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Mohamed FR, Rose A, Sheehan-Hennessy L, Pedersen SK, Cornthwaite K, Laven-Law G, Young GP, Symonds EL, Winter JM. A blood test measuring DNA methylation of BCAT1 and IKZF1 for detection of lung adenocarcinoma. Cancer Treat Res Commun 2024; 40:100838. [PMID: 39154541 DOI: 10.1016/j.ctarc.2024.100838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Colorectal (CRC) and lung adenocarcinoma share many genetic and pathological similarities. A circulating tumor DNA (ctDNA) test for CRC may also be useful for detection of lung adenocarcinoma. This study determined if a methylated BCAT1/IKZF1 ctDNA test for CRC can be used for detection of lung adenocarcinoma. PATIENTS AND METHODS Circulating cell free DNA (ccfDNA) was extracted from plasma collected prospectively from healthy controls, patients in remission from CRC, patients with lung adenocarcinoma, and patients with isolated metastatic CRC lung lesions. Plasma ccfDNA was bisulfite converted and assessed for methylated BCAT1/IKZF1 by quantitative real-time PCR. Comparisons between the different patient groups for a positive ctDNA test (BCAT1 and/or IKZF1) and ctDNA levels (% of total ccfDNA), as well as any associations with clinicopathological and demographic features, were assessed. RESULTS Methylated BCAT1/IKZF1 ctDNA was detected in 18/39 (46.2 %) patients with lung adenocarcinoma, which was significantly (p < 0.001) higher compared to healthy controls (49/606; 8.1 %) and patients in remission from CRC (22/171, 12.9 %). Patients with stage III/IV lung adenocarcinoma had higher BCAT1/IKZF1 ctDNA positivity compared to stage I/II cases (68.2 % vs 17.7 %, p < 0.01), where a significantly higher proportion tested positive for methylated IKZF1 ctDNA alone (54.6 % vs 5.9 %, p < 0.001). There was no difference in BCAT1/IKZF1 ctDNA test positivity between patients with stage IV primary lung adenocarcinoma (n = 17) compared to lung-metastasising CRC cases (n = 17; 70.6 % v 64.3 %). CONCLUSION A ctDNA test measuring methylated BCAT1/IKZF1 can sensitively detect lung adenocarcinoma and may be a promising aid for detection of advanced disease. CLINICAL TRIAL REGISTRATIONS Australian and New Zealand Clinical Trials Registry, www.anzctr.org.au, ACTRN12616001138471, ACTRN12611000318987.
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Affiliation(s)
- Faridh Raja Mohamed
- Department of Respiratory Sleep Medicine and Ventilation, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Anand Rose
- Department of Respiratory Sleep Medicine and Ventilation, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Lorraine Sheehan-Hennessy
- Cancer Impact Program, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Susanne K Pedersen
- Cancer Impact Program, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Kathryn Cornthwaite
- Cancer Impact Program, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Geraldine Laven-Law
- Cancer Impact Program, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Graeme P Young
- Cancer Impact Program, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Erin L Symonds
- Cancer Impact Program, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia; Department of Gastroenterology and Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA, Australia
| | - Jean M Winter
- Cancer Impact Program, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.
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Donevant S, Heiney SP, Wineglass C, Schooley B, Singh A, Sheng J. Perceptions of Endocrine Therapy in African-American Breast Cancer Survivors: Mixed Methods Study. JMIR Form Res 2021; 5:e23884. [PMID: 34114955 PMCID: PMC8235283 DOI: 10.2196/23884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/05/2021] [Accepted: 04/30/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although the incidence of breast cancer is lower in African-American women than in White women, African-American women have a decreased survival rate. The difference in survival rate may stem from poor endocrine therapy adherence, which increases breast cancer recurrence. Therefore, accessible and culturally sensitive interventions to increase endocrine therapy adherence are necessary. OBJECTIVE The purpose of this concurrent convergent mixed methods study was to provide further data to guide the development of the proposed culturally sensitive mHealth app, STORY+ for African-American women with breast cancer. METHODS We recruited 20 African-American women diagnosed with estrogen-positive breast cancer and currently prescribed endocrine therapy. We used a concurrent convergent data collection method to (1) assess the use of smartphones and computers related to health care and (2) identify foundational aspects to support endocrine therapy adherence for incorporation in a mobile health app. RESULTS Overwhelmingly, the participants preferred using smartphones to using computers for health care. Communicating with health care providers and pharmacies was the most frequent health care use of smartphones, followed by exercise tracking, and accessing the patient portal. We identified 4 aspects of adherence to endocrine therapy and smartphone use for incorporation in app development. The factors that emerged from the integrated qualitative and quantitative data were (1) willingness to use, (2) side effects, (3) social connection, and (4) beliefs about endocrine therapy. CONCLUSIONS Further research is needed to develop a culturally sensitive app for African-American women with breast cancer to improve adherence to endocrine therapy. Our work strongly suggests that this population would use the app to connect with other African-American breast cancer survivors and manage endocrine therapy.
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Affiliation(s)
- Sara Donevant
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Sue P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Cassandra Wineglass
- College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Benjamin Schooley
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Akanksha Singh
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Jingxi Sheng
- College of Nursing, University of South Carolina, Columbia, SC, United States
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Vladimir C, Zdenek K, Lukas F, Kamil H, Vaclav K, Alzbeta K, Ladislav M, Petr M, Sylva R, Katerina S, Marketa S, Robert V, Teodor H. Clarification of the resection line non-intubated segmentectomy using indocyanine green. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:38. [PMID: 30854391 DOI: 10.21037/atm.2019.01.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A reflection on the measure of fluorescence specificity of indocyanine green (ICG) in non-intubated pulmonary segmentectomy.
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Affiliation(s)
- Can Vladimir
- Department of Surgery, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Kala Zdenek
- Department of Surgery, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Frola Lukas
- Institute of Pathology, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Hudacek Kamil
- Department of Anesthesiology, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Kalis Vaclav
- Department of Anesthesiology, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Kodytkova Alzbeta
- Department of Surgery, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Mitas Ladislav
- Department of Surgery, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Moravcik Petr
- Department of Surgery, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Rybnickova Sylva
- Institute of Pathology, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Skrivanova Katerina
- Department of Surgery, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Spankova Marketa
- Department of Surgery, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Vach Robert
- Department of Anesthesiology, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
| | - Horvath Teodor
- Department of Surgery, Resuscitation, and Intensive Care, Faculty of Medicine, Masaryk University Brno, University Hospital Brno, Bohunice, Czech Republic
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Yoon HJ, Chung MJ, Hwang HS, Moon JW, Lee KS. Adaptive Statistical Iterative Reconstruction-Applied Ultra-Low-Dose CT with Radiography-Comparable Radiation Dose: Usefulness for Lung Nodule Detection. Korean J Radiol 2015; 16:1132-41. [PMID: 26357505 PMCID: PMC4559785 DOI: 10.3348/kjr.2015.16.5.1132] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 06/02/2015] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the performance of adaptive statistical iterative reconstruction (ASIR)-applied ultra-low-dose CT (ULDCT) in detecting small lung nodules. Materials and Methods Thirty patients underwent both ULDCT and standard dose CT (SCT). After determining the reference standard nodules, five observers, blinded to the reference standard reading results, independently evaluated SCT and both subsets of ASIR- and filtered back projection (FBP)-driven ULDCT images. Data assessed by observers were compared statistically. Results Converted effective doses in SCT and ULDCT were 2.81 ± 0.92 and 0.17 ± 0.02 mSv, respectively. A total of 114 lung nodules were detected on SCT as a standard reference. There was no statistically significant difference in sensitivity between ASIR-driven ULDCT and SCT for three out of the five observers (p = 0.678, 0.735, < 0.01, 0.038, and < 0.868 for observers 1, 2, 3, 4, and 5, respectively). The sensitivity of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT in three out of the five observers (p < 0.01 for three observers, and p = 0.064 and 0.146 for two observers). In jackknife alternative free-response receiver operating characteristic analysis, the mean values of figure-of-merit (FOM) for FBP, ASIR-driven ULDCT, and SCT were 0.682, 0.772, and 0.821, respectively, and there were no significant differences in FOM values between ASIR-driven ULDCT and SCT (p = 0.11), but the FOM value of FBP-driven ULDCT was significantly lower than that of ASIR-driven ULDCT and SCT (p = 0.01 and 0.00). Conclusion Adaptive statistical iterative reconstruction-driven ULDCT delivering a radiation dose of only 0.17 mSv offers acceptable sensitivity in nodule detection compared with SCT and has better performance than FBP-driven ULDCT.
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Affiliation(s)
- Hyun Jung Yoon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea. ; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul 04763, Korea
| | - Myung Jin Chung
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hye Sun Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jung Won Moon
- Department of Radiology, Kangbuk Samsung Hospital, Seoul 03181, Korea
| | - Kyung Soo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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Lung Cancer Screening: Review and Performance Comparison Under Different Risk Scenarios. Lung 2013; 192:55-63. [DOI: 10.1007/s00408-013-9517-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 10/02/2013] [Indexed: 02/04/2023]
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Abstract
BACKGROUND This is an updated version of the original review published in The Cochrane Library in 1999 and updated in 2004 and 2010. Population-based screening for lung cancer has not been adopted in the majority of countries. However it is not clear whether sputum examinations, chest radiography or newer methods such as computed tomography (CT) are effective in reducing mortality from lung cancer. OBJECTIVES To determine whether screening for lung cancer, using regular sputum examinations, chest radiography or CT scanning of the chest, reduces lung cancer mortality. SEARCH METHODS We searched electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 5), MEDLINE (1966 to 2012), PREMEDLINE and EMBASE (to 2012) and bibliographies. We handsearched the journal Lung Cancer (to 2000) and contacted experts in the field to identify published and unpublished trials. SELECTION CRITERIA Controlled trials of screening for lung cancer using sputum examinations, chest radiography or chest CT. DATA COLLECTION AND ANALYSIS We performed an intention-to-screen analysis. Where there was significant statistical heterogeneity, we reported risk ratios (RRs) using the random-effects model. For other outcomes we used the fixed-effect model. MAIN RESULTS We included nine trials in the review (eight randomised controlled studies and one controlled trial) with a total of 453,965 subjects. In one large study that included both smokers and non-smokers comparing annual chest x-ray screening with usual care there was no reduction in lung cancer mortality (RR 0.99, 95% CI 0.91 to 1.07). In a meta-analysis of studies comparing different frequencies of chest x-ray screening, frequent screening with chest x-rays was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, 95% CI 1.00 to 1.23); however several of the trials included in this meta-analysis had potential methodological weaknesses. We observed a non-statistically significant trend to reduced mortality from lung cancer when screening with chest x-ray and sputum cytology was compared with chest x-ray alone (RR 0.88, 95% CI 0.74 to 1.03). There was one large methodologically rigorous trial in high-risk smokers and ex-smokers (those aged 55 to 74 years with ≥ 30 pack-years of smoking and who quit ≤ 15 years prior to entry if ex-smokers) comparing annual low-dose CT screening with annual chest x-ray screening; in this study the relative risk of death from lung cancer was significantly reduced in the low-dose CT group (RR 0.80, 95% CI 0.70 to 0.92). AUTHORS' CONCLUSIONS The current evidence does not support screening for lung cancer with chest radiography or sputum cytology. Annual low-dose CT screening is associated with a reduction in lung cancer mortality in high-risk smokers but further data are required on the cost effectiveness of screening and the relative harms and benefits of screening across a range of different risk groups and settings.
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Affiliation(s)
- Renée Manser
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Institute, St Andrew's Place, East Melbourne 3002, Victoria, and Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia.
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Importin subunit alpha-2 is identified as a potential biomarker for non-small cell lung cancer by integration of the cancer cell secretome and tissue transcriptome. Int J Cancer 2010; 128:2364-72. [DOI: 10.1002/ijc.25568] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Chen W, Jian W, Li HT, Li C, Zhang YK, Xie B, Zhou DQ, Dai YM, Lin Y, Lu M, Huang XQ, Xu CX, Chen L. Whole-body diffusion-weighted imaging vs. FDG-PET for the detection of non-small-cell lung cancer. How do they measure up? Magn Reson Imaging 2010; 28:613-20. [PMID: 20418042 DOI: 10.1016/j.mri.2010.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 12/04/2009] [Accepted: 02/08/2010] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare the diagnostic efficacy of whole-body diffusion-weighted imaging (WB-DWI) and [18F] fluoro-2-D-glucose PET/CT(FDG-PET/CT)for assessment of non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS A group of 56 patients (21 female, 35 male; 35-76 years) with NSCLC proved by pathologic examination or follow-up imaging findings was set as reference standards, and all patients underwent both WB-DWI at 1.5T (MAGNETOM Avanto) and PET/CT (Biograph 16). For WB-DWI, a free breathing diffusion-weighted single-shot spin-echo epi-sequence in five-stations (head-neck, thorax, abdomen, pelvis-thigh) was used. Each station-series contained 30 contiguous axial slices. Imaging parameters: FOV 360x360 mm, matrix size 128x80. B-values: 0 and 1000 s/mm(2) applied along x, y and z, 5 averages, acquisition time: 2.23 min/series, total: 11.55 min. The efficacy of WB-DWI and PET/CT were determined in a blinded reading by two radiologists and two nuclear medicine physicians using pathology and size change during follow up exams as the reference standard. RESULTS Primary tumors (n=56 patients) were correctly detected in 56 (100%) patients by both PET/CT and WB-DWI. Ninety-six lymph nodes metastases were determined with pathologic and follow-up examinations. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV) being for lymph node metastases: 91%, 90%, 90%, 96%, 80% with WB-DWI and 98%, 97%, 97%, 99%, 93% with PET-CT, other metastases: 90%, 95%, 92%, 97%, 83% with WB-DWI and 98%, 100%, 98%, 100%, 95% with PET-CT). Differences in the accuracy of lymph node metastasis detection between PET/CT and WB-DWI (P=.031) were significant. The differences were not statistically significant for detection of other metastases. CONCLUSIONS WB-DWI is a feasible clinical technique for the assessment of NSCLC, lymph nodes and metastastic spread with high sensitivity and accuracy, but it was limited in the evaluation of neck lymph node metastases and small metastastic lung nodules.
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Affiliation(s)
- Wei Chen
- Department of Radiology, Southwest Hospital, The Third Military Medical University, Chongqing, China
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Metastases in mediastinal and hilar lymph nodes in patients with non-small cell lung cancer: quantitative assessment with diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient. J Comput Assist Tomogr 2010; 34:1-8. [PMID: 20118713 DOI: 10.1097/rct.0b013e3181a9cc07] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate diffusion-weighted magnetic resonance (DW-MR) imaging for detection of metastases in lymph nodes by using quantitative analysis. METHODS Seventy patients with non-small cell lung cancer were examined with DW and short inversion time inversion recovery (STIR) turbo-spin-echo MR imaging. Apparent diffusion coefficient of each lung cancer and lymph node was calculated from DW-MR images. Difference of the apparent diffusion coefficient in a lung cancer and a lymph node was calculated (D1). From STIR turbo-spin-echo MR images, ratios of signal intensity in a lymph node to that in a 0.9% saline phantom was calculated (lymph node-saline ratio [LSR1]). For quantitative analysis, the threshold value for a positive test was determined on a per node basis and tested for ability to enable a correct diagnosis on a per patient basis. Results of quantitative analyses of DW- and STIR-MR images were compared on a per patient basis with McNemar testing. RESULTS Mean D1 in the lymph node group with metastases was lower than that in the group without metastases (P < 0.001). When an D1 of 0.24 x 10(-3) mm2/s was used as the positive test threshold, sensitivity, specificity, and accuracy were 69.2%, 100%, and 94.0%, respectively, on a per patient basis. There was no significant difference (P > 0.05) between quantitative analyses of DW-MR images and STIR-MR images. CONCLUSIONS Quantitative analysis of DW-MR images enables differentiation of lymph nodes with metastasis from those without.
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Takenaka D, Ohno Y, Koyama H, Nogami M, Onishi Y, Matsumoto K, Matsumoto S, Yoshikawa T, Sugimura K. Integrated FDG-PET/CT vs. standard radiological examinations: comparison of capability for assessment of postoperative recurrence in non-small cell lung cancer patients. Eur J Radiol 2009; 74:458-64. [PMID: 19398291 DOI: 10.1016/j.ejrad.2009.03.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 02/09/2009] [Accepted: 03/05/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this study was to prospectively and directly compare diagnostic capabilities of whole-body integrated FDG-PET/CT and standard radiologic examination for assessment of recurrence in postoperative non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS A total of 92 consecutive pathologically diagnosed NSCLC patients (65 males, 27 females; mean age, 71 years) underwent pathologically and surgically proven complete resection, followed by prospective whole-body FDG-PET/CT and standard radiological examinations. Final diagnosis of recurrence was based on the results of more than 1 year of follow-up and/or pathological examinations. On both methods, the probability of recurrence was assessed in each patient by using a five-point visual scoring system, and the each final diagnosis was made by consensus between two readers. Kappa analyses were performed to determine inter-observer agreement for both methods, and ROC analyses were used to compare capability of the two methods for assessment of postoperative recurrence on a per-patient basis. Sensitivity, specificity and accuracy were also compared between PET/CT and standard radiological examination by means of McNemar's test. RESULTS All inter-observer agreements were almost perfect (integrated PET/CT: kappa=0.89; standard radiological examination: kappa=0.81). There were no statistically significant differences in area under the curve, sensitivity, specificity and accuracy between integrated FDG-PET/CT and standard radiologic examinations (p>0.05). CONCLUSION Integrated FDG-PET/CT can be used for assessment of postoperative recurrence in NSCLC patients with accuracy as good as that of standard radiological examinations.
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Affiliation(s)
- Daisuke Takenaka
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
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Kagna O, Solomonov A, Keidar Z, Bar-Shalom R, Fruchter O, Yigla M, Israel O, Guralnik L. The value of FDG-PET/CT in assessing single pulmonary nodules in patients at high risk of lung cancer. Eur J Nucl Med Mol Imaging 2009; 36:997-1004. [PMID: 19194704 DOI: 10.1007/s00259-009-1061-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Accepted: 12/30/2008] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate whether PET/low-dose CT (ldCT) using (18)F-fluorodeoxyglucose (FDG) improves characterization of indeterminate single pulmonary nodules (SPNs) in patients at high risk of lung cancer. METHODS Retrospective analysis of 307 patients who underwent FDG-PET/CT for indeterminate SPNs identified 93 (70 men, age range 46-90 years) at high risk of lung cancer (age >40 years, minimum 10 pack-year smokers). SPNs were evaluated for the presence and intensity of FDG avidity and ldCT patterns. The performance of visual and semiquantitative FDG-PET/ldCT algorithms for characterization of SPNs was compared to that of ldCT. Incongruent FDG-PET and ldCT patterns were analyzed for significance in further patient management. RESULTS Malignancy was diagnosed in 38% patients. FDG avidity defined 33 SPNs as true-positive (TP) and 2 as false-negative (FN) (malignant), and 41 as true-negative (TN) and 17 as false-positive (FP) (benign). For SUVmax of 2.2 (by ROC analysis) there were 27 TP, 8 FN, 48 TN and 10 FP SPNs. LdCT defined 34 TP, 1 FN, 28 TN and 30 FP lesions. Of the FP lesions on ldCT, 60% were FDG-negative. Visual PET/ldCT analysis had a sensitivity of 94%, a specificity of 70%, an accuracy of 80%, a positive predictive value (PPV) of 66%, and a negative predictive value (NPV) of 95% as compared to 77%, 83%, 81%, 73%, 86% for semiquantitative PET/ldCT and 97%, 48%, 66%, 53%, 96% for ldCT, respectively. Both PET/ldCT algorithms had statistically significantly higher specificity and accuracy than ldCT. Semiquantitative analysis showed significantly higher PPV and lower sensitivity and NPV than found with ldCT. CONCLUSION A single screening procedure encompassing FDG-PET and ldCT may improve screening for lung cancer in high-risk patients. The significantly improved specificity may potentially reduce FP ldCT results and further unnecessary invasive procedures.
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Affiliation(s)
- Olga Kagna
- Department of Nuclear Medicine, Ramban Health Care Campus, Technion, Israel Institute of Technology, Haifa, Israel.
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Ohno Y, Koyama H, Onishi Y, Takenaka D, Nogami M, Yoshikawa T, Matsumoto S, Kotani Y, Sugimura K. Non-small cell lung cancer: whole-body MR examination for M-stage assessment--utility for whole-body diffusion-weighted imaging compared with integrated FDG PET/CT. Radiology 2008; 248:643-54. [PMID: 18539889 DOI: 10.1148/radiol.2482072039] [Citation(s) in RCA: 181] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE To prospectively and directly compare the capability of whole-body diffusion-weighted (DW) imaging, whole-body magnetic resonance (MR) imaging with and that without DW imaging, and integrated fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for M-stage assessment in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS The institutional review board approved this study; informed consent was obtained from patients. A total of 203 NSCLC patients (109 men, 94 women; mean age, 72 years) prospectively underwent whole-body DW imaging, whole-body MR imaging, and FDG PET/CT. Final diagnosis of the M-stage in each patient was determined on the basis of results of all radiologic and follow-up examinations. Two chest radiologists and two nuclear medicine physicians independently assessed all examination results and used a five-point visual scoring system to evaluate the probability of metastases. Final diagnosis based on each of the methods was made by consensus of two readers. Receiver operating characteristic (ROC) analysis was used to compare the capability for M-stage assessment among whole-body DW imaging, whole-body MR imaging with and that without DW imaging, and PET/CT on a per-patient basis. Sensitivity, specificity, and accuracy were compared with the McNemar test. RESULTS Area under ROC curve (A(z)) values of whole-body MR imaging with DW imaging (A(z) = 0.87, P = .04) and integrated FDG PET/CT (A(z) = 0.89, P = .02) were significantly larger than that of whole-body DW imaging (A(z) = 0.79). Specificity and accuracy of whole-body MR imaging with (specificity, P = .02; accuracy, P < .01) and that without DW imaging (specificity, P = .02; accuracy, P = .01) and integrated FDG PET/CT (specificity, P < .01; accuracy, P < .01) were significantly higher than those of whole-body DW imaging. CONCLUSION Whole-body MR imaging with DW imaging can be used for M-stage assessment in NSCLC patients with accuracy as good as that of PET/CT.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
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Ohno Y, Koyama H, Nogami M, Takenaka D, Yoshikawa T, Yoshimura M, Ohbayashi C, Sugimura K. STIR turbo SE MR imaging vs. coregistered FDG-PET/CT: Quantitative and qualitative assessment of N-stage in non-small-cell lung cancer patients. J Magn Reson Imaging 2007; 26:1071-80. [PMID: 17896365 DOI: 10.1002/jmri.21106] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To conduct a prospective comparison of the accuracy of short inversion time (TI) inversion-recovery (STIR) turbo spin-echo (SE) imaging and coregistered 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) with computed tomography (CT) (coregistered FDG-PET/CT) to assess the N-stage in non-small-cell lung cancer (NSCLC) patients. MATERIALS AND METHODS A total of 115 consecutive NSCLC patients prospectively underwent CT, STIR turbo SE imaging, and FDG-PET, as well as surgical and pathological examinations. All STIR turbo SE images were obtained with a 0.9% saline phantom, which was placed alongside the chest wall of each patient, and coregistered FDG-PET/CTs were reconstructed using commercially available software. For quantitative assessments, the ratio of signal intensity (SI) of each lymph node to that of 0.9% saline phantom (lymph node-saline ratio [LSR]) and maximal standardized uptake value (SUV(max)) of each lymph node were calculated. Feasible threshold values were determined by using the receiver operating characteristic (ROC) curve-based positive test, and diagnostic capabilities of N-stage were compared by McNemar's test on a per patient basis. RESULTS When feasible, threshold values were adopted, quantitative sensitivity (90.1%) and accuracy (92.2%) of STIR turbo SE imaging were significantly higher than those of quantitative and qualitative sensitivities (76.7% and 74.4%) and accuracies (83.5% and 82.6%) of coregistered FDG-PET/CT on a per patient basis (P < 0.05). CONCLUSION STIR turbo SE imaging is at least as valid as coregistered FDG-PET/CT for quantitative and qualitative assessment of the N-stage for NSCLC patients.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
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15
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Ohno Y, Koyama H, Nogami M, Takenaka D, Yoshikawa T, Yoshimura M, Kotani Y, Nishimura Y, Higashino T, Sugimura K. Whole-body MR imaging vs. FDG-PET: Comparison of accuracy of M-stage diagnosis for lung cancer patients. J Magn Reson Imaging 2007; 26:498-509. [PMID: 17729341 DOI: 10.1002/jmri.21031] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To conduct a prospective comparison of the accuracy of whole-body MR imaging and positron emission tomography (PET) with fluorine-18 deoxyglucose (FDG) (FDG-PET) to assess the M-stage in lung cancer patients. MATERIALS AND METHODS A total of 90 consecutive lung cancer patients (mean age = 68 years) underwent whole-body MR imaging and FDG-PET as well as other standard radiological imaging procedures before and after treatment. Probabilities of metastases on whole-body MR imaging and FDG-PET were assessed by using 5-point scoring systems on a per-site basis and on a per-patient basis. Receiver operating characteristic (ROC) curve analysis was used to compare diagnostic capabilities. Sensitivity, specificity, and accuracy were also compared by using the McNemar's test on a per-site and per-patient basis. RESULTS For assessment of head and neck metastases and bone metastases, accuracies of whole-body MR imaging (95.0% and 94.8%, respectively) were significantly higher than those of FDG-PET (89.1% and 88.2%, respectively; P < 0.05). For assessment of the M-stage on a per-patient basis, accuracy of whole-body MR imaging (80.0%) was also significantly higher than that of FDG-PET (73.3%; P < 0.05). CONCLUSION Whole-body MR imaging is an accurate diagnostic technique and may be considered at least as effective as FDG-PET for assessment of the M-stage of lung cancer patients.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
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Shaham D, Breuer R, Copel L, Agid R, Makori A, Kisselgoff D, Goitein O, Izhar U, Berkman N, Heching N, Sosna J, Bar-Ziv J, Libson E. Computed Tomography Screening for Lung Cancer: Applicability of an International Protocol in a Single-Institution Environment. Clin Lung Cancer 2006; 7:262-7. [PMID: 16512980 DOI: 10.3816/clc.2006.n.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study was to assess the applicability of an annual low-dose computed tomography (CT) screening program for lung cancer in a single institution in Israel, which has a relatively lower prevalence of lung cancer compared with other Western countries, and to examine stage distribution of detected lung cancers. PATIENTS AND METHODS A cohort of 842 former and current smokers underwent baseline low-dose CT screening and a total of 942 annual repeat screenings over a period of 68 months. The definition of positive results on baseline and repeat screening and their diagnostic workup were guided by the common International Early Lung Cancer Action Program protocol. Recommendations for biopsy of suspicious nodules were based on nodule size, nodule growth, non-resolution following antibiotic therapy, and positron emission tomography scan. RESULTS The test result was positive in 102 of the 842 baseline screenings (12%) and in 45 of the 942 annual repeat screenings (5%), and biopsy was recommended in 12 baseline and 2 annual screenings. Twelve of the 14 cancers diagnosed (86%) were stage I tumors. CONCLUSION Our study indicates that the adoption of a common international protocol is feasible, even in a very different clinical setting, yielding a high proportion of early-stage lung cancers.
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Affiliation(s)
- Dorith Shaham
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
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Brunworth LS, Dharmasena D, Virgo KS, Johnson FE. Pulmonary resection for non-small cell lung cancer in patients with prior spinal cord injury. J Spinal Cord Med 2006; 29:133-7. [PMID: 16739556 PMCID: PMC1864802 DOI: 10.1080/10790268.2006.11753866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Accepted: 01/08/2006] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE We sought to determine the clinical course of patients with spinal cord injury (SCI) who subsequently developed bronchogenic carcinoma and underwent pulmonary resection. METHODS A nationwide retrospective study was conducted of all veterans at Department of Veterans Affairs Medical Centers for fiscal years 1993-2002 who were diagnosed with SCI, subsequently developed non-small cell lung cancer, and were surgically treated with curative intent. Inclusion criteria included American Spinal Injury Association type A injury (complete loss of neural function distal to the injury site) and traumatic etiology. Data were compiled from national Department of Veterans Affairs data sets and supplemented by operative reports, pathology reports, progress notes, and discharge summaries. RESULTS Seven patients met the inclusion/exclusion criteria and were considered evaluable. Five (71%) had one or more comorbid conditions in addition to their SCIs. All 7 underwent pulmonary lobectomy. Postoperative complications occurred in 4 patients (57%). Two patients died postoperatively on days 29 and 499, yielding a 30-day mortality rate of 14% and an in-hospital mortality rate of 29%. CONCLUSIONS This seems to be the only case study in the English language literature on this topic. Patients with SCI who had resectable lung cancer had a high incidence of comorbid conditions. Those who underwent curative-intent surgery had high morbidity and mortality rates. Available evidence suggests that SCI should be considered a risk factor for adverse outcomes in major surgery of all types, including operations for primary lung cancer.
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Affiliation(s)
- Louis S Brunworth
- Department of Surgery, Saint Louis University Health Sciences Center, St. Louis, Missouri
- Surgical Service, Department of Veterans Affairs Medical Center, St. Louis, Missouri
| | - Dharson Dharmasena
- Surgical Service, Department of Veterans Affairs Medical Center, St. Louis, Missouri
- Guy's, King's and St. Thomas' College, London, United Kingdom
| | - Katherine S Virgo
- Department of Surgery, Saint Louis University Health Sciences Center, St. Louis, Missouri
- Surgical Service, Department of Veterans Affairs Medical Center, St. Louis, Missouri
| | - Frank E Johnson
- Department of Surgery, Saint Louis University Health Sciences Center, St. Louis, Missouri
- Surgical Service, Department of Veterans Affairs Medical Center, St. Louis, Missouri
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Higashino T, Ohno Y, Takenaka D, Watanabe H, Nogami M, Ohbayashi C, Yoshimura M, Satouchi M, Nishimura Y, Fujii M, Sugimura K. Thin-section multiplanar reformats from multidetector-row CT data: Utility for assessment of regional tumor extent in non-small cell lung cancer. Eur J Radiol 2005; 56:48-55. [PMID: 16168264 DOI: 10.1016/j.ejrad.2005.04.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the clinical utility of thin-section multiplanar reformats (MPRs) from multidetector-row CT (MDCT) data sets for assessing the extent of regional tumors in non-small cell lung cancer (NSCLC) patients. MATERIALS AND METHODS Sixty consecutive NSCLC patients, who were considered candidates for surgical treatment, underwent contrast-enhanced MDCT examinations, surgical resection and pathological examinations. All MDCT examinations were performed with a 4-detector row computed tomography (CT). From each raw CT data set, 5mm section thickness CT images (routine CT), 1.25 mm section thickness CT images (thin-section CT) and 1.25 mm section thickness sagittal (thin-section sagittal MPR) and coronal images (thin-section coronal MPR) were reconstructed. A 4-point visual score was used to assess mediastinal, interlobar and chest wall invasions on each image set. For assessment of utility in routine clinical practice, mean reading times for each image set were compared by means of Fisher's protected least significant difference (PLSD) test. A receiver operator characteristic (ROC) analysis was performed to determine the diagnostic capability of each of the image data sets. Finally, sensitivity, specificity and accuracy of the reconstructed images were compared by McNemar test. RESULTS Mean reading times for thin-section sagittal and coronal MPRs were significantly shorter than those for routine CT and thin-section CT (p<0.05). Areas under the curve (Azs) showing interlobar invasion on thin-section sagittal and coronal MPRs were significantly larger than that on routine CT (p=0.03), and the Az on thin-section sagittal MPR was also significantly larger than that on routine CT (p=0.02). Accuracy of chest wall invasion by thin-section sagittal MPR was significantly higher than that by routine CT (p=0.04). CONCLUSION Thin-section multiplanar reformats from multidetector-row CT data sets are useful for assessing the extent of regional tumors in non-small cell lung cancer patients.
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Affiliation(s)
- Takanori Higashino
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
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19
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Ohno Y, Hatabu H, Takenaka D, Higashino T, Watanabe H, Ohbayashi C, Yoshimura M, Satouchi M, Nishimura Y, Sugimura K. Metastases in Mediastinal and Hilar Lymph Nodes in Patients with Non–Small Cell Lung Cancer: Quantitative and Qualitative Assessment with STIR Turbo Spin-Echo MR Imaging. Radiology 2004; 231:872-9. [PMID: 15163823 DOI: 10.1148/radiol.2313030103] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate short inversion time inversion-recovery (STIR) turbo spin-echo (TSE) magnetic resonance (MR) imaging for detection of metastases in lymph nodes by using quantitative and qualitative analyses. MATERIALS AND METHODS One hundred ten patients (68 men and 42 women) with non-small cell lung cancer who ranged in age from 36 to 82 years (mean age, 64 years) were examined with respiratory-triggered STIR TSE MR imaging. Ratios of signal intensity in a lymph node to that in a 0.9% saline phantom (lymph node-saline ratios [LSRs]) for all lymph nodes were classified into three groups according to nodal short-axis diameter. LSRs of each group were compared by using pathologic diagnosis as the standard of reference. For quantitative analysis, the LSR threshold value for a positive test was determined on a per-node basis and tested for ability to enable a correct diagnosis on a per-patient basis. For qualitative analysis, signal intensities of lymph nodes were assessed by using a five-point visual scoring system. Results of quantitative and qualitative analyses were compared on a per-patient basis with McNemar testing. RESULTS In 110 patients, 92 of 802 lymph nodes were pathologically diagnosed as containing metastases, while 710 lymph nodes did not contain metastases. Mean LSR in the lymph node group with metastasis was higher than that in the group without metastasis (P <.05). When an LSR of 0.6 was used as the positive-test threshold at quantitative analysis, sensitivity was 93% (37 of 40 patients) and specificity was 87% (61 of 70 patients) on a per-patient basis. With a score of 4 as the positive-test threshold at qualitative analysis, sensitivity was 88% (35 of 40 patients) and specificity was 86% (60 of 70 patients) on a per-patient basis. There was no significant difference (P >.05) between results of quantitative and those of qualitative analysis. CONCLUSION Quantitative and qualitative analyses of STIR TSE MR images enable differentiation of lymph nodes with metastasis from those without. Qualitative analysis can substitute for quantitative analysis of STIR TSE MR imaging data.
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Affiliation(s)
- Yoshiharu Ohno
- Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
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Abstract
BACKGROUND While population based screening for lung cancer has not been adopted by most countries, it is not clear whether sputum examinations, chest radiography or newer methods such as computed tomography are effective in reducing mortality from lung cancer. OBJECTIVES To determine whether screening for lung cancer using regular sputum examinations or chest radiography or CT chest reduces lung cancer mortality. SEARCH STRATEGY Electronic databases (the Cochrane Central Register of Controlled Trials, MEDLINE, PREMEDLINE and EMBASE; 1966 to July 2000) ), bibliographies, hand searching of a journal and discussion with experts were used to identify published and unpublished trials. SELECTION CRITERIA Controlled trials of screening for lung cancer using sputum examinations, chest radiography or CT chest. DATA COLLECTION AND ANALYSIS Intention to screen analysis was performed. Where there was significant statistical heterogeneity relative risks were reported using the random effects model, but for other outcomes the fixed effect model was used. MAIN RESULTS Seven trials were included (6 randomised controlled studies and 1 non-randomised controlled trial) with a total of 245,610 subjects. There were no studies with an unscreened control group. Frequent screening with chest x-rays was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, CI: 1.00-1.23). A non statistically significant trend was observed to reduced mortality from lung cancer when screening with chest x-ray and sputum cytology was compared with chest x-ray alone (RR 0.88, CI:0.74-1.03). Several of the included studies had potential methodological weaknesses. There were no controlled studies of spiral CT. REVIEWER'S CONCLUSIONS The current evidence does not support screening for lung cancer with chest radiography or sputum cytology. Frequent chest x-ray screening might be harmful. Further, methodologically rigorous trials are required.
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Affiliation(s)
- R L Manser
- Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia
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21
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Tan YK, Wee TC, Koh WP, Wang YT, Eng P, Tan WC, Seow A. Survival among Chinese women with lung cancer in Singapore: a comparison by stage, histology and smoking status. Lung Cancer 2003; 40:237-46. [PMID: 12781422 DOI: 10.1016/s0169-5002(03)00038-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lung cancer generally carries a poor prognosis and the determinants of survival have been of interest. However, survival estimates in Asian populations are scarce. This study describes survival rates and their determinants in Singapore Chinese women, a primarily non-smoking population. Three hundred and twenty-six Chinese women, diagnosed with primary lung carcinoma in three major hospitals in Singapore between April 1996 and December 1998, were followed up till 31 December 2000. The Kaplan-Meier method was used for survival analysis. Two hundred and eighty (85.7%) died from the disease during follow-up. The median survival time was 0.7 years and the three-year survival was 15.8%. These survival rates are similar to those of Western populations, and they provide a basis for examining trends over time. Age at diagnosis was an independent prognostic factor [adjusted hazard ratio (relative risk) 1.4, 95% confidence intervals (CI) 1.1-1.9 for women above 65 years relative to younger women]. Most (70.5%) tumours were stage III/IV at diagnosis. Three-year survival ranged from 72% among patients with stage I tumours to 7% for stage IV tumours. Overall, there was no survival difference among different histological types in all stages combined. When limited to stages I and II cancers, adenocarcinomas were associated with a better outcome relative to other histological subtypes combined (adjusted relative risk 0.4, 95% CI 0.1-1.0). Smoking was an independent risk factor (adjusted relative risk 1.3, 95% CI 1.0-1.8). Nevertheless, non-smokers comprised 57.4% of this series, highlighting the importance of increased awareness among health professionals and the public that lung cancer is not only a disease of smokers. The high proportion of late-stage tumours in this study and the impact of disease stage on outcome underline the importance of early detection in improving survival of lung cancer.
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Affiliation(s)
- Y K Tan
- Department of Community, Occupational and Family Medicine, National University of Singapore, 16 Medical Drive, MD3, 117597 Singapore, Republic of Singapore
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Mahadevia PJ, Fleisher LA, Frick KD, Eng J, Goodman SN, Powe NR. Lung cancer screening with helical computed tomography in older adult smokers: a decision and cost-effectiveness analysis. JAMA 2003; 289:313-22. [PMID: 12525232 DOI: 10.1001/jama.289.3.313] [Citation(s) in RCA: 245] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
CONTEXT Encouraged by direct-to-consumer marketing, smokers and their physicians are contemplating lung cancer screening with a promising but unproven imaging procedure, helical computed tomography (CT). OBJECTIVE To estimate the potential benefits, harms, and cost-effectiveness of lung cancer screening with helical CT in various efficacy scenarios. DESIGN, SETTING, AND POPULATION Using a computer-simulated model, we compared annual helical CT screening to no screening for hypothetical cohorts of 100 000 current, quitting, and former heavy smokers, aged 60 years, of whom 55% were men. We simulated efficacy by changing the clinical stage distribution of lung cancers so that the screened group would have fewer advanced-stage cancers and more localized-stage cancers than the nonscreened group (ie, a stage shift). Our model incorporated known biases in screening programs such as lead time, length, and overdiagnosis bias. MAIN OUTCOME MEASURES We measured the benefits of screening by comparing the absolute and relative difference in lung cancer-specific deaths. We measured harms by the number of false-positive invasive tests or surgeries per 100 000 and incremental cost-effectiveness in US dollars per quality-adjusted life-year (QALY) gained. RESULTS Over a 20-year period, assuming a 50% stage shift, the current heavy smoker cohort had 553 fewer lung cancer deaths (13% lung cancer-specific mortality reduction) and 1186 false-positive invasive procedures per 100 000 persons. The incremental cost-effectiveness for current smokers was $116 300 per QALY gained. For quitting and former smokers, the incremental cost-effectiveness was $558 600 and $2 322 700 per QALY gained, respectively. Other than the degree of stage shift, the most influential parameters were adherence to screening, degree of length or overdiagnosis bias in the first year of screening, quality of life of persons with screen-detected localized lung cancers, cost of helical CT, and anxiety about indeterminate nodule diagnoses. In 1-way sensitivity analyses, none of these parameters was sufficient to make screening highly cost-effective for any of the cohorts. In multiway sensitivity analyses, a program screening current smokers was $42 500 per QALY gained if extremely favorable estimates were used for all of the influential parameters simultaneously. CONCLUSION Even if efficacy is eventually proven, screening must overcome multiple additional barriers to be highly cost-effective. Given the current uncertainty of benefits, the harms from invasive testing, and the high costs associated with screening, direct-to-consumer marketing of helical CT is not advisable.
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Affiliation(s)
- Parthiv J Mahadevia
- Robert Wood Johnson Clinical Scholars Program, Johns Hopkins School of Medicine, Baltimore, Md, USA.
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23
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Caulet-Maugendre S, Birolleau S, Corbineau H, Bassen R, Desrues B, Bidon N, Delaval P, Ramée MP, Brichory F, Dazord L. Immunohistochemical expression of the intracellular component of galectin-8 in squamous cell metaplasia of the bronchial epithelium in neoplastic and benign processes. Pathol Res Pract 2002; 197:797-801. [PMID: 11795826 DOI: 10.1078/0344-0338-00162] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Specified galectins are known to play a role in regulating cell proliferation, differentiation, adhesion and migration. Po66, a mouse IgG1 monoclonal antibody produced by immunization against squamous cell cancer, reacts against a carbohydrate-binding protein (Po66-CBP), recently shown to be a member of the galectin family with a strong homology with galectin-8 (PCTA-1), identified as a human tumor-associated antigen. We studied Po66 in squamous metaplasia of the bronchi in order to determine whether it could be specifically involved in neoplastic conditions and if so, if it would be helpful in distinguishing metaplasia at risk of cancer. Twenty-eight formalin-fixed, paraffin-embedded archival tissues of 17 metaplasias with SCC, 3 metaplasia with distant neoplastic disease and 8 metaplasias with an inflammatory process, were immunostained using a streptavidin biotin peroxydase method. The squamous metaplasias were positively stained in non-neoplastic disease as well as in neoplastic processes. Expression was also observed in stromal and normal cells. Po66-CBP was not associated with a pre-neoplastic character. We discussed the expression of this intra-cellular component of galectin-8 according to the functions of galectins in cellular differentiation, host reaction against tumor, and inflammation.
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Affiliation(s)
- S Caulet-Maugendre
- Service d'Anatomie et de Cytologie pathologiques B, Centre Hospitalier-Régional et Universitaire Pontchaillou, Rennes, France
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Henschke CI, Yankelevitz DF, Libby D, McCauley D, Pasmantier M, Smith JP. Computed tomography screening for lung cancer. Clin Chest Med 2002; 23:49-57, viii. [PMID: 11901919 DOI: 10.1016/s0272-5231(03)00059-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The development of CT technology reopened the lung cancer screening debate. Computed tomography screening for lung cancer certainly meets all the criteria required for an appropriate screening test. First and perhaps most importantly, the disease for which the screening is being performed should have a significant prevalence in the population being studied and be a significant health risk for those afflicted with it. Lung cancer is the leading cause of cancer death in both men and women, and one of the most lethal of all cancers.
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Affiliation(s)
- Claudia I Henschke
- Department of Radiology, Weill Medical College, Cornell University, New York, New York, USA.
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25
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Gupta NC, Tamim WJ, Graeber GG, Bishop HA, Hobbs GR. Mediastinal lymph node sampling following positron emission tomography with fluorodeoxyglucose imaging in lung cancer staging. Chest 2001; 120:521-7. [PMID: 11502653 DOI: 10.1378/chest.120.2.521] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To evaluate the predictive accuracy as well as the rates of false-positive and false-negative results of CT and positron emission tomography (PET)-fluorodeoxyglucose (FDG) imaging in detecting the metastatic intrathoracic lymph nodes in patients with suspected or proven non-small cell lung cancer (NSCLC). Our other objective was to determine the need for routine invasive sampling procedure in confirming PET/CT staging results. METHODS The results of CT and PET-FDG scanning in 77 patients with suspected or proven NSCLC were correlated with the histologic findings of hilar/mediastinal lymph node sampling using mediastinoscopy, open biopsy, thoracotomy, or thoracotomy with resection. Patients were then classified into resectable and unresectable groups based initially on PET results and compared to histologic findings. RESULTS The sensitivity, specificity, and accuracy of CT and PET for detecting metastatic lymphadenopathy were 68%, 61%, 63%, and 87%, 91%, and 82%, respectively. A change of management with routine sampling following PET was seen in five of six patients (83%) with false-positive findings (13%) but in none of four patients (9%) with false-negative findings. CONCLUSION The false-positive findings of PET-FDG imaging affected selection of treatment in 83% of patients. However, false-negative results did not change management in any patient. This could potentially prevent unnecessary invasive thoracotomy, mediastinoscopy, or other sampling procedures in patients with negative PET results.
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Affiliation(s)
- N C Gupta
- West Virginia University PET Center and Department of Surgery, Robert C. Byrd Health Sciences Center, Morgantown, WV 26506, USA.
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Lung Neoplasms. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
BACKGROUND The effectiveness of screening for lung cancer with chest radiography, sputum cytology or spiral CT has not been established. OBJECTIVES To determine whether screening for lung cancer using regular sputum examinations or chest radiography or CT chest reduces lung cancer mortality. SEARCH STRATEGY Electronic databases, bibliographies, hand searching of a journal and discussion with experts were used to identify published and unpublished trials. SELECTION CRITERIA Controlled trials of screening for lung cancer using sputum examinations, chest radiography or CT chest. DATA COLLECTION AND ANALYSIS Intention to screen analysis was performed. Where there was significant statistical heterogeneity relative risks were reported using the random effect model, but for other outcomes the fixed effect model was used. MAIN RESULTS Seven trials were included (6 randomised controlled studies and 1 non-randomised controlled trial) with a total of 245,610 subjects. There were no studies with an unscreened control group. Frequent screening with chest x-rays was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, CI: 1.00-1.23). A non statistically significant trend was observed to reduced mortality from lung cancer when screening with chest x-ray and sputum cytology was compared with chest x-ray alone (RR 0.88, CI:0.74-1.03). Several of the included studies had potential methodological weaknesses. There were no controlled studies of spiral CT. REVIEWER'S CONCLUSIONS The current evidence does not support screening for lung cancer with chest radiography or sputum cytology. Frequent chest x-ray screening might be harmful. Further, methodologically rigorous trials are required.
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Affiliation(s)
- R L Manser
- Clinical Epidemiology and Health Service Evaluation Unit, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, Australia, 3050.
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Gupta NC, Bishop HA, Rogers JS, Tamim WZ, Reesman SD. Treatment Outcome of Lung Cancer Patients as Optimized by Preoperative Whole-Body Positron Emission Tomography Fluorodeoxyglucose Imaging. Clin Lung Cancer 2000; 2:146-50; discussion 151. [PMID: 14731326 DOI: 10.3816/clc.2000.n.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Positron emission tomography (PET) fluorodeoxyglucose (FDG) imaging may be more accurate than computed tomography (CT) scanning for staging of lung cancer disease. In the present study, we evaluate whether whole-body PET-FDG imaging can accurately stratify lung cancer patients by stage and thus predict patient outcome. Forty-one consecutive patients underwent whole-body PET and CT scanning for preoperative staging, which was then confirmed by mediastinoscopy, thoracotomy, and/or other tests revealing distant metastases. The effect of PET on patient management was determined. PET was significantly more accurate than CT for staging of lung cancer (97.6% vs. 70.7%). One-year follow-up for survival rate and treatment response was also compared in different patient groups. PET accurately identified patients with resectable disease (Group A). Group B patients, with medically inoperable disease, and Group C patients, with unresectable advanced disease, had 100% and 53% incidence of adverse events (defined as recurrence, evidence of new disease, or death), respectively. Group A patients with resectable disease who underwent surgery showed the best patient outcome, with only 7% incidence of adverse events. In conclusion, whole-body PET can be useful in identifying a group of lung cancer patients with resectable disease most likely to benefit from surgical resection. Further studies are needed to explore whether PET can predict patient outcome of various lung cancer patients receiving different treatment regimens.
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Affiliation(s)
- N C Gupta
- West Virginia University PET Center, West Virginia University School of Medicine, Health Sciences Center South, Morgantown, WV 26506, USA.
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Alavi A. Commentary on “Treatment Outcome of Lung Cancer Patients as Optimized by Preoperative Whole-Body Positron Emission Tomography Fluorodeoxyglucose Imaging”. Clin Lung Cancer 2000. [DOI: 10.1016/s1525-7304(11)70630-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- J C Porter
- Department of Thoracic Medicine, The Middlesex Hospital, London, UK
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Abstract
Recommendations against screening for lung cancer were based on the lack of a reduction in mortality of the screened group as compared with the control group in randomized control trials. These results were interpreted as showing that early detection of lung cancer as a result of screening did not decrease the mortality rate compared with detection after presentation of symptoms for the populations being screened. Evidence, however, shows that earlier-stage intervention leads to substantially higher rates of survival. Screening, therefore, is an effective means to prevent deaths from this otherwise fatal disease. This article discusses the evidence of both CT and chest radiograph screening.
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Affiliation(s)
- C I Henschke
- Department of Radiology, New York Presbyterian Hospital, Joan and Sanford I. Weill Medical College, Cornell University, New York, USA
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Kennedy TC, Miller Y, Prindiville S. Screening for lung cancer revisited and the role of sputum cytology and fluorescence bronchoscopy in a high-risk group. Chest 2000; 117:72S-79S. [PMID: 10777459 DOI: 10.1378/chest.117.4_suppl_1.72s] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Lung cancer is an epidemic disease that is underrepresented in the research funding for early detection and chemoprevention arenas. Screening programs have been discouraged for both financial and political reasons. Yet, increasing evidence suggests that screening and early detection may improve outcome in lung cancer. Sputum cytology examination has been shown in several studies to lead to detection of lung cancer at an earlier stage, resulting in an improved 5-year survival rate. Monoclonal antibody detection, fluorescence bronchoscopy, and low-dose spiral CT increase diagnostic sensitivity and improve the ability to localize early-stage lesions. Utilizing these new techniques and improving the definition of high-risk groups may improve the success and cost-effectiveness of early detection based on sputum cytology. The ultimate goal of improving long-term survival in lung cancer will be achieved only when cancer can be detected in its early stages and lesions can be localized in large numbers. Advances in the last 15 years offer an encouraging vision for the value of early detection and effective treatment for lung cancer.
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Affiliation(s)
- T C Kennedy
- University of Colorado Health Science Center, Division of Pulmonary and Critical Care Medicine, Lung Cancer Institute of Colorado, Denver, CO, USA
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Abstract
Screening for lung cancer has remained controversial since the completion, more than two decades ago, of the three large randomized controlled trials, sponsored by the National Cancer Institute, which led to the recommendation against screening by major medical organizations. Details of the controversy are given, which include concerns about the study design, implementation, and analysis. New evidence about the potential benefit of screening with chest radiography that has emerged since the completion of those trials is reviewed, as well as the results of studies of CT screening for lung cancer.
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Affiliation(s)
- C I Henschke
- New York Presbyterian Hospital-Weill Cornell Medical Center, NY 10021, USA
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Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP, McGuinness G, Miettinen OS, Libby DM, Pasmantier MW, Koizumi J, Altorki NK, Smith JP. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999; 354:99-105. [PMID: 10408484 DOI: 10.1016/s0140-6736(99)06093-6] [Citation(s) in RCA: 1599] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low-radiation-dose computed tomography (low-dose CT) in people at high risk of lung cancer. We report the baseline experience. METHODS ELCAP has enrolled 1000 symptom-free volunteers, aged 60 years or older, with at least 10 pack-years of cigarette smoking and no previous cancer, who were medically fit to undergo thoracic surgery. After a structured interview and informed consent, chest radiographs and low-dose CT were done for each participant. The diagnostic investigation of screen-detected non-calcified pulmonary nodules was guided by ELCAP recommendations, which included short-term high-resolution CT follow-up for the smallest non-calcified nodules. FINDINGS Non-calcified nodules were detected in 233 (23% [95% CI 21-26]) participants by low-dose CT at baseline, compared with 68 (7% [5-9]) by chest radiography. Malignant disease was detected in 27 (2.7% [1.8-3.8]) by CT and seven (0.7% [0.3-1.3]) by chest radiography, and stage I malignant disease in 23 (2.3% [1.5-3.3]) and four (0.4% [0.1-0.9]), respectively. Of the 27 CT-detected cancers, 26 were resectable. Biopsies were done on 28 of the 233 participants with non-calcified nodules; 27 had malignant non-calcified nodules and one had a benign nodule. Another three individuals underwent biopsy against the ELCAP recommendations; all had benign non-calcified nodules. No participant had thoracotomy for a benign nodule. INTERPRETATION Low-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage. Although false-positive CT results are common, they can be managed with little use of invasive diagnostic procedures.
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Affiliation(s)
- C I Henschke
- Weill Medical College of Cornell University and New York Presbyterian Hospital, NY 10021, USA.
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Hsieh CC, Chow KC, Fahn HJ, Tsai CM, Li WY, Huang MH, Wang LS. Prognostic significance of HER-2/neu overexpression in stage I adenocarcinoma of lung. Ann Thorac Surg 1998; 66:1159-63; discussion 1163-4. [PMID: 9800799 DOI: 10.1016/s0003-4975(98)00792-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Even with early diagnosis and adequate resection, the 5-year survival rate for stage I lung cancer patients is around 60% to 70%. Overexpression of HER-2/neu protein is associated with poor prognosis in lung cancers. In this study, we evaluated the expression of HER-2/neu in cancer cells of lung and assessed their clinicopathologic and prognostic significance. METHODS From 1986 to 1995, clinical data on 42 consecutive patients who underwent complete surgical resection for stage I lung adenocarcinoma were collected. Expression of HER-2/neu in paraffin-embedded tumor samples was determined by immunohistochemistry and scored with a semiquantitative method. RESULTS Twenty-one of 42 patients were positive for HER-2/neu overexpression in tumor. Compared with patients with low HER-2/neu expression, patients with HER-2/neu overexpression had a significantly higher incidence of early tumor recurrence (p = 0.014). Survival was also significantly better in patients without HER-2/neu overexpression than in those with HER-2/neu overexpression (p = 0.0047). By univariate analysis, HER-2/neu overexpression and poor cell differentiation are two important factors correlated with poor prognosis. CONCLUSIONS Expression of HER-2/neu oncoprotein in stage I lung adenocarcinoma can predict the tumor's aggressiveness. Early tumor recurrence was frequently detected in patients with HER-2/neu overexpression. We recommend an individualized therapeutic strategy based on the level of HER-2/neu oncoprotein in the tumor cells.
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Affiliation(s)
- C C Hsieh
- Department of Surgery, Cancer Center, Veterans General Hospital-Taipei, and National Yang Ming University, Taiwan, Republic of China
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McLean AN, Semple PA, Franklin DH, Petrie G, Millar EA, Douglas JG. The Scottish multi-centre prospective study of bronchoscopy for bronchial carcinoma and suggested audit standards. Respir Med 1998; 92:1110-5. [PMID: 9926164 DOI: 10.1016/s0954-6111(98)90403-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Fibre-optic bronchoscopy is widely used to diagnose bronchial carcinoma. There is considerable variation in techniques for patient sedation, methods of obtaining samples and histopathological yield. We wished to examine variations in practice in different centres throughout Scotland and derive realistic audit standards for best clinical practice from these results. Diagnostic bronchoscopies from five centres were included. Patient details, grade of individual performing the test, endobronchial abnormalities, specimens taken and the histocytological yield were recorded. A patient satisfaction questionnaire was completed. One thousand eight hundred and two bronchoscopies were performed to look for bronchial carcinoma. Sedation and anaesthesia techniques varied considerably between centres. There were marked differences in patient satisfaction between centres. Nearly twice as many females as males would prefer not to have bronchoscopy repeated. Six hundred and fifty-eight carcinomas were confirmed by histocytology. Yield was unaffected by the grade of doctor performing bronchoscopy. Improving yield may be achieved by increasing the number of sampling techniques employed and changing the order in which specimens are taken (biopsies first and washings last). Eighty-seven percent of endoscopically visible tumours were confirmed histocytologically. There was a considerable variation in histological spectra between centres that may relate to differences in pathological interpretation rather than actual differences in case mix. Suggested audit standards are discussed. This study demonstrates the variety of techniques and also the levels of histocytological yield and patient satisfaction that can be achieved. Provisional standards of practice for this procedure have been agreed with a view to auditing performance against these. It is hoped that centres will adopt the methods that are shown to achieve the highest standards.
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Affiliation(s)
- A N McLean
- Department of Respiratory Medicine, Stobhill Hospital, Glasgow, U.K
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Mercader VP, Gatenby RA, Mohr RM, Fisher MS, Caroline DF. CT surveillance of the thorax in patients with squamous cell carcinoma of the head and neck: a preliminary experience. J Comput Assist Tomogr 1997; 21:412-7. [PMID: 9135650 DOI: 10.1097/00004728-199705000-00014] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Our goal was to determine the number of malignancies detected by thoracic CT in patients with head and neck squamous cell carcinoma (SCCA) in three clinical settings. METHOD We retrospectively examined 168 thorax CT scans in 93 patients with head and neck SCCA and determined the number of malignancies (second primary cancers or metastasis) (a) at the time of diagnosis of the primary neck tumor (57 patients), (b) at approximately yearly intervals following treatment of the primary cancer (93 examinations in 43 patients), and (c) at the time of local/regional recurrence of the neck neoplasm (18 patients). RESULTS CT detected malignancy in 9 of 57 patients examined during diagnosis of the neck tumor, in 9 of 43 patients during follow-up, and in 6 of 18 patients evaluated at the time of local/regional neck recurrence. CONCLUSION Chest CT demonstrates a high number of additional malignancies in patients presenting with advanced SCCA of the head and neck.
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Affiliation(s)
- V P Mercader
- Department of Diagnostic Imaging, Temple University Hospital, Philadelphia, PA 19140, USA
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Logan PM, Miller RR, Evans K, Muller NL. Bronchogenic carcinoma and coexistent bronchioloalveolar cell adenomas. Assessment of radiologic detection and follow-up in 28 patients. Chest 1996; 109:713-7. [PMID: 8617081 DOI: 10.1378/chest.109.3.713] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE Bronchioloalveolar cell adenomas (BAAs) have been described in up to 10% of patients with bronchogenic carcinoma. Their prognostic significance is unknown. The purpose of this study was to determine the prognostic implications of finding BAAs coexisting in specimens resected for primary bronchogenic carcinoma and to determine how frequently BAAs can be detected radiologically. METHODS Follow-up information for a mean of 30 months was obtained on 28 patients with a single primary bronchogenic carcinoma and one or more coexistent BAAs. Preoperative chest radiographs (n=27) and CT scans (n=24) were retrospectively reviewed to assess the number of patients in whom BAAs could be detected radiologically. RESULTS There was no significant difference between percentage survival of patients with a primary bronchogenic carcinoma and coexistent BAAs when compared with the percentage predicted survival of these patients based on their primary bronchogenic carcinoma alone. BAAs could be detected retrospectively in 1 of 27 (4%) preoperative radiographs and 11 of 24 (46%) CT scans. CONCLUSIONS On standard preoperative imaging for bronchogenic carcinoma, BAAs were retrospectively detected in more than one third of patients in whom they were detected pathologically. However, the presence of coexistent BAAs with bronchogenic carcinoma does not affect short- and medium-term prognosis.
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Affiliation(s)
- P M Logan
- Department of Radiology, University of British Columbia, Vancouver, Canada
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Harpole DH, Herndon JE, Young WG, Wolfe WG, Sabiston DC. Stage I nonsmall cell lung cancer. A multivariate analysis of treatment methods and patterns of recurrence. Cancer 1995; 76:787-96. [PMID: 8625181 DOI: 10.1002/1097-0142(19950901)76:5<787::aid-cncr2820760512>3.0.co;2-q] [Citation(s) in RCA: 249] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Nonsmall cell lung cancer (NSCLC) has become the leading cause of cancer-related deaths in women and men in the United States, with more than 157,000 estimated deaths in 1995. Surgical resection remains the mainstay of therapy in Stage I and II disease. However, local and distant recurrence account for the disappointing survival rates after resection. Appropriate selection of surgical procedures and effective use of adjuvant therapies will depend upon the elucidation of prognostic factors that predict for recurrence. METHODS A detailed analysis was undertaken to evaluate surgical therapy and to define risk factors associated with recurrence and cancer death in 289 consecutive patients with NSCLC who were diagnosed, resected and followed at the Duke University Medical Center from January 1, 1980, until December 31, 1988. These patients had no evidence of metastases on head and chest/abdominal computed tomograms and radionuclide bone scans before resection. Resected specimens from these patients pathologic verification of Stage I disease. Follow-up was complete in all cases through 8/1/94 (median, 61 months). Variables analyzed included age, sex, smoking history, presenting signs and symptoms, operative procedure, histopathology, hospital course including complications, and the time and location of any recurrence or cancer death. RESULTS The 30-day mortality rate was 5 of 289 (1.7%), with minor and major morbidity rates of 17% and 9%, respectively. Statistical comparison of lobectomy (193) wedge resection (75) and pneumonectomy (21) revealed significantly (P < 0.04) smaller tumors (T1), more comorbidity, and fewer complications for wedge resection patients. A trend (P < 0.09) toward an increased rate of local/regional recurrence and no difference in survival was also observed for wedge resection. One hundred five patients died of cancer (13-month median time to recurrence) for an actual 5-year survival of 63%. Significant univariate predictors of early recurrence and decreased survival (P < 0.01) were: male sex, the presence of symptoms, hemoptysis, chest pain, type of cough, tumor size in cm and by T-classification, visceral pleural invasion, high mitotic index, and vascular invasion. Significant (P < 0.05) multivariate independent variables for early recurrence and cancer death were the presence of symptoms, vascular invasion, pleural invasion, high mitotic index, and tumor size greater than 3 cm. CONCLUSION Current surgical therapy for stage I NSCLC has an acceptable morbidity and mortality rate. The current data also stratify patients with Stage I NSCLC into high and low risk populations that can be used in future randomized trials of adjuvant therapy.
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Affiliation(s)
- D H Harpole
- Lung Cancer Research Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Ladekarl M, Bæk-Hansen T, Henrik-Nielsen R, Mouritzen C, Henriques U, Sørensen FB. Objective malignancy grading of squamous cell carcinoma of the lung. Stereologic estimates of mean nuclear size are of prognostic value, independent of clinical stage of disease. Cancer 1995; 76:797-802. [PMID: 8625182 DOI: 10.1002/1097-0142(19950901)76:5<797::aid-cncr2820760513>3.0.co;2-m] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prognostic value of quantitative histopathologic parameters was evaluated in 55 consecutively treated patients with operable lung carcinoma of squamous (N = 39) and mixed, adenosquamous (N = 16) cell type. Patients alive were followed for at least 12 years. METHODS Using a projection microscope and a simple test system in fields of vision systematically selected from the whole tumor area of one routine section, five quantitative histopathologic variables were estimated: the mean nuclear volume, the mean nuclear profile area, the density of nuclear profiles, the volume fraction of nuclei to tissue, and the number of mitotic profiles per 10(3) nuclear profiles. For each patient, information was recorded regarding sex, age at diagnosis, and clinical stage of disease. RESULTS Single-factor analyses showed that a favorable prognosis was associated with early clinical stages (Stages I and II) and young age (P < or = 0.03), and that females tended to do better than males (P = 0.09). Estimates of the mean nuclear volume were of prognostic significance (P = 0.02), small nuclei being associated with the worst prognosis. In a multivariate Cox analysis, clinical stage, age, and mean nuclear volume were found to be parameters of significant, independent prognostic value. CONCLUSIONS The present feasibility study indicates that estimates of the mean nuclear volume are of prognostic value, independent of the clinical stage of disease. This quantitative histopathologic variable is highly reproducible and easily obtained using an unbiased stereologic method. Thus, the mean nuclear volume may be a parameter of future importance in the clinical management of patients with carcinoma of the lung.
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Affiliation(s)
- M Ladekarl
- Stereological Research Laboratory, University of Aarhus, Denmark
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Affiliation(s)
- D H Harpole
- Harvard Medical School Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
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Henschke CI, Miettinen OS, Yankelevitz DF, Libby DM, Smith JP. Radiographic screening for cancer. Proposed paradigm for requisite research. Clin Imaging 1994; 18:16-20. [PMID: 8180854 DOI: 10.1016/0899-7071(94)90140-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Computed tomography (CT) imaging as an excellent approach to the detection and characterization of small solitary pulmonary nodules (SSPN) raises three questions: (1) How often does CT imaging lead to detection of SSPN? (2) How often is such an SSPN malignant? (3) If malignant, how curable is it? The first question pertains to decisions about screening use of CT (clinical or mass screening), the second to decisions about screening for SSPN and diagnosis of malignancy given SSPN, and the third--in the context of known curability at ordinary clinical diagnosis--to decisions about screening for SSPN, diagnosis given SSPN and intervention given malignant SSPN. We present a three component study design that addresses these questions. The first is directed primarily to the first question. Some 1000 persons at high risk for lung cancer will be screened for SSPN using screening-type CT. The primary aim is to determine the prevalence of CT-detectable SSPN as a joint function of risk-relevant aspects of the person. The second component addresses the prevalence of malignancy among the detected cases of SSPN. To develop the prevalence function, a larger series of CT-detected SSPN will be obtained by developing a multi-center SSPN "registry." A subsequent, third component will focus on the registered cases of malignant SSPN screening incidentally detected and address their curability on the basis of long-term follow-up. This design, in lieu of a randomized trial, may represent a new paradigm for applied research on radiologic technologies in cancer screening, given its advantages in terms of research efficiency and implications to decisions about diagnostic workup and therapeutic intervention.
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Affiliation(s)
- C I Henschke
- Department of Radiology, New York Hospital-Cornell Medical Center, New York 10021
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46
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Affiliation(s)
- L G Koss
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467
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47
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Pasche P, Pellissier S, Gloor E, Monnier P. Apport de la cytologie œsophagienne et bronchique dans le suivi des cancéreux O.R.L. ACTA ACUST UNITED AC 1991. [DOI: 10.1007/bf02968560] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- C F Mountain
- Department of Pathology, Baylor College of Medicine, Houston 77030
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Abstract
The present staging methods for non-small-cell lung cancer provide little more than epidemiologic assessment of prognosis for grossly defined groups of patients. Except in extreme instances, physicians can tell patients very little about their prognosis or the need for supplemental therapy. More effective and less toxic chemotherapeutic agents are needed to treat this disease. Although improved results have been attained with combination therapy in patients with good functional status and less advanced disease, little help is available for lung cancer patients with advanced disease. Treating this large group of patients remains a great challenge for the surgical and medical oncologist.
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Affiliation(s)
- R J Landreneau
- Department of Surgery, University of Missouri, Columbia School of Medicine
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Salvati F, Teodori L, Gagliardi L, Signora M, Aquilini M, Storniello G. DNA flow cytometric studies of 66 human lung tumors analyzed before treatment. Prognostic implications. Chest 1989; 96:1092-8. [PMID: 2553342 DOI: 10.1378/chest.96.5.1092] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
To investigate the prognostic implications of DNA flow cytometry in human lung tumors, we analyzed specimens from patients with neoplastic and non-neoplastic lung disease. Most non-neoplastic and normal (taken at the resection border) lung samples yielded a single cell population with diploid DNA content (only two normal lung specimens from two cancer patients had aneuploid DNA content). At least one aneuploid cell subpopulation was seen in 91 percent of NSCLC and 50 percent on SCLC. To show intratumor heterogeneity, multiple-site sampling was done whenever possible in both primary tumor and metastatic sites, revealing a high incidence of multiclonality (50 percent). Although diploid tumors were rare, they associated with a higher survival rate than aneuploid monoclonal and multiclonal tumors with hypoploid and/or hypertetraploid clones, which had the lowest survival. Cellular DNA content analysis in patients with lung tumors may be useful in prognostic evaluation.
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Affiliation(s)
- F Salvati
- 8th Division of Pneumology, C. Forlanini Hospital, Rome, Italy
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