action Program (I-ELCAP). Radiology 2023; 309:e231988. [PMID: 37934099 DOI: 10.1148/radiol.231988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Background The low-dose CT (≤3 mGy) screening report of 1000 Early Lung Cancer Action Program (ELCAP) participants in 1999 led to the International ELCAP (I-ELCAP) collaboration, which enrolled 31 567 participants in annual low-dose CT screening between 1992 and 2005. In 2006, I-ELCAP investigators reported the 10-year lung cancer-specific survival of 80% for 484 participants diagnosed with a first primary lung cancer through annual screening, with a high frequency of clinical stage I lung cancer (85%). Purpose To update the cure rate by determining the 20-year lung cancer-specific survival of participants diagnosed with first primary lung cancer through annual low-dose CT screening in the expanded I-ELCAP cohort. Materials and Methods For participants enrolled in the HIPAA-compliant prospective I-ELCAP cohort between 1992 and 2022 and observed until December 30, 2022, Kaplan-Meier survival analysis was used to determine the 10- and 20-year lung cancer-specific survival of participants diagnosed with first primary lung cancer through annual low-dose CT screening. Eligible participants were aged at least 40 years and had current or former cigarette use or had never smoked but had been exposed to secondhand tobacco smoke. Results Among 89 404 I-ELCAP participants, 1257 (1.4%) were diagnosed with a first primary lung cancer (684 male, 573 female; median age, 66 years; IQR, 61-72), with a median smoking history of 43.0 pack-years (IQR, 29.0-60.0). Median follow-up duration was 105 months (IQR, 41-182). The frequency of clinical stage I at pretreatment CT was 81% (1017 of 1257). The 10-year lung cancer-specific survival of 1257 participants was 81% (95% CI: 79, 84) and the 20-year lung cancer-specific survival was 81% (95% CI: 78, 83), and it was 95% (95% CI: 91, 98) for 181 participants with pathologic T1aN0M0 lung cancer. Conclusion The 10-year lung cancer-specific survival of 80% reported in 2006 for I-ELCAP participants enrolled in annual low-dose CT screening and diagnosed with a first primary lung cancer has persisted, as shown by the updated 20-year lung cancer-specific survival for the expanded I-ELCAP cohort. © RSNA, 2023 See also the editorials by Grenier and by Sequist and Olazagasti in this issue.
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Affiliation(s)
- Claudia I Henschke
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Rowena Yip
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Dorith Shaham
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Steven Markowitz
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - José Cervera Deval
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Javier J Zulueta
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Luis M Seijo
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Cheryl Aylesworth
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Karl Klingler
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Shahriyour Andaz
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Cynthia Chin
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - James P Smith
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Emanuela Taioli
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Nasser Altorki
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Raja M Flores
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - David F Yankelevitz
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
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Kim YW, Kwon BS, Lim SY, Lee YJ, Park JS, Cho YJ, Yoon HI, Lee KW, Lee JH, Chung JH, Ji E, Lee CT. Lung cancer probability and clinical outcomes of baseline and new subsolid nodules detected on low-dose CT screening. Thorax 2021; 76:980-988. [PMID: 33859050 PMCID: PMC8461405 DOI: 10.1136/thoraxjnl-2020-215107] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Limited data are available regarding the management of subsolid nodules detected on lung cancer screening with low-dose CT (LDCT). We aimed to determine the characteristics of screen-detected subsolid nodules, and to evaluate the probability of lung cancer and the clinical course of subsolid nodules detected at baseline and during follow-up screening. METHODS We evaluated 50 132 asymptomatic adults (22 631 never-smokers and 27 501 ever-smokers) who underwent LDCT screening for lung cancer between May 2003 and June 2019 at a tertiary centre in South Korea. The incidence, characteristics and clinical outcomes of the baseline and new screen-detected subsolid nodules were determined. RESULTS A total of 6725 subsolid nodules (5116 pure ground glass opacity nodules and 1609 part-solid nodules) were detected in 4545 participants (1484 new subsolid nodules detected in 937 (1.9%) participants; the overall incidence of subsolid nodules: 10.7% in never-smokers and 7.7% in ever-smokers, p<0.001). Among 4918 subsolid nodules that underwent follow-up with CT scans (the mean number of CT scans, including the baseline LDCT scan: 4.6), 2116 nodules (30.0% of baseline subsolid nodules and 78.9% of new subsolid nodules) resolved spontaneously. Among 293 biopsied subsolid nodules, 227 (77.5%) nodules were diagnosed as lung cancer, of which 226 (99.6%) were adenocarcinomas. No significant difference was observed in pathological invasiveness or the initial stage between the baseline and new cancerous subsolid nodules. Multivariable analyses revealed that new detection at follow-up screening was significantly associated with a lower probability of lung cancer (OR 0.26, 95% CI 0.14 to 0.49) and overall growth (OR 0.39, 95% CI 0.26 to 0.59), but with a higher probability of resolution (OR 6.30, 95% CI 5.09 to 7.81). CONCLUSIONS LDCT screening led to a considerably high rate of subsolid nodule detection, particularly in never-smokers. Compared with the baseline subsolid nodules, the new subsolid nodules were associated with a lower probability of lung cancer and higher probability of spontaneous resolution, indicating their more inflammatory nature. Less aggressive follow-up may be allowed for new subsolid nodules, particularly in screening programmes for Asian populations.
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Affiliation(s)
- Yeon Wook Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Byoung Soo Kwon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung Yoon Lim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yeon Joo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jong Sun Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Jae Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ho Il Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyung Won Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Ho Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin-Haeng Chung
- Department of Pathology and Translational Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eunjeong Ji
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Choon-Taek Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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6
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Zhu Y, Yip R, You N, Cai Q, Henschke CI, Yankelevitz DF. Characterization of Newly Detected Costal Pleura-attached Noncalcified Nodules at Annual Low-Dose CT Screenings. Radiology 2021; 301:724-731. [PMID: 34546130 DOI: 10.1148/radiol.2021210807] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Solid costal pleura-attached noncalcified nodules (CP-NCNs) less than 10.0 mm with lentiform, oval, or semicircular (LOS) or triangular shapes and smooth margins on baseline low-dose CT scans from the Mount Sinai Early Lung and Cardiac Action Program (MS-ELCAP) were reviewed, and it was determined that they can be followed up at the first annual screening rather than having a shorter-term work-up. Purpose To determine whether the same criteria could be used for solid CP-NCNs newly identified at annual screening examinations. Materials and Methods With use of the same MS-ELCAP database, all new solid CP-NCNs measuring 30.0 mm or less were identified at 4425 annual screening examinations between 2010 and 2019. In addition, to ensure that no malignant CP-NCNs met the criteria, all solid malignant CP-NCNs of 30.0 mm or less in the International Early Lung Cancer Action Program, or I-ELCAP, database of 111 102 annual screening examinations from the 76 participating institutions between 1992 and 2019 were identified; Mount Sinai is one of these institutions. All identified solid CP-NCNs were reviewed-with the radiologists blinded to diagnosis-for shape (triangular, LOS, polygonal, round, or irregular), margin (smooth or nonsmooth), pleural attachment (broad or narrow), and the presence of emphysema and/or fibrosis within 10.0 mm of each CP-NCN. Intra- and interreader readings were performed, and agreements were determined by using the B-statistic. Results Of the 76 new solid CP-NCNs, 21 were lung cancers. Benign CP-NCNs were smaller than malignant ones (median diameter, 4.2 mm vs 11 mm; P < .001), had a different shape distributions, more frequently had smooth margins (67% vs 14%; P < .001), and less frequently had emphysema (38% vs 81%; P = .003) or fibrosis (3.6% vs 19%; P = .045) within a 10.0 mm radius. All 22 solid CP-NCNs less than 10.0 mm in average diameter with triangular or LOS shapes and smooth margins were benign, and none of the 21 solid malignant CP-NCNs had these characteristics. Intra- and interobserver agreement for triangular or LOS-shaped CP-NCNs with smooth margins was almost perfect (0.77 and 0.69, respectively). Conclusion The same follow-up recommendation developed for baseline costal pleura-attached noncalcified nodules (CP-NCNs) can be used for CP-NCNs newly identified at annual screening rounds. © RSNA, 2021.
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Affiliation(s)
- Yeqing Zhu
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | - Rowena Yip
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | - Nan You
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | - Qiang Cai
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | - Claudia I Henschke
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | - David F Yankelevitz
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | -
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
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Succony L, Rassl DM, Barker AP, McCaughan FM, Rintoul RC. Adenocarcinoma spectrum lesions of the lung: Detection, pathology and treatment strategies. Cancer Treat Rev 2021; 99:102237. [PMID: 34182217 DOI: 10.1016/j.ctrv.2021.102237] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 02/07/2023]
Abstract
Adenocarcinoma has become the most prevalent lung cancer sub-type and its frequency is increasing. The earliest stages in the development of lung adenocarcinomas are visible using modern computed tomography (CT) as ground glass nodules. These pre-invasive nodules can progress over time to become invasive lung adenocarcinomas. Lesions in this developmental pathway are termed 'adenocarcinoma spectrum' lesions. With the introduction of lung cancer screening programs there has been an increase in the detection of these lesions raising questions about natural history, surveillance and treatment. Here we review how the radiological appearance of an adenocarcinoma spectrum lesion relates to its underlying pathology and explore the natural history and factors driving lesion progression. We examine the molecular changes that occur at each stage of adenocarcinoma spectrum lesion development, including the effects of the driver mutations, EGFR and KRAS, that are key to invasive adenocarcinoma pathology. A better understanding of the development of pre-invasive disease will create treatment targets. Our understanding of how tumours interact with the immune system has led to the development of new therapeutic strategies. We review the role of the immune system in the development of adenocarcinoma spectrum lesions. With a clear preinvasive phase there is an opportunity to treat early adenocarcinoma spectrum lesions before an invasive lung cancer develops. We review current management including surveillance, surgical resection and oncological therapy as well as exploring potential future treatment avenues.
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Affiliation(s)
- L Succony
- Department of Thoracic Oncology, Royal Papworth Hospital, Cambridge CB2 0AY, United Kingdom
| | - D M Rassl
- Department of Pathology, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, United Kingdom
| | - A P Barker
- Department of Radiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, United Kingdom
| | - F M McCaughan
- Department of Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge CB2 0QQ, United Kingdom
| | - R C Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital, Cambridge CB2 0AY, United Kingdom; Department of Oncology, University of Cambridge, Cambridge CB2 0QQ United Kingdom.
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8
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Han DH, Duan F, Wu Y, Goo JM, Kim HY, Patz EF. Clinical Significance of Lung-RADS Category 3 Lesions in the National Lung Screening Trial. J Thorac Oncol 2021; 16:1118-1126. [PMID: 33722708 DOI: 10.1016/j.jtho.2021.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION To determine the clinical significance of category 3 (CAT3) abnormalities and the necessity of a 6-month follow-up computed tomography (CT). We also explored features associated with increased lung cancer risk. METHODS From the National Lung Screening Trial database, we identified participants with CAT3 lesions at prevalence screen. Rates of lung cancer and lung cancer-specific deaths (LSDs) were compared between those who underwent first follow-up CT before 6 months (early diagnostic group) and those who underwent annual screening (annual diagnostic group). We estimated the change in LSD if the 6-month CT was eliminated. Regression analysis was performed to identify features associated with participants with CAT3 who developed lung cancer. RESULTS A total of 1763 CAT3s were identified (6.6% of all participants who had low-dose CT), with 108 lung cancers (6.1%) and 41 LSDs (2.3%) in a 7-year period. Rates of lung cancer (7.5% versus 3.1%) and LSD (4.0% versus 1.0%) were higher in the early diagnostic group than in the annual diagnostic group. We estimated an increase in LSD of 0.6% of all participants with CAT3 (24.4% of all LSDs) if the 6-month CT was not performed. Multivariate regression analysis found that increased age, emphysema, and a part-solid nodule greater than 5 mm were associated with participants with CAT3 who developed lung cancer. CONCLUSIONS CAT3 lesions are uncommon, and eliminating the 6-month CT would potentially increase LSD by 0.6% of all patients with CAT3. Age, emphysema, and part-solid nodule greater than 5 mm may be useful in risk prediction models to determine which participants with CAT3 are more likely to develop lung cancer and suggest which patients may need more intense follow-up.
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Affiliation(s)
- Dae Hee Han
- Department of Radiology, Duke University Health System, Durham, North Carolina; Present Address: Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Yanning Wu
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyae Young Kim
- Department of Radiology, Research Institute & Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Edward F Patz
- Department of Radiology, Duke University Health System, Durham, North Carolina; Department of Pharmacology and Cancer Biology, Duke University Health System, Durham, North Carolina.
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9
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Dziadziuszko K, Szurowska E. Pulmonary nodule radiological diagnostic algorithm in lung cancer screening. Transl Lung Cancer Res 2021; 10:1124-1135. [PMID: 33718050 PMCID: PMC7947388 DOI: 10.21037/tlcr-20-755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Publications of the final results of the two largest randomized lung cancer screening (LCS) trials in the United States and Europe confirmed the reduction in the mortality rate associated with the use of screening with low-dose computed tomography (LDCT). Results of these trials led to widespread acceptance of LCS in properly defined high-risk populations, and its implementation in the clinical practice. Many countries started preparation for national LCS and refreshed still open debate about lung nodule management. Detection of lung cancer in the early stage with a reduction of lung cancer mortality requires dedicated programs with optimized protocols, including a specified pulmonary nodule diagnostic algorithm. The screening protocol should be clear with a precise nodule diameter or volume threshold, based on which a positive screen result is defined. The application of risk-prediction models and the introduction of the semiautomated assessment of detected nodules improves screening accuracy and should be applied in LCS protocols as verified tools to aid radiological diagnosis. In this review, we have summarized recent data about the radiological protocols from the most important LCS programs and pulmonary diagnostic algorithms. These protocols should be taken into consideration in the ongoing and planned LCS programs.
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Affiliation(s)
| | - Edyta Szurowska
- II Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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10
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Henschke CI, Yip R, Shaham D, Zulueta JJ, Aguayo SM, Reeves AP, Jirapatnakul A, Avila R, Moghanaki D, Yankelevitz DF. The Regimen of Computed Tomography Screening for Lung Cancer: Lessons Learned Over 25 Years From the International Early Lung Cancer Action Program. J Thorac Imaging 2021; 36:6-23. [PMID: 32520848 PMCID: PMC7771636 DOI: 10.1097/rti.0000000000000538] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We learned many unanticipated and valuable lessons since we started planning our study of low-dose computed tomography (CT) screening for lung cancer in 1991. The publication of the baseline results of the Early Lung Cancer Action Project (ELCAP) in Lancet 1999 showed that CT screening could identify a high proportion of early, curable lung cancers. This stimulated large national screening studies to be quickly started. The ELCAP design, which provided evidence about screening in the context of a clinical program, was able to rapidly expand to a 12-institution study in New York State (NY-ELCAP) and to many international institutions (International-ELCAP), ultimately working with 82 institutions, all using the common I-ELCAP protocol. This expansion was possible because the investigators had developed the ELCAP Management System for screening, capturing data and CT images, and providing for quality assurance. This advanced registry and its rapid accumulation of data and images allowed continual assessment and updating of the regimen of screening as advances in knowledge and new technology emerged. For example, in the initial ELCAP study, introduction of helical CT scanners had allowed imaging of the entire lungs in a single breath, but the images were obtained in 10 mm increments resulting in about 30 images per person. Today, images are obtained in submillimeter slice thickness, resulting in around 700 images per person, which are viewed on high-resolution monitors. The regimen provides the imaging acquisition parameters, imaging interpretation, definition of positive result, and the recommendations for further workup, which now include identification of emphysema and coronary artery calcifications. Continual updating is critical to maximize the benefit of screening and to minimize potential harms. Insights were gained about the natural history of lung cancers, identification and management of nodule subtypes, increased understanding of nodule imaging and pathologic features, and measurement variability inherent in CT scanners. The registry also provides the foundation for assessment of new statistical techniques, including artificial intelligence, and integration of effective genomic and blood-based biomarkers, as they are developed.
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Affiliation(s)
- Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York
| | - Dorith Shaham
- Department of Medical Imaging, Hadassah Medical Center, Jerusalem, Israel
| | - Javier J. Zulueta
- Clinica Universidad de Navarra, University of Navarra School of Medicine, Pamplona, Spain
| | | | - Anthony P. Reeves
- Department of Electrical and Computer Engineering, Cornell University, Ithaca
| | - Artit Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York
| | | | - Drew Moghanaki
- Department of Radiation Oncology, Atlanta VA Medical Center, Decatur, GA
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Veronesi G, Baldwin DR, Henschke CI, Ghislandi S, Iavicoli S, Oudkerk M, De Koning HJ, Shemesh J, Field JK, Zulueta JJ, Horgan D, Fiestas Navarrete L, Infante MV, Novellis P, Murray RL, Peled N, Rampinelli C, Rocco G, Rzyman W, Scagliotti GV, Tammemagi MC, Bertolaccini L, Triphuridet N, Yip R, Rossi A, Senan S, Ferrante G, Brain K, van der Aalst C, Bonomo L, Consonni D, Van Meerbeeck JP, Maisonneuve P, Novello S, Devaraj A, Saghir Z, Pelosi G. Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe. Cancers (Basel) 2020; 12:E1672. [PMID: 32599792 PMCID: PMC7352874 DOI: 10.3390/cancers12061672] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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Affiliation(s)
- Giulia Veronesi
- Faculty of Medicine and Surgery—Vita-Salute San Raffaele University, 20132 Milan, Italy;
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - David R. Baldwin
- Department of Respiratory Medicine, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK;
| | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
| | - Simone Ghislandi
- Department of Social and Political Sciences, Bocconi University, 20136 Milan, Italy; (S.G.); (L.F.N.)
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority (INAIL), 00078 Rome, Italy;
| | - Matthijs Oudkerk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands;
| | - Harry J. De Koning
- Department of Public Health, Erasmus MC—University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.J.D.K.); (C.v.d.A.)
| | - Joseph Shemesh
- The Grace Ballas Cardiac Research Unit, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, 52621 Tel Aviv-Yafo, Israel;
| | - John K. Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool L69 3BX, UK;
| | - Javier J. Zulueta
- Department of Pulmonology, Clinica Universidad de Navarra, 31008 Pamplona, Spain;
- Visiongate Inc., Phoenix, AZ 85044, USA
| | - Denis Horgan
- European Alliance for Personalised Medicine (EAPM), Avenue de l’Armée Legerlaan 10, 1040 Brussels, Belgium;
| | - Lucia Fiestas Navarrete
- Department of Social and Political Sciences, Bocconi University, 20136 Milan, Italy; (S.G.); (L.F.N.)
| | | | - Pierluigi Novellis
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Rachael L. Murray
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham NG5 1PB, UK;
| | - Nir Peled
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, 84101 Beer-Sheva, Israel;
| | - Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Gaetano Rocco
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | | | - Martin C. Tammemagi
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St Catharines, ON L2S 3A1, Canada;
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Natthaya Triphuridet
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
- Faculty of Medicine and Public Health, Chulabhorn Royal Academy, HRH Princess Chulabhorn College of Medical Science, Bangkok 10210, Thailand
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele (MI), Italy;
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, VU location, De Boelelaan 1117, Postbox 7057, 1007 MB Amsterdam, The Netherlands;
| | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano (MI), Italy;
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS, UK;
| | - Carlijn van der Aalst
- Department of Public Health, Erasmus MC—University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.J.D.K.); (C.v.d.A.)
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University, 00168 Rome, Italy;
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Jan P. Van Meerbeeck
- Thoracic Oncology, Antwerp University Hospital and Ghent University, 2650 Edegem, Belgium;
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Silvia Novello
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.V.S.); (S.N.)
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London SW3 6NP, UK;
| | - Zaigham Saghir
- Department of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark;
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Inter-Hospital Pathology Division, IRCCS MultiMedica, 20138 Milan, Italy
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12
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Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe. Cancers (Basel) 2020; 12:0. [PMID: 32599792 PMCID: PMC7352874 DOI: 10.3390/cancers12060000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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13
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Healey TT, Singer T, Baird GL, Agarwal S. Implementation of Lung Imaging Reporting and Data Systems in a Community Private Radiology Practice: It Can Be Done. J Am Coll Radiol 2019; 16:1688-1690. [PMID: 31247155 DOI: 10.1016/j.jacr.2019.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/23/2019] [Accepted: 05/25/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Terrance T Healey
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Tish Singer
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Grayson L Baird
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Saurabh Agarwal
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, Rhode Island
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14
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Zhu Y, Hou D, Lan M, Sun X, Ma X. A comparison of ultra-high-resolution CT target scan versus conventional CT target reconstruction in the evaluation of ground-glass-nodule-like lung adenocarcinoma. Quant Imaging Med Surg 2019; 9:1087-1094. [PMID: 31367562 DOI: 10.21037/qims.2019.06.09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of this study was to determine whether the clinical value of scanned computed tomography (CT) images is higher when using ultra-high-resolution CT (U-HRCT) target scanning than conventional CT target reconstruction scanning in the evaluation of ground-glass-nodule (GGN)-like lung adenocarcinoma. Methods A total of 91 consecutive patients with isolated GGN-like lung adenocarcinoma were included in this study from April 2017 to June 2018. U-HRCT and conventional CT scans were conducted in all enrolled patients. Two experienced thoracic radiologists independently assessed image quality and made diagnoses. Based on the pathological results, the accuracies of U-HRCT target scanning and conventional CT target reconstruction for detecting morphological features on CT, including spiculation of GGNs, bronchial vascular bundles, solid components in the nodules, burr, vacuole, air bronchial signs, and fissure distortion, were calculated. All statistical analyses were performed using SPSS 17.0 software. Enumeration data were tested using the Chi-square test. A P value of <0.05 was considered statistically significant. Results When both techniques were compared with the pathological findings, the detection rate for CT images obtained using U-HRCT target scanning and conventional CT target reconstruction with regard to the spiculation of GGNs, bronchial vascular bundles, and solid components in the nodules were 78% vs. 61.5%, 72.5% vs. 54.9%, 65.9% vs. 49.5%, respectively. The presence of the spiculation of GGNs, bronchial vascular bundles, and solid components in the nodules in U-HRCT target scanning was significantly higher than that in conventional CT target reconstruction (all P<0.05). However, no significant difference was observed between the two techniques with regard to the burr, vacuole, air bronchial signs, and fissure distortion (all P>0.05). Conclusions When viewing GGNs, the detection rate was higher for U-HRCT target scanning than for conventional CT target reconstruction, and this improvement significantly enhanced the diagnostic accuracy of early lung adenocarcinoma.
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Affiliation(s)
- Yanyan Zhu
- Division of Computed Tomography, Department of Radiology, Shandong University School of Medicine, Shandong Provincial Third Hospital, Jinan 250031, China
| | - Dailun Hou
- Department of Radiology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - Meihong Lan
- Department of Radiology, Shandong Chest Hospital, Jinan 250101, China
| | - Xiaoli Sun
- Department of Computed Tomography, Beijing Shijitan Hospital, Ninth Clinical Medical College of Peking University, Capital Medical University, Beijing 100038, China
| | - Xiangxing Ma
- Department of Radiology, Qilu Hospital, Shandong University, Jinan 250012, China
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15
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Grøndahl V, Binderup T, Langer SW, Petersen RH, Nielsen K, Kjaer A, Federspiel B, Knigge U. Characteristics of 252 patients with bronchopulmonary neuroendocrine tumours treated at the Copenhagen NET Centre of Excellence. Lung Cancer 2019; 132:141-149. [PMID: 31097087 DOI: 10.1016/j.lungcan.2019.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/20/2019] [Accepted: 03/14/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Bronchopulmonary neuroendocrine tumours are divided into typical carcinoid (TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC), and small cell lung cancer (SCLC). AIM To thoroughly describe a cohort of 252 patients with TC, AC and LCNEC (SCLC excluded). MATERIAL AND METHODS Collection of data from 252 patients referred to and treated at Rigshospitalet 2008-2016. Data was collected from electronic patient files and our prospective NET database. Statistics were performed in SPSS. RESULTS 162 (64%) had TC, 29 (12%) had AC and 61 (24%) had LCNEC. Median age at diagnosis was 69 years (range: 19-89) with no difference between genders. Thoraco-abdominal CT was performed in all patients at diagnosis. FDG-PET/CT was performed in 207 (82%) at diagnosis and was positive in 95% of the entire cohort, with no difference between tumour types. Synaptophysin was positive in 98%, chromogranin A in 92% and CD56 in 97%. Mean Ki67 index was 5% in TC, 16% in AC and 69% in LCNEC (p < 0.001). Metastatic disease was found in 4% of TC, 27% of AC and 58% of LCNEC at time of initial diagnosis (p < 0.001). In total 179 patients (71%) underwent surgical resection; TC: 87%, AC: 72% and LCNEC: 28% (p < 0.001). Of the resected patients, 11 (6%) had recurrence. Five-year survival rate was 88% for TC, 63% for AC and 20% for LCNEC. CONCLUSION In this comprehensive study of a cohort of 252 patients, one of the largest until date, with TC, AC and LCNEC, the gender distribution showed female predominance with 68%. FDG-PET/CT was positive in 95% of the patients independent of tumour type, which confirms that FDG-PET/CT should be a part of the preoperative work-up for TC, AC and LCNEC. Tumour type was the single most potent independent prognostic factor.
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Affiliation(s)
- V Grøndahl
- Department of Gastrointestinal Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumour Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark.
| | - T Binderup
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Denmark; ENETS Neuroendocrine Tumour Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark
| | - S W Langer
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumour Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark
| | - R H Petersen
- Department of Thoracic Surgery, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumour Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark
| | - K Nielsen
- Department of Gastrointestinal Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumour Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark
| | - A Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Denmark; ENETS Neuroendocrine Tumour Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark
| | - B Federspiel
- Department of Pathology, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumour Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark
| | - U Knigge
- Department of Gastrointestinal Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark; ENETS Neuroendocrine Tumour Centre of Excellence Rigshospitalet, University of Copenhagen, Denmark
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16
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Yip R, Ma T, Flores RM, Yankelevitz D, Henschke CI. Survival with Parenchymal and Pleural Invasion of Non-Small Cell Lung Cancers Less than 30 mm. J Thorac Oncol 2019; 14:890-902. [PMID: 30685507 DOI: 10.1016/j.jtho.2019.01.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/12/2018] [Accepted: 01/06/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter. METHODS Kaplan-Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (≤10 mm, 11-20 mm, and 21-30 mm) and nodule consistency. Log-rank test statistics were calculated. RESULTS The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p < 0.0001]), and correspondingly, Kaplan-Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] =1.07, 95% confidence interval [CI]: 1.01-1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25-7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10-fold (HR = 10.06, 95% CI: 1.35-75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01-5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01-1.13), whereas PAI was no longer significant (p = 0.19). CONCLUSIONS Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules.
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Affiliation(s)
- Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Teng Ma
- Department of Diagnostic Ultrasound, Tong Ren Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - David Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
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17
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CT screening for lung cancer: comparison of three baseline screening protocols. Eur Radiol 2018; 29:5217-5226. [PMID: 30511179 DOI: 10.1007/s00330-018-5857-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/03/2018] [Accepted: 10/24/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Clinical management decisions arising from the baseline round for lung cancer screening are the most challenging, as findings have accumulated over a lifetime and may be of no clinical concern. To minimize unnecessary harms and costs of workup prior to the first, annual repeat screening, workup should be limited to participants with the highest suspicion of lung cancer while still aiming to identify small, early lung cancers. METHODS We compared recommendations for immediate, delayed (by 3 or 6 months) workup to assess growth at a malignant rate, and the resulting overall and potential biopsies of three baseline screening protocols: I-ELCAP, the two scenarios of ACR-LungRADS, and the European Consortium. For each protocol, the efficiency ratio (ER) of each recommendation was calculated by dividing the number of participants recommended for that workup by the number of resulting lung cancer diagnoses. The ER for potential biopsies was calculated, assuming that biopsies were performed on all participants recommended for immediate workup as well as those diagnosed with lung cancer after delayed workup. RESULTS For I-ELCAP, ACR-LungRADS Scenario 1, ACR-LungRADS Scenario 2, and the European consortium, the overall ER was 13.9, 18.3, 18.3, and 31.9, respectively, and for potential biopsies, it was 2.2, 8.1, 3.2, and 4.4, respectively. ER for immediate workup was 2.9, 8.6, 3.9, and 5.6, respectively, and for delayed workup was 36.1, 160.3, 57.8, and 111.9, respectively. CONCLUSIONS I-ELCAP recommendations had the lowest ER values for overall, immediate, and delayed workup, and for potential biopsies. KEY POINTS • Small differences in protocol thresholds can lead to many unnecessary diagnostic workups. • I-ELCAP recommendations were the most efficient for immediate and overall workup, and potential biopsies. • Definition of a "positive result" and recommendations for further workup in the baseline round needs to be continually reevaluated and updated.
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18
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Wang L, Anraku M, Sato M, Nitadori JI, Nagayama K, Kitano K, Nakajima J. Impact of the 8th Edition of the UICC-TNM Classification on Clinical Stage 0-IA Lung Adenocarcinoma: Does the New Classification Predict Postoperative Prognosis More Precisely than the Previous One? Ann Thorac Cardiovasc Surg 2018; 24:223-229. [PMID: 29848840 PMCID: PMC6197998 DOI: 10.5761/atcs.oa.18-00051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/01/2018] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Early lung adenocarcinoma has been more frequently found recently. The 8th edition of the Union for International Cancer Control (UICC)-Tumor Node Metastasis (TNM) classification for lung cancer has been effective since January 2017. This study aims to elucidate advantages of the current classification for patients with clinical stage 0-IA lung adenocarcinoma, in comparison with the older one. METHODS We retrospectively reviewed the data of clinical stage IA (7th edition) lung adenocarcinoma patients who underwent surgery at our institute from 2001 to 2012, and reclassified them by the 8th edition. Survival analysis was used to evaluate the impact of the two classifications. RESULTS In all, 281 cases were eligible. Clinical T-factors (8th) were significant prognostic factors for overall survival (P = 0.001), recurrence-free survival (P <0.001), and cancer-specific survival (P = 0.001). However, those in the previous edition were not (P = 0.894, P = 0.144, and P = 0.822, respectively). CONCLUSION The 8th edition of the UICC-TNM classification predicts postoperative prognosis more precisely than the 7th one in clinical stage 0-IA lung adenocarcinoma. It is probably because the stage distribution of the population, which included in the research project the 8th edition based on, has been changed, and the new edition develops more accurate staging criteria for ground-glass nodule (GGN).
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Affiliation(s)
- Liming Wang
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
- Department of Thoracic Surgery, The 1st Affiliated Hospital of China Medical University, Shenyang, China
| | - Masaki Anraku
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Sato
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun-Ichi Nitadori
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kazuhiro Nagayama
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kentaro Kitano
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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19
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Inamura K. Clinicopathological Characteristics and Mutations Driving Development of Early Lung Adenocarcinoma: Tumor Initiation and Progression. Int J Mol Sci 2018; 19:ijms19041259. [PMID: 29690599 PMCID: PMC5979290 DOI: 10.3390/ijms19041259] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 04/19/2018] [Accepted: 04/20/2018] [Indexed: 01/01/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide, with lung adenocarcinoma representing the most common lung cancer subtype. Among all lung adenocarcinomas, the most prevalent subset develops via tumorigenesis and progression from atypical adenomatous hyperplasia (AAH) to adenocarcinoma in situ (AIS), to minimally invasive adenocarcinoma (MIA), to overt invasive adenocarcinoma with a lepidic pattern. This stepwise development is supported by the clinicopathological and molecular characteristics of these tumors. In the 2015 World Health Organization classification, AAH and AIS are both defined as preinvasive lesions, whereas MIA is identified as an early invasive adenocarcinoma that is not expected to recur if removed completely. Recent studies have examined the molecular features of lung adenocarcinoma tumorigenesis and progression. EGFR-mutated adenocarcinoma frequently develops via the multistep progression. Oncogene-induced senescence appears to decrease the frequency of the multistep progression in KRAS- or BRAF-mutated adenocarcinoma, whose tumor evolution may be associated with epigenetic alterations and kinase-inactive mutations. This review summarizes the current knowledge of tumorigenesis and tumor progression in early lung adenocarcinoma, with special focus on its clinicopathological characteristics and their associations with driver mutations (EGFR, KRAS, and BRAF) as well as on its molecular pathogenesis and progression.
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Affiliation(s)
- Kentaro Inamura
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan.
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20
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Mascalchi M, Comin CE, Bertelli E, Sali L, Maddau C, Zuccherelli S, Picozzi G, Carrozzi L, Grazzini M, Fontanini G, Voltolini L, Vella A, Castiglione F, Carozzi F, Paci E, Zompatori M, Lopes Pegna A, Falaschi F. Screen-detected multiple primary lung cancers in the ITALUNG trial. J Thorac Dis 2018; 10:1058-1066. [PMID: 29607181 DOI: 10.21037/jtd.2018.01.95] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Occurrence of multiple primary lung cancers (MPLC) in individuals undergoing low-dose computed tomography (LDCT) screening has not been thoroughly addressed. We investigated MPLC in subjects recruited in the ITALUNG randomized clinical trial. Cases of cytologically/histologically proven MPLC detected at screening LDCT or follow-up CT were selected and pathologically re-evaluated according to the WHO 2015 classification. Overall 16 MPLC were diagnosed at screening LDCT (n=14, all present at baseline) or follow-up CT (n=2) in six subjects (4 in one subject, 3 in two and 2 in three subjects), representing 0.43% of the 1,406 screenees and 15.8% of the 38 subjects with at least one screen-detected primary lung cancer. MPLC included 9 adenocarcinomas in three subjects and a combination of 7 different tumour histotypes in three subjects. MPLC, mostly adenocarcinomas, are not uncommon in smokers and ex-smokers with at least one LDCT screen detected primary lung cancer.
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Affiliation(s)
- Mario Mascalchi
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Camilla E Comin
- Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Elena Bertelli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Lapo Sali
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Cristina Maddau
- Institute for Cancer Research and Prevention (ISPO), Florence, Italy
| | - Stefania Zuccherelli
- "Mario Serio" Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Giulia Picozzi
- Institute for Cancer Research and Prevention (ISPO), Florence, Italy
| | - Laura Carrozzi
- Cardiopulmonary Department, Pisa University Hospital, Pisa, Italy
| | | | | | - Luca Voltolini
- Division of Thoracic Surgery, Careggi University Hospital, Florence, Italy
| | | | - Francesca Castiglione
- Division of Pathological Anatomy, Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Francesca Carozzi
- Institute for Cancer Research and Prevention (ISPO), Florence, Italy
| | - Eugenio Paci
- Institute for Cancer Research and Prevention (ISPO), Florence, Italy
| | - Maurizio Zompatori
- Radiology Department, Multimedica Group, IRCCS, Sesto San Giovanni, Italy
| | - Andrea Lopes Pegna
- Pulmonology, Cardio-Thoracic-Vascular Department, Careggi Hospital, Florence, Italy
| | - Fabio Falaschi
- 2nd Radiology Unit, University Hospital of Pisa, Pisa, Italy
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Hu H, Chen X, Zhou C, Li B, Yang Y, Ying X, Mao Y, Zhang Y, Zhong J, Dai J, Yu H, Wu B, Li X, Wang T, Duan S. Aberrant methylation of mutL homolog 1 is associated with increased risk of non-small cell lung cancer. J Clin Lab Anal 2017; 32:e22370. [PMID: 29205508 DOI: 10.1002/jcla.22370] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/13/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is a common malignant tumor. DNA hypermethylation in the promoter region has been served as a potential molecular marker for several tumors. The goal of the current study was to assess the diagnostic ability of mutL homolog 1 (MLH1) promoter methylation in NSCLC. METHODS A total of 111 NSCLC patients' paired tissue samples were obtained to explore the association between MLH1 promoter methylation and NSCLC by methylation-specific polymerase chain reaction (MSP) method. Public databases including The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) were used to verify our findings. RESULTS Our results showed a significantly higher MLH1 methylation frequency in tumor tissue samples than their paired adjacent tissues (P = .008). ROC curve indicated that MLH1MSP assay was a sensitive but not a specific method in the diagnosis for NSCLC (sensitivity = 0.964, specificity = 0.135, AUC = 0.550). And the association between the methylation level and clinical characteristics has no statistical significance. TCGA cohort evinced a higher methylation probability in tumor group compared with nontumor group (the mean β value: -0.449 [-0.467, -0.437] vs -0.466 [-0.472, -0.437], P = .011), which was consistent with our results. Meanwhile, an inverse correlation between MLH1 methylation and MLH1 expression was detected in TCGA and GEO databases. CONCLUSIONS The MSP method for MLH1 methylation was a sensitive but not a specific diagnostic method for NSCLC.
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Affiliation(s)
- Haochang Hu
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Xiaoying Chen
- Department of Medical Record, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Cong Zhou
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Bin Li
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yong Yang
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Xiuru Ying
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yiyi Mao
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yihan Zhang
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Jie Zhong
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Jie Dai
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Hang Yu
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Boyi Wu
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Xiaodong Li
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Tiangong Wang
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Shiwei Duan
- Medical Genetics Center, School of Medicine, Ningbo University, Ningbo, Zhejiang, China
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Oudkerk M, Devaraj A, Vliegenthart R, Henzler T, Prosch H, Heussel CP, Bastarrika G, Sverzellati N, Mascalchi M, Delorme S, Baldwin DR, Callister ME, Becker N, Heuvelmans MA, Rzyman W, Infante MV, Pastorino U, Pedersen JH, Paci E, Duffy SW, de Koning H, Field JK. European position statement on lung cancer screening. Lancet Oncol 2017; 18:e754-e766. [DOI: 10.1016/s1470-2045(17)30861-6] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/11/2017] [Accepted: 09/14/2017] [Indexed: 12/23/2022]
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23
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Henschke CI, Salvatore M, Cham M, Powell CA, DiFabrizio L, Flores R, Kaufman A, Eber C, Yip R, Yankelevitz DF. Baseline and annual repeat rounds of screening: implications for optimal regimens of screening. Eur Radiol 2017; 28:1085-1094. [DOI: 10.1007/s00330-017-5029-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/10/2017] [Accepted: 08/09/2017] [Indexed: 12/19/2022]
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Computed Tomography Screening for Lung Cancer: Mediastinal Lymph Node Resection in Stage IA Nonsmall Cell Lung Cancer Manifesting as Subsolid and Solid Nodules. Ann Surg 2017; 265:1025-1033. [PMID: 27232256 DOI: 10.1097/sla.0000000000001802] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare long-term survival rates of patients with first, primary, clinical stage IA nonsmall cell lung cancer from a large cohort undergoing computed tomography screening with and without mediastinal lymph node resection (MLNR) under an Institutional Review Board-approved common protocol from 1992 to 2014. BACKGROUND Assessing survival differences of patients with and without MLNR manifesting as solid and subsolid nodules. METHODS Long-term Kaplan-Meier (K-M) survival rates for those with and without MLNR were compared and Cox regression analyses were used to adjust for demographic, computed tomography, and surgical covariates. RESULTS The long-term K-M rates for 462 with and 145 without MLNR was 92% versus 96% (P = 0.19), respectively. For 203 patients with a subsolid nodule, 151 with and 52 without MLNR, the rate was 100%. For the 404 patients with a solid nodule, 311 with and 93 without MLNR, the rate was 87% versus 94% (P = 0.24) and Cox regression showed no statistically significant difference (P = 0.28) when adjusted for all covariates. Risk of dying increased significantly with increasing decades of age (hazard ratio [HR] 2.3, 95% confidence interval [CI] 1.4-3.8), centrally located tumor (HR 2.5, 95% CI 1.2-5.2), tumor size 21 to 30 mm (HR 2.7, 95% CI 1.2-6.0), and invasion beyond the lung stroma (HR 3.0, 95% CI 1.4-6.1). For the 346 patients with MLNR, tumor size was 20 mm or less; K-M rates for the 269 patients with and 169 patients without MLNR were also not significantly different (HR 2.1, P = 0.24). CONCLUSIONS It is not mandatory to perform MLNR when screen-diagnosed nonsmall cell lung cancer manifests as a subsolid nodule.
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Walter JE, Heuvelmans MA, Oudkerk M. Small pulmonary nodules in baseline and incidence screening rounds of low-dose CT lung cancer screening. Transl Lung Cancer Res 2017; 6:42-51. [PMID: 28331823 DOI: 10.21037/tlcr.2016.11.05] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Currently, lung cancer screening by low-dose computed tomography (LDCT) is widely recommended for high-risk individuals by US guidelines, but there still is an ongoing debate concerning respective recommendations for European countries. Nevertheless, the available data regarding pulmonary nodules released by lung cancer screening studies could improve future screening guidelines, as well as the clinical practice of incidentally detected pulmonary nodules on routine CT scans. Most lung cancer screening trials present results for baseline and incidence screening rounds separately, clustering pulmonary nodules initially found at baseline screening and newly detected pulmonary nodules after baseline screening together. This approach does not appreciate possible differences among pulmonary nodules detected at baseline and firstly detected at incidence screening rounds and is heavily influenced by methodological differences of the respective screening trials. This review intends to create a basis for assessing non-calcified pulmonary nodules detected during LDCT lung cancer screening in a more clinical relevant manner. The aim is to present data of non-calcified pulmonary baseline nodules and new non-calcified pulmonary incident nodules without clustering them together, thereby also simplifying translation to the clinical practice of incidentally detected pulmonary nodules. Small pulmonary nodules newly detected at incidence screening rounds of LDCT lung cancer screening may possess a greater lung cancer probability than pulmonary baseline nodules at a smaller size, which is essential for the development of new guidelines.
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Affiliation(s)
- Joan E Walter
- University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
| | - Marjolein A Heuvelmans
- University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
| | - Matthijs Oudkerk
- University Medical Center Groningen, Center for Medical Imaging-North East Netherlands, Groningen, The Netherlands
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Outcome Analysis of First-line Somatostatin Analog Treatment in Metastatic Pulmonary Neuroendocrine Tumors and Prognostic Significance of 18FDG-PET/CT. Clin Lung Cancer 2016; 18:415-420. [PMID: 27956089 DOI: 10.1016/j.cllc.2016.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/08/2016] [Accepted: 11/08/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Pulmonary carcinoids (PCs) are classed according to the World Health Organization 2004 classification as typical or atypical carcinoids. Owing to their rarity, no dedicated clinical trials with somatostatin analogs (SSAs) have been carried out on primary PCs. PATIENTS AND METHODS From January 2007 to December 2015, 30 patients with metastatic PCs underwent first-line SSA treatment (20 with octreotide long-acting repeatable 30 mg and 10 with lanreotide 120 mg every 28 days). Eight (23.3%) patients had typical carcinoids and 23 (76.7%) had atypical carcinoids. RESULTS The median age was 65.5 years (range, 47-82 years). All patients (23 males and 7 females) were Gallium-68-DOTA-TOC-positron emission tomography/computed tomography (PET/CT)-positive (29 patients) or octreoscan-positive (1 patient). Of the 20 patients who performed fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18FDG-PET/CT), 14 (70.0%) were positive and 6 negative (30.0%). The median treatment duration was 10 months (range, 2-59 months). One patient achieved a partial response (3.3%), and 26 (86.6%) showed stable disease. One patient interrupted SSA treatment owing to symptomatic cholelithiasis. Five-year survival was 53.0% (95% confidence interval [CI], 15.0%-80.0%). The median progression-free survival (mPFS) was 11.1 months (95% CI, 7.0-15.0 months). Negative 18FDG-PET/CT patients had an mPFS of 15.2 months (95% CI, 7.6 months to not reached) compared with 7.0 months (95% CI, 4.0-10.1 months) for 18FDG-PET/CT-positive patients. No differences in mPFS were found in relation to TTF1-value, histologic subtype, and presence of extrahepatic metastases. CONCLUSION SSAs showed antitumor activity in terms of disease control rate and PFS and proved safe, even in patients with poor Eastern Cooperative Oncology Group status. 18FDG-PET/CT would appear to be a prognostic factor.
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Hilal T. Current understanding and approach to well differentiated lung neuroendocrine tumors: an update on classification and management. Ther Adv Med Oncol 2016; 9:189-199. [PMID: 28344664 DOI: 10.1177/1758834016678149] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Neuroendocrine tumors (NETs) are rare neoplasms that can arise from any tissue. They are classified based on embryonic gut derivative (i.e. foregut, midgut and hindgut) with midgut tumors being the most common (e.g. gastrointestinal NET). The second most common category of NETs is that which arises from the lung. In fact, 25% of primary lung cancers are NETs, including small cell lung cancer (SCLC), which comprises 20% of all lung cancers. The remaining 5% are large cell neuroendocrine cancer (LCNEC, 3%), typical carcinoids (TCs, 1.8%), and atypical carcinoids (ACs, 0.2%). The less common TCs/ACs are well differentiated lung NETs. Their incidence has been increasing in more recent years and although these tumors are slow growing, advanced disease is associated with poor survival. There have been advances in classification of lung NETs that have allowed for more appropriate management upfront. They are cured by surgical resection when disease is limited. However, advanced and metastatic disease requires medical therapy that is ever changing and expanding. In this review, the aim is to summarize the current understanding and classification of well differentiated lung NETs (i.e. TCs and ACs), and focus on recent updates in medical management of advanced disease, along with a brief discussion on potential future discoveries.
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Affiliation(s)
- Talal Hilal
- Division of Hematology and Medical Oncology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA
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CT Screening for Lung Cancer: Part-Solid Nodules in Baseline and Annual Repeat Rounds. AJR Am J Roentgenol 2016; 207:1176-1184. [PMID: 27726410 DOI: 10.2214/ajr.16.16043] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study was to assess the frequencies of identifying participants with part-solid nodules, of diagnostic pursuit, of diagnoses of lung cancer, and long-term lung cancer survival in baseline and annual repeat rounds of CT screening in the International Early Lung Cancer Action Project. MATERIALS AND METHODS Screenings were performed under a common protocol. Participants with solid, nonsolid, and part-solid nodules and the diagnoses of lung cancer were documented. RESULTS Part-solid nodules were identified in 2892 of 57,496 (5.0%) baseline screening studies; 567 (19.6%) of these nodules resolved or decreased in size. Diagnostic pursuit led to the diagnosis of adenocarcinoma in 79 cases, all clinical stage I. At resection, one nodule (12-mm solid component) had a single N2 metastasis. A new part-solid nodule was identified in 541 of 64,677 (0.8%) annual repeat screenings; 377 (69.7%) of these nodules resolved or decreased in size. In eight cases among the 541, the diagnosis of adenocarcinoma manifesting as a part solid nodule was made; on retrospective review the nodule originally had been a nonsolid nodule. In another 20 cases, the cancer originally had manifested as a nonsolid nodule but had progressed to become part-solid at annual repeat screening before any diagnosis was pursued. These 28 annual repeat cases of lung cancer were all pathologic stage IA. Of the 107 cases of lung cancer (79 baseline cases and 28 annual repeat cases), 106 were surgically resected, and one baseline case was followed up with imaging for 4 years. The lung cancer survival rate was 100% with a median follow-up period from diagnosis of 89 months (interquartile range, 52-134 months). CONCLUSION Lung cancers manifesting as part-solid nodules at repeat screening studies all started as nonsolid nodules. Among 107 cases of adenocarcinoma manifesting as a part-solid nodule, a single lymph node metastasis was found in a single case (solid component, 12 mm).
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Schabath MB, Massion PP, Thompson ZJ, Eschrich SA, Balagurunathan Y, Goldof D, Aberle DR, Gillies RJ. Differences in Patient Outcomes of Prevalence, Interval, and Screen-Detected Lung Cancers in the CT Arm of the National Lung Screening Trial. PLoS One 2016; 11:e0159880. [PMID: 27509046 PMCID: PMC4980050 DOI: 10.1371/journal.pone.0159880] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 07/08/2016] [Indexed: 12/18/2022] Open
Abstract
Lung cancer screening identifies cancers with heterogeneous behaviors. Some lung cancers will be identified among patients who had prior negative CT screens and upon follow-up scans develop a de novo nodule that was determined to be cancerous. Other lung cancers will be identified among patients who had one or more prior stable positive scans that were not determined to be lung cancer (indeterminate pulmonary nodules), but in follow-up scans was diagnosed with an incidence lung cancer. Using data from the CT arm of the National Lung Screening Trial, this analysis investigated differences in patient characteristics and survival endpoints between prevalence-, interval-, and screen-detected lung cancers, characterized based on sequence of screening results. Lung cancers immediately following a positive baseline (T0), and prior to the T1 screen, formed the prevalence cohort. Interval cancers were diagnosed following a negative screen at any time point prior to the next screening round. Two cohorts of screen-detected lung cancers (SDLC) were identified that had a baseline positive screen that was that was not determined to be lung cancer (i.e., an indeterminate pulmonary nodule), but in follow-up scans was diagnosed with an incidence lung cancer 12 (SDLC1) or 24 (SDLC2) months later. Two other incidence cohorts had screen-detected lung cancers that had baseline negative screen and upon follow-up scans developed a de novo nodule determined to be cancerous at 12 (SDLC3) or 24 (SDLC4) months later. Differences in patient characteristics, progression-free survival (PFS), and overall survival (OS) were assessed. The lung cancer-specific death rate was higher for SDLC3/SDLC4 compared to SDLC1/SDLC2 lung cancers (136.6/1,000 person-years vs. 71.3/1,000 person-years, P < 0.001). Moreover, PFS and OS were significantly lower for SDLC3/SDLC4 compared to SDLC1/SDLC2 (P < 0.004; P < 0.002, respectively). The findings were consistent when stratified by stage and histology. Multivariable Cox proportional models revealed that the SDLC3/SDLC4 case groups were associated with significantly poorer PFS (HR = 1.89; 95% CI 1.31-2.74) and OS (HR = 1.80; 95% CI 1.21-2.67) compared to SDLC1/SDLC2 lung cancers (HR = 1.00). Lung cancer patients who develop a de novo nodule that determined to be cancerous (i.e., at least one negative CT screen prior to cancer diagnosis) had poorer survival outcomes compared to patients who had at least one positive screen prior to cancer diagnosis. As such, the observation that de novo screen-detected are associated with poorer survival could be attributed to faster growing, more aggressive cancers that arose from a lung environment previously lacking focal abnormalities.
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Affiliation(s)
- Matthew B. Schabath
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Pierre P. Massion
- Thoracic Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, United States of America
| | - Zachary J. Thompson
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Steven A. Eschrich
- Department of Biomedical Informatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Yoganand Balagurunathan
- Department of Cancer Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
| | - Dmitry Goldof
- Department of Computer Science and Engineering; University of South Florida, Tampa, Florida, United States of America
| | - Denise R. Aberle
- Department of Radiological Sciences; David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Robert J. Gillies
- Department of Cancer Imaging, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, United States of America
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Yip R, Yankelevitz DF, Hu M, Li K, Xu DM, Jirapatnakul A, Henschke CI. Lung Cancer Deaths in the National Lung Screening Trial Attributed to Nonsolid Nodules. Radiology 2016; 281:589-596. [PMID: 27378239 DOI: 10.1148/radiol.2016152333] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To validate the recommendation of performing annual follow-up of nonsolid nodules (NSNs) identified by computed tomographic (CT) screening for lung cancer, all cases of lung cancer manifesting as NSN in the National Lung Screening Trial (NLST) were reviewed. Materials and Methods Institutional review board and informed consent were waived for this study. The NLST database was searched to identify all participants with at least one NSN on CT scan with lung cancer as the cause of death (COD) documented by the NLST endpoint verification process. Among the 26 722 participants, 2534 (9.4%) had one or more NSNs, and lung cancer as the COD occurred for 48 participants. On review, 21 of the 48 patients had no NSN in the cancerous lobe, which left 27 patients whose CT scans were reviewed by four radiologists: Group A (n = 12) were cases of lung cancer as the COD because of adenocarcinoma, and group B (n = 15) were cases of lung cancer as the COD because of other cell types. Frequency of lung cancer as the COD because of NSN and the time from randomization to diagnosis within these groups was determined. Results Six of the 12 patients in group A had no NSN in the cancerous lobe whereas the remaining six patients had a dominant solid or part-solid nodule in the lobe that rapidly grew in four patients, was multifocal in one patient, and had a growing NSN in one patient in whom diagnosis was delayed for over 3 years. Five of the 15 patients in group B had no NSN, and for the remaining 10 patients, lung cancer as the COD was not because of NSN. Conclusion It seems unlikely that patients with lung cancer as the COD occurred with solitary or dominant NSN as long as annual follow-up was performed. This lends further support that lung cancers that manifest as NSNs have an indolent course and can be managed with annual follow-up. © RSNA, 2016.
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Affiliation(s)
- Rowena Yip
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - David F Yankelevitz
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - Minxia Hu
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - Kunwei Li
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - Dong Ming Xu
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - Artit Jirapatnakul
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
| | - Claudia I Henschke
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY 10029
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Walter JE, Heuvelmans MA, de Jong PA, Vliegenthart R, van Ooijen PMA, Peters RB, ten Haaf K, Yousaf-Khan U, van der Aalst CM, de Bock GH, Mali W, Groen HJM, de Koning HJ, Oudkerk M. Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: analysis of data from the randomised, controlled NELSON trial. Lancet Oncol 2016; 17:907-916. [DOI: 10.1016/s1470-2045(16)30069-9] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 12/17/2022]
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Henschke CI, Li K, Yip R, Salvatore M, Yankelevitz DF. The importance of the regimen of screening in maximizing the benefit and minimizing the harms. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:153. [PMID: 27195271 PMCID: PMC4860488 DOI: 10.21037/atm.2016.04.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 04/14/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND In CT screening for lung cancer, the regimen of screening is critical in diagnosing lung cancer early while limiting unnecessary tests and invasive procedures. The International Early Lung Cancer Action Program (I-ELCAP) has developed a regimen based on evidence collected in the I-ELCAP cohort of more than 70,000 participants. METHODS Important in the development of the regimen is the recognition of the profound difference between the first, baseline round of screening and all subsequent rounds of repeat screening. For each person undergoing screening, the baseline round happens only once while repeat rounds will be performed annually for many years. This difference needs to be clearly recognized as it is these annual rounds which allow for identification of small, early, yet aggressive, lung cancers which have high cure rates despite their aggressiveness. The importance of nodule consistency and size are key factors in the regimen. The regimen needs to be continuously updated by incorporating advances in technology and knowledge. RESULTS The use of the I-ELCAP regimen reduces the workup of participants in the screening program to less than 10% in the baseline round and less than 6% in the annual repeat rounds. By use of this regimen, estimated cure rate of lung cancers diagnosed under screening is 80% or higher in both baseline and annual repeat rounds. CONCLUSIONS The I-ELCAP collaboration provides a new paradigm that answers the 2002 NCI call for multiple approaches to address relevant questions about screening and the Institute of Medicine (IOM) Roundtable on Evidence-based Medicine from the National Academy of Science's call for a "new clinical research paradigm that takes better advantage of data generated in the course of healthcare delivery would speed and improve the development of evidence for real-world decision making".
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Zhang L, Li M, Wu N, Chen Y. Time Trends in Epidemiologic Characteristics and Imaging Features of Lung Adenocarcinoma: A Population Study of 21,113 Cases in China. PLoS One 2015; 10:e0136727. [PMID: 26317971 PMCID: PMC4552856 DOI: 10.1371/journal.pone.0136727] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/08/2015] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES This study aims to describe time trends of epidemiologic characteristics and imaging features over 14 years among histologically confirmed lung adenocarcinoma (ADC) in China and to discuss the possible reasons for these changes. MATERIALS AND METHODS Data of 21,113 pathologically confirmed lung cancer patients from January 1999 to December 2012 were analyzed retrospectively. Preoperative high-resolution computer tomography (HRCT) images were available and reviewed in 5,439 lung ADC patients since 2005. Time trends of the ADC proportion of lung cancer cases, gender distribution, age at diagnosis, the proportion of early-stage ADC and imaging features were investigated. RESULTS The proportion of ADC increased during the 14 years (P = 0.000). The ratio of female to male ADC cases was higher than both squamous cell carcinoma (SQCC) and total lung cancer cases (P = 0.000). The median age at diagnosis of ADC patients was younger than that of both SQCC and total lung cancer during the 14 years (P = 0.000). The proportion of age group 45-59 years increased in total lung cancer cases (P = 0.000). When stratified by lung cancer histopathologic subtypes, this trend was also observed in ADC (P = 0.001) and SQCC (P = 0.007). The proportion of early-stage cases of ADC increased from 2008 to 2012 (P < 0.001). The proportion of subsolid nodules (SSN) in ADC increased (P = 0.001) from 2005 to 2012. CONCLUSION The data suggests that the proportion of ADC increased from 1999 to 2012 especially in middle-aged, female patients; early-stage ADC and SSN on HRCT images gradually increased, which may have been caused by a change in smoking habits and increased application of HRCT.
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Affiliation(s)
- Li Zhang
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Meng Li
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Ning Wu
- Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- PET-CT Center, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
- * E-mail:
| | - Yuheng Chen
- Cancer Foundation of China, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Yankelevitz DF, Yip R, Smith JP, Liang M, Liu Y, Xu DM, Salvatore MM, Wolf AS, Flores RM, Henschke CI. CT Screening for Lung Cancer: Nonsolid Nodules in Baseline and Annual Repeat Rounds. Radiology 2015; 277:555-64. [PMID: 26101879 DOI: 10.1148/radiol.2015142554] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To address the frequency of identifying nonsolid nodules, diagnosing lung cancer manifesting as such nodules, and the long-term outcome after treatment in a prospective cohort, the International Early Lung Cancer Action Program. MATERIALS AND METHODS A total of 57,496 participants underwent baseline and subsequent annual repeat computed tomographic (CT) screenings according to an institutional review board, HIPAA-compliant protocol. Informed consent was obtained. The frequency of participants with nonsolid nodules, the course of the nodule at follow-up, and the resulting diagnoses of lung cancer, treatment, and outcome are given separately for baseline and annual repeat rounds of screening. The χ(2) statistic was used to compare percentages. RESULTS A nonsolid nodule was identified in 2392 (4.2%) of 57,496 baseline screenings, and pathologic pursuit led to the diagnosis of 73 cases of adenocarcinoma. A new nonsolid nodule was identified in 485 (0.7%) of 64,677 annual repeat screenings, and 11 had a diagnosis of stage I adenocarcinoma; none were in nodules 15 mm or larger in diameter. Nonsolid nodules resolved or decreased more frequently in annual repeat than in baseline rounds (322 [66%] of 485 vs 628 [26%] of 2392, P < .0001). Treatment of the cases of lung cancer was with lobectomy in 55, bilobectomy in two, sublobar resection in 26, and radiation therapy in one. Median time to treatment was 19 months (interquartile range [IQR], 6-41 months). A solid component had developed in 22 cases prior to treatment (median transition time from nonsolid to part-solid, 25 months). The lung cancer-survival rate was 100% with median follow-up since diagnosis of 78 months (IQR, 45-122 months). CONCLUSION Nonsolid nodules of any size can be safely followed with CT at 12-month intervals to assess transition to part-solid. Surgery was 100% curative in all cases, regardless of the time to treatment.
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Affiliation(s)
- David F Yankelevitz
- From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.)
| | - Rowena Yip
- From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.)
| | - James P Smith
- From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.)
| | - Mingzhu Liang
- From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.)
| | - Ying Liu
- From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.)
| | - Dong Ming Xu
- From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.)
| | - Mary M Salvatore
- From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.)
| | - Andrea S Wolf
- From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.)
| | - Raja M Flores
- From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.)
| | - Claudia I Henschke
- From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.)
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ACR-STR practice parameter for the performance and reporting of lung cancer screening thoracic computed tomography (CT): 2014 (Resolution 4). J Thorac Imaging 2015; 29:310-6. [PMID: 24992501 DOI: 10.1097/rti.0000000000000097] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Henschke CI, Boffetta P, Yankelevitz DF, Altorki N. Computed Tomography Screening. Thorac Surg Clin 2015; 25:129-43. [DOI: 10.1016/j.thorsurg.2014.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wang X, Ling L, Su H, Cheng J, Jin L. Aberrant methylation of genes in sputum samples as diagnostic biomarkers for non-small cell lung cancer: a meta-analysis. Asian Pac J Cancer Prev 2015; 15:4467-74. [PMID: 24969871 DOI: 10.7314/apjcp.2014.15.11.4467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to comprehensively review the evidence for using sputum DNA to detect non-small cell lung cancer (NSCLC). MATERIALS AND METHODS We searched PubMed, Science Direct, Web of Science, Chinese Biological Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang, Vip Databases and Google Scholar from 2003 to 2013. The meta-analysis was carried out using a random-effect model with sensitivity, specificity, diagnostic odd ratios (DOR), summary receiver operating characteristic curves (ROC curves), area under the curve (AUC), and 95% confidence intervals (CI) as effect measurements. RESULTS There were twenty-two studies meeting the inclusion criteria for the meta-analysis. Combined sensitivity and specificity were 0.62 (95%CI: 0.59-0.65) and 0.73 (95%CI: 0.70-0.75), respectively. The DOR was 10.3 (95%CI: 5.88-18.1) and the AUC was 0.78. CONCLUSIONS The overall accuracy of the test was currently not strong enough for the detection of NSCLC for clinical application. Discovery and evaluation of additional biomarkers with improved sensitivity and specificity from studies rated high quality deserve further attention.
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Affiliation(s)
- Xu Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui Province, China E-mail :
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Caplin ME, Baudin E, Ferolla P, Filosso P, Garcia-Yuste M, Lim E, Oberg K, Pelosi G, Perren A, Rossi RE, Travis WD, Capdevila J, Costa F, Cwikla J, de Herder W, Delle Fave G, Eriksson B, Falconi M, Ferone D, Gross D, Grossman A, Ito T, Jensen R, Kaltsas G, Kelestimur F, Kianmanesh R, Knigge U, Kos-Kudla B, Krenning E, Mitry E, Nicolson M, O'Connor J, O'Toole D, Pape UF, Pavel M, Ramage J, Raymond E, Rindi G, Rockall A, Ruszniewski P, Salazar R, Scarpa A, Sedlackova E, Sundin A, Toumpanakis C, Vullierme MP, Weber W, Wiedenmann B, Zheng-Pei Z. Pulmonary neuroendocrine (carcinoid) tumors: European Neuroendocrine Tumor Society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids. Ann Oncol 2015; 26:1604-20. [PMID: 25646366 DOI: 10.1093/annonc/mdv041] [Citation(s) in RCA: 411] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 01/22/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pulmonary carcinoids (PCs) are rare tumors. As there is a paucity of randomized studies, this expert consensus document represents an initiative by the European Neuroendocrine Tumor Society to provide guidance on their management. PATIENTS AND METHODS Bibliographical searches were carried out in PubMed for the terms 'pulmonary neuroendocrine tumors', 'bronchial neuroendocrine tumors', 'bronchial carcinoid tumors', 'pulmonary carcinoid', 'pulmonary typical/atypical carcinoid', and 'pulmonary carcinoid and diagnosis/treatment/epidemiology/prognosis'. A systematic review of the relevant literature was carried out, followed by expert review. RESULTS PCs are well-differentiated neuroendocrine tumors and include low- and intermediate-grade malignant tumors, i.e. typical (TC) and atypical carcinoid (AC), respectively. Contrast CT scan is the diagnostic gold standard for PCs, but pathology examination is mandatory for their correct classification. Somatostatin receptor imaging may visualize nearly 80% of the primary tumors and is most sensitive for metastatic disease. Plasma chromogranin A can be increased in PCs. Surgery is the treatment of choice for PCs with the aim of removing the tumor and preserving as much lung tissue as possible. Resection of metastases should be considered whenever possible with curative intent. Somatostatin analogs are the first-line treatment of carcinoid syndrome and may be considered as first-line systemic antiproliferative treatment in unresectable PCs, particularly of low-grade TC and AC. Locoregional or radiotargeted therapies should be considered for metastatic disease. Systemic chemotherapy is used for progressive PCs, although cytotoxic regimens have demonstrated limited effects with etoposide and platinum combination the most commonly used, however, temozolomide has shown most clinical benefit. CONCLUSIONS PCs are complex tumors which require a multidisciplinary approach and long-term follow-up.
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Affiliation(s)
- M E Caplin
- Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK
| | - E Baudin
- Department of Nuclear Medicine, Endocrine Cancer and Interventional Radiology, Institut Gustave Roussy, Université Paris Sud, Villejuif Cedex, France
| | - P Ferolla
- NET Center, Umbria Regional Cancer Network, Università degli Studi di Perugia, Perugia
| | - P Filosso
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - M Garcia-Yuste
- Department of Thoracic Surgery, University Clinic Hospital, Valladolid, Spain
| | - E Lim
- Imperial College and The Academic Division of Thoracic Surgery, The Royal Brompton Hospital, London, UK
| | - K Oberg
- Endocrine Oncology Unit, Department of Medicine, University Hospital, Uppsala, Sweden
| | - G Pelosi
- Fondazione IRCCS Istituto Nazionale dei Tumori and Dipartimento di Scienze Biologiche e Cliniche Luigi Sacco, Università degli studi di Milano, Milan, Italy
| | - A Perren
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - R E Rossi
- Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico and Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - W D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
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Yip R, Henschke CI, Yankelevitz DF, Smith JP. CT Screening for Lung Cancer: Alternative Definitions of Positive Test Result Based on the National Lung Screening Trial and International Early Lung Cancer Action Program Databases. Radiology 2014; 273:591-6. [DOI: 10.1148/radiol.14132950] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Retrospective Review of Lung Cancers Diagnosed in Annual Rounds of CT Screening. AJR Am J Roentgenol 2014; 203:965-72. [DOI: 10.2214/ajr.13.12115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Godoy MCB, Truong MT, Sabloff B, Naidich DP. Subsolid pulmonary nodule management and lung adenocarcinoma classification: state of the art and future trends. Semin Roentgenol 2014; 48:295-307. [PMID: 24034262 DOI: 10.1053/j.ro.2013.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Myrna C B Godoy
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX.
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Altorki NK, Yip R, Hanaoka T, Bauer T, Aye R, Kohman L, Sheppard B, Thurer R, Andaz S, Smith M, Mayfield W, Grannis F, Korst R, Pass H, Straznicka M, Flores R, Henschke CI. Sublobar resection is equivalent to lobectomy for clinical stage 1A lung cancer in solid nodules. J Thorac Cardiovasc Surg 2013; 147:754-62; Discussion 762-4. [PMID: 24280722 DOI: 10.1016/j.jtcvs.2013.09.065] [Citation(s) in RCA: 247] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 07/30/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES A single randomized trial established lobectomy as the standard of care for the surgical treatment of early-stage non-small cell lung cancer. Recent advances in imaging/staging modalities and detection of smaller tumors have once again rekindled interest in sublobar resection for early-stage disease. The objective of this study was to compare lung cancer survival in patients with non-small cell lung cancer with a diameter of 30 mm or less with clinical stage 1 disease who underwent lobectomy or sublobar resection. METHODS We identified 347 patients diagnosed with lung cancer who underwent lobectomy (n = 294) or sublobar resection (n = 53) for non-small cell lung cancer manifesting as a solid nodule in the International Early Lung Cancer Action Program from 1993 to 2011. Differences in the distribution of the presurgical covariates between sublobar resection and lobectomy were assessed using unadjusted P values determined by logistic regression analysis. Propensity scoring was performed using the same covariates. Differences in the distribution of the same covariates between sublobar resection and lobectomy were assessed using adjusted P values determined by logistic regression analysis with adjustment for the propensity scores. Lung cancer-specific survival was determined by the Kaplan-Meier method. Cox survival regression analysis was used to compare sublobar resection with lobectomy, adjusted for the propensity scores, surgical, and pathology findings, when adjusted and stratified by propensity quintiles. RESULTS Among 347 patients, 10-year Kaplan-Meier for 53 patients treated by sublobar resection compared with 294 patients treated by lobectomy was 85% (95% confidence interval, 80-91) versus 86% (confidence interval, 75-96) (P = .86). Cox survival analysis showed no significant difference between sublobar resection and lobectomy when adjusted for propensity scores or when using propensity quintiles (P = .62 and P = .79, respectively). For those with cancers 20 mm or less in diameter, the 10-year rates were 88% (95% confidence interval, 82-93) versus 84% (95% confidence interval, 73-96) (P = .45), and Cox survival analysis showed no significant difference between sublobar resection and lobectomy using either approach (P = .42 and P = .52, respectively). CONCLUSIONS Sublobar resection and lobectomy have equivalent survival for patients with clinical stage IA non-small cell lung cancer in the context of computed tomography screening for lung cancer.
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Affiliation(s)
- Nasser K Altorki
- NY Presbyterian Hospital/Weill Cornell Medical College, New York, NY
| | - Rowena Yip
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Ralph Aye
- Swedish Medical Center, Seattle, Wash
| | | | - Barry Sheppard
- Dorothy E. Schneider Cancer Center, Mills-Peninsula Health Services, San Mateo, Calif
| | - Richard Thurer
- Jackson Memorial Hospital, University of Miami, Miami, Fla
| | | | - Michael Smith
- Georgia Institute for Lung Cancer Research, Atlanta, Ga
| | | | - Fred Grannis
- City of Hope National Medical Center, Duarte, Calif
| | | | - Harvey Pass
- New York University Medical Center, New York, NY
| | | | - Raja Flores
- Icahn School of Medicine at Mount Sinai, New York, NY
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Grannis FW. Minimizing over-diagnosis in lung cancer screening. J Surg Oncol 2013; 108:289-93. [DOI: 10.1002/jso.23400] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 07/16/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Frederic W. Grannis
- Thoracic Surgery Section; City of Hope National Medical Center; Duarte California
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Silva M, Mario S, Sverzellati N, Nicola S, Manna C, Carmelinda M, Negrini G, Giulio N, Marchianò A, Alfonso M, Zompatori M, Maurizio Z, Rossi C, Cristina R, Pastorino U, Ugo P. Long-term surveillance of ground-glass nodules: evidence from the MILD trial. J Thorac Oncol 2013; 7:1541-6. [PMID: 22968185 DOI: 10.1097/jto.0b013e3182641bba] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the natural evolution of ground-glass nodules (GGNs) in the Multicentric Italian Lung Detection (MILD) trial, which adopted a nonsurgical approach to this subset of lesions. METHODS From September 2005 to August 2007, 56 consecutive MILD participants with 76 GGNs were identified from 1866 individuals who underwent baseline low-dose computed tomography. The features of GGNs were assessed and compared with the corresponding repeat low-dose computed tomographies after a mean time of 50.26 ± 7.3 months. The GGNs were classified as pure (pGGN) or part-solid (psGGN) GGNs. The average of the maximum and the minimum diameters for both pGGNs and psGGNs and the maximum diameter of the solid portion of psGGNs were manually measured. At follow-up, GGNs were classified as follows: resolved, decreased, stable, or progressed (according to three defined growth patterns). RESULTS A total of 15 of 48 pGGNs (31.3%) resolved, 4 of 48 (8.3%) decreased in size, 21 of 48 (43.8%) remained stable, and 8 of 48 (16.7%) progressed. Among the psGGNs with a solid component smaller than 5 mm, 3 of 26 (11.5%) resolved, 11 of 26 (42.3%) remained stable, and 12 of 26 (46.2%) progressed. One of the two psGGNs with a solid component larger than 5 mm remained stable, and the other decreased in size. Four lung cancers were detected among the GGN subjects, but only one arose from a psGGN, and was resected in stage Ia. CONCLUSIONS The progression rate of the GGNs toward clinically relevant disease was extremely low in the MILD trial and supports an active surveillance attitude.
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Affiliation(s)
- Mario Silva
- Department of Clinical Sciences, Section of Diagnostic Imaging, University of Parma, Italy
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Abstract
OBJECTIVE The objectives of this study were to determine the frequency of lung cancers associated with a discrete cystic airspace and to characterize the morphologic and pathologic features of the cancer and the cystic airspace. MATERIALS AND METHODS We reviewed all diagnosed cases of lung cancer resulting from baseline screening (n=595) and annual screening (n=111) in the International Early Lung Cancer Action Program to identify those abutting or in the wall of a cystic airspace. We also reviewed the pathologic specimens. RESULTS A total of 26 lung cancers were identified abutting or in the wall of a cystic airspace. Of these, 13 were identified at baseline (13/595, 2%) and 13 at annual screening (13/111, 12%), which was significant (p<0.0001). The median circumferential portion of wall involved was less for the annual cancers than for the baseline ones, but this difference did not reach significance (90° vs 240°, p=0.07). The diagnosis was adenocarcinoma in all but three cases. Histologic analysis showed that the cystic space was a bulla, a fibrous walled cyst without a defined lining, or a pleural bleb and that in all but one case, the tumor was eccentric relative to the airspace and the wall of the airspace was unevenly thickened. CONCLUSION At annual repeat CT screening, the finding of an isolated cystic airspace with increased wall thickness should raise the suspicion of lung cancer.
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Naidich DP, Bankier AA, MacMahon H, Schaefer-Prokop CM, Pistolesi M, Goo JM, Macchiarini P, Crapo JD, Herold CJ, Austin JH, Travis WD. Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 2012; 266:304-17. [PMID: 23070270 DOI: 10.1148/radiol.12120628] [Citation(s) in RCA: 702] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This report is to complement the original Fleischner Society recommendations for incidentally detected solid nodules by proposing a set of recommendations specifically aimed at subsolid nodules. The development of a standardized approach to the interpretation and management of subsolid nodules remains critically important given that peripheral adenocarcinomas represent the most common type of lung cancer, with evidence of increasing frequency. Following an initial consideration of appropriate terminology to describe subsolid nodules and a brief review of the new classification system for peripheral lung adenocarcinomas sponsored by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS), six specific recommendations were made, three with regard to solitary subsolid nodules and three with regard to multiple subsolid nodules. Each recommendation is followed first by the rationales underlying the recommendation and then by specific pertinent remarks. Finally, issues for which future research is needed are discussed. The recommendations are the result of careful review of the literature now available regarding subsolid nodules. Given the complexity of these lesions, the current recommendations are more varied than the original Fleischner Society guidelines for solid nodules. It cannot be overemphasized that these guidelines must be interpreted in light of an individual's clinical history. Given the frequency with which subsolid nodules are encountered in daily clinical practice, and notwithstanding continuing controversy on many of these issues, it is anticipated that further refinements and modifications to these recommendations will be forthcoming as information continues to emerge from ongoing research.
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Affiliation(s)
- David P Naidich
- Department of Radiology, New York University Medical Center, 560 First Ave, New York, NY 10016, USA.
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Abstract
PURPOSE OF REVIEW Given the higher rate of malignancy of subsolid pulmonary nodules and the considerably lower growth rate of ground-glass nodules (GGNs), dedicated standardized guidelines for management of these nodules have been proposed, including long-term low-dose computed tomography (CT) follow-up (≥3 years). Physicians must be familiar with the strategic management of subsolid pulmonary nodules, and should be able to identify imaging features that suggest invasive adenocarcinoma requiring a more aggressive management. RECENT FINDINGS Low-dose CT screening studies for early detection of lung cancer have increased our knowledge of pulmonary nodules, and in particular our understanding of the strong although imperfect correlation of the subsolid pulmonary nodules, including pure GGNs and part-solid nodules, with the spectrum of preinvasive to invasive lung adenocarcinoma. Serial CT imaging has shown stepwise progression in a subset of these nodules, characterized by increase in size and density of pure GGNs and development of a solid component, the latter usually indicating invasive adenocarcinoma. SUMMARY There is close correlation between the CT features of subsolid nodules (SSNs) and the spectrum of lung adenocarcinoma. Standardized guidelines are suggested for management of SSNs.
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Goldwasser DL, Kimmel M. Small median tumor diameter at cure threshold (<20 mm) among aggressive non-small cell lung cancers in male smokers predicts both chest X-ray and CT screening outcomes in a novel simulation framework. Int J Cancer 2012; 132:189-97. [DOI: 10.1002/ijc.27599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Accepted: 03/27/2012] [Indexed: 11/06/2022]
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Henschke CI, Yankelevitz DF, Reeves AP, Cham MD. Image analysis of small pulmonary nodules identified by computed tomography. ACTA ACUST UNITED AC 2012; 78:882-93. [PMID: 22069212 DOI: 10.1002/msj.20300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Detection of small pulmonary nodules has markedly increased as computed tomography (CT) technology has advanced and interpretation evolved from viewing small CT images on film to magnified images on large, high-resolution computer monitors. Despite these advances, determining the etiology of a lung nodule short of major surgery remains problematic. Initial nodule size is a major criterion in evaluating the risk for malignancy, and the majority of CT detected nodules are <10 mm in diameter. Also, the likelihood that the nodule is a lung cancer increases with increasing age and smoking history, and such clinical information needs to be integrated into algorithms that guide the workup of such nodules. Baseline and annual repeat screening results are also very helpful in developing and assessing the usefulness of such algorithms. Based on CT morphology, subtypes of nodules have been identified; today nodules are routinely classified as being solid, part-solid, or nonsolid. It has been shown that part-solid nodules have a higher frequency of being malignant than solid or nonsolid ones. Other nodule characteristics such as spiculation are useful, although granulomas and fibrosis also have such features, so these characteristics have not been as useful as nodule-growth assessment. Depending on the aggressiveness of the lung cancer and the size of the nodule when it is initially seen, a follow-up CT scan 1-3 months after the first CT scan can identify those nodules with growth at a malignant rate. Software has been developed by all CT scanner manufacturers for such growth assessment, but the inherent variability of such assessments needs further development. Nodule-growth assessment based on 2-dimensional approaches is limited; therefore, software has been developed for the 3-dimensional assessment of growth. Different approaches for such growth assessment have been developed, either using automated computer segmentation techniques or hybrid methods that allow the radiologist to adjust such segmentation. There are, however, inherent reasons for variability in such measurements that need to be carefully considered, and this, together with continued technologic advances and integration of the relevant clinical information, will allow for individualization of the algorithms for the workup of small pulmonary nodules.
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Affiliation(s)
- Claudia I Henschke
- Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA.
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Henschke CI, Yankelevitz DF, Yip R, Reeves AP, Farooqi A, Xu D, Smith JP, Libby DM, Pasmantier MW, Miettinen OS. Lung cancers diagnosed at annual CT screening: volume doubling times. Radiology 2012; 263:578-83. [PMID: 22454506 DOI: 10.1148/radiol.12102489] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To empirically address the distribution of the volume doubling time (VDT) of lung cancers diagnosed in repeat annual rounds of computed tomographic (CT) screening in the International Early Lung Cancer Action Program (I-ELCAP), first and foremost with respect to rates of tumor growth but also in terms of cell types. MATERIALS AND METHODS All CT screenings in I-ELCAP from 1993 to 2009 were performed according to HIPAA-compliant protocols approved by the institutional review boards of the collaborating institutions. All instances of first diagnosis of primary lung cancer after a negative screening result 7-18 months earlier were identified, with symptom-prompted diagnoses included. Lesion diameter was calculated by using the measured length and width of each cancer at the time when the nodule was first identified for further work-up and at the time of the most recent prior screening, 7-18 months earlier. The length and width were measured a second time for each cancer, and the geometric mean of the two calculated diameters was used to calculate the VDT. The χ(2) statistic was used to compare the VDT distributions. RESULTS The median VDT for 111 cancers was 98 days (interquartile range, 108). For 56 (50%) cancers it was less than 100 days, and for three (3%) cancers it was more than 400 days. Adenocarcinoma was the most frequent cell type (50%), followed by squamous cell carcinoma (19%), small cell carcinoma (19%), and others (12%). Lung cancers manifesting as subsolid nodules had significantly longer VDTs than those manifesting as solid nodules (P < .0001). CONCLUSION Lung cancers diagnosed in annual repeat rounds of CT screening, as manifest by the VDT and cell-type distributions, are similar to those diagnosed in the absence of screening.
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Affiliation(s)
- Claudia I Henschke
- Department of Radiology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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