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Leleu O, Storme N, Basille D, Auquier M, Petigny V, Berna P, Letierce A, Couraud S, de Bermont J, Milleron B, Jounieaux V. Lung cancer screening by low-dose CT scan in France: final results of the DEP KP80 study after three rounds. EBioMedicine 2024; 109:105396. [PMID: 39396424 DOI: 10.1016/j.ebiom.2024.105396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 08/23/2024] [Accepted: 09/27/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUND In prior randomised controlled trials, lung cancer screening using low-dose computed tomography (LDCT) has been shown to reduce lung cancer mortality and overall mortality. Despite these results, organised screening in France remains a challenge. This study assessed the feasibility and efficacy of lung cancer screening within a real-life context in a French administrative territory. METHODS DEP KP80 was a single-arm prospective study. Participants aged between 55 and 74 years, smokers or former smokers of ≥30 pack-years, were recruited. An annual LDCT scan was scheduled and three rounds were performed. Subjects were selected by general practitioners or pulmonologists, who checked the inclusion criteria and prescribed the CT scan. FINDINGS Between March 2016 and February 2020, 1254 participants were enrolled. Overall, 945 (75.4%) participants underwent baseline LDCT (T0), 376 (42.8%) completed the first round (T1) and 270 (31%) the second (T2) one. Forty-two lung cancers were diagnosed, 30 cancers (71.4%) were stage I or II and 34 cancers (80.9%) were treated surgically. In this study, the overall positive predictive value for a positive screening was 48% (95% CI 37-59) and the negative predictive value 100% (95% CI 100-100). INTERPRETATION This study demonstrated the feasibility and efficacy of lung cancer screening in a real-life context with most lung cancers diagnosed at an early stage and surgically removed. Our results also highlighted the importance of participation in each round, underlining the fact that optimising organisation is a major goal. FUNDING Agence Régionale de Santé de Picardie, La Ligue contre le cancer, le Conseil Départemental de la Somme, and AstraZeneca.
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Affiliation(s)
- Olivier Leleu
- Department of Pulmonology and Thoracic Oncology Centre Hospitalier Abbeville, Abbeville Cedex, France.
| | - Nicolas Storme
- Department of Pulmonology and Thoracic Oncology CHU Amiens, Amiens, France
| | - Damien Basille
- Department of Pulmonology and Thoracic Oncology CHU Amiens, Amiens, France; AGIR Unit, University of Picardie Jules Verne, Amiens, France
| | | | | | - Pascal Berna
- Department of Thoracic Surgery CHU Amiens, France
| | | | | | | | - Bernard Milleron
- Intergroupe Francophone de Cancérologie Thoracique, Paris, France
| | - Vincent Jounieaux
- Department of Pulmonology and Thoracic Oncology CHU Amiens, Amiens, France; AGIR Unit, University of Picardie Jules Verne, Amiens, France
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Hosseini SA, Hajianfar G, Ghaffarian P, Seyfi M, Hosseini E, Aval AH, Servaes S, Hanaoka M, Rosa-Neto P, Chawla S, Zaidi H, Ay MR. PET radiomics-based lymphovascular invasion prediction in lung cancer using multiple segmentation and multi-machine learning algorithms. Phys Eng Sci Med 2024:10.1007/s13246-024-01475-0. [PMID: 39225775 DOI: 10.1007/s13246-024-01475-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024]
Abstract
The current study aimed to predict lymphovascular invasion (LVI) using multiple machine learning algorithms and multi-segmentation positron emission tomography (PET) radiomics in non-small cell lung cancer (NSCLC) patients, offering new avenues for personalized treatment strategies and improving patient outcomes. One hundred and twenty-six patients with NSCLC were enrolled in this study. Various automated and semi-automated PET image segmentation methods were applied, including Local Active Contour (LAC), Fuzzy-C-mean (FCM), K-means (KM), Watershed, Region Growing (RG), and Iterative thresholding (IT) with different percentages of the threshold. One hundred five radiomic features were extracted from each region of interest (ROI). Multiple feature selection methods, including Minimum Redundancy Maximum Relevance (MRMR), Recursive Feature Elimination (RFE), and Boruta, and multiple classifiers, including Multilayer Perceptron (MLP), Logistic Regression (LR), XGBoost (XGB), Naive Bayes (NB), and Random Forest (RF), were employed. Synthetic Minority Oversampling Technique (SMOTE) was also used to determine if it boosts the area under the ROC curve (AUC), accuracy (ACC), sensitivity (SEN), and specificity (SPE). Our results indicated that the combination of SMOTE, IT (with 45% threshold), RFE feature selection and LR classifier showed the best performance (AUC = 0.93, ACC = 0.84, SEN = 0.85, SPE = 0.84) followed by SMOTE, FCM segmentation, MRMR feature selection, and LR classifier (AUC = 0.92, ACC = 0.87, SEN = 1, SPE = 0.84). The highest ACC belonged to the IT segmentation (with 45 and 50% thresholds) alongside Boruta feature selection and the NB classifier without SMOTE (ACC = 0.9, AUC = 0.78 and 0.76, SEN = 0.7, and SPE = 0.94, respectively). Our results indicate that selection of appropriate segmentation method and machine learning algorithm may be helpful in successful prediction of LVI in patients with NSCLC with high accuracy using PET radiomics analysis.
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Affiliation(s)
- Seyyed Ali Hosseini
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital, McGill University, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ghasem Hajianfar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Science, Tehran, Iran
| | - Pardis Ghaffarian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
- PET/CT and cyclotron center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Seyfi
- Department of Medical Physics and Biomedical Engineering School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Research Center for Molecular and Cellular Imaging (RCMCI), Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Elahe Hosseini
- Department of Electrical and Computer Engineering, Kharazmi University, Tehran, Iran
| | - Atlas Haddadi Aval
- School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Stijn Servaes
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital, McGill University, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mauro Hanaoka
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Pedro Rosa-Neto
- Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Douglas Hospital, McGill University, Montréal, Québec, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, Geneva, 1211, Switzerland.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center, Groningen, 9700 RB, Netherlands.
- Department of Nuclear Medicine, University of Southern Denmark, Odense, 500, Denmark.
- University Research and Innovation Center, Óbuda University, Budapest, Hungary.
| | - Mohammad Reza Ay
- Department of Medical Physics and Biomedical Engineering School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Research Center for Molecular and Cellular Imaging (RCMCI), Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Darnaud N, Mory JE, Romy P, Berger J, Eve K, Lantheaume S. Perceptions and feelings of a French sample regarding lung cancer screening. BMC Public Health 2023; 23:2333. [PMID: 38001431 PMCID: PMC10675874 DOI: 10.1186/s12889-023-17110-8] [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: 10/30/2022] [Accepted: 10/30/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION This study investigated the perceptions and feelings of a French sample about the possible introduction of lung cancer screening. METHODS A total of 146 individuals, aged between 19- and 64-years, participated in this study conducted between November 2020 and January 2021. Participants were divided into three groups according to their smoking status: (i) active smokers (G1); former smokers (G2); and non-smokers (G3). Each individual completed an online questionnaire evaluating their perceptions and feelings about lung cancer, screening and scans. RESULTS Overall, a higher percentage of former smokers (47%) indicated a greater willingness to participate in lung cancer screening compared to active smokers (19%) and non-smokers (32%). Active smokers and former smokers reported anxiety about the development of lung cancer. Active smokers who wished to participate in screening reported a greater motivation to reduce their tobacco consumption. The perception of lung cancer risk had less influence than age and socio-economic category on the participation in screening. Finally, stigma did not appear to be a barrier to undergoing screening. CONCLUSION Active and former smokers were generally optimistic about screening; however, active smokers showed less inclination to participate in screening compared to former smokers and non-smokers. Three main factors appeared to influence this participation: the perception of the risk of developing cancer, age and socio-economic category.
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Affiliation(s)
- Nicolas Darnaud
- Institut Supérieur Technologique Montplaisir, Valence, France
| | - Jean-Eudes Mory
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France
| | - Pascal Romy
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France
| | - Jacques Berger
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France
| | - Karine Eve
- Institut Supérieur Technologique Montplaisir, Valence, France
| | - Sophie Lantheaume
- Institut Supérieur Technologique Montplaisir, Valence, France.
- Ramsay Santé Hôpital Privé Drôme Ardèche, Guilherand-Granges, France.
- Laboratoire Inter-Universitaire de Psychologie, Personnalité, Cognition, Changement Social (LIP/PC2S), Université Grenoble Alpes, Grenoble, France.
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Yao L, Li Y, Wang Q, Chen T, Li J, Wang Y, Zhang L, Su L, Li L, Lou Q, Li F, Zhao J, Gao J, Gao J, Li H. Multi-Biomarkers Panel in Identifying Benign and Malignant Lung Diseases and Pathological Types of Lung Cancer. J Cancer 2023; 14:1904-1912. [PMID: 37476198 PMCID: PMC10355209 DOI: 10.7150/jca.85846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/17/2023] [Indexed: 07/22/2023] Open
Abstract
With the discovery of many tumor markers, there are new strategies for the early diagnosis and treatment of lung cancer and the prediction of prognosis. We examined the multi-protein markers panel (4MP, consisting of Pro-SFTPB, CA125, Cyfra21-1, and CEA) diagnosis performance in differentiating benign and malignant lung diseases and identifying pathological types of lung cancer. Meantime, the complementary performance of three conventional tumor markers (NSE, SCC, and Pro-GRP) for 4MP was assessed. A total of 294 patients with lung cancer or benign lung disease are contained in this study. The AUCs of 4MP and 7MP (NSE, SCC, Pro-GRP, and 4MP) in distinguishing benign lung disease and lung cancer were 0.808 and 0.832, respectively. In distinguishing SQCLC and SCLC, the AUCs were 0.716 and 0.985, respectively. In distinguishing LADC and SCLC, the AUCs were 0.849 and 0.998, respectively. This study demonstrated that 4MP can distinguish lung cancer from benign disease. Traditional biomarkers NSE, SCC, and Pro-GRP can significantly improve the performance of 4MP in the differentiation of LADC, SQCLC, and SCLC, which is expected to contribute to the accurate diagnosis and personalized treatment of patients.
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Affiliation(s)
- Lige Yao
- The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Yanli Li
- The First People's Hospital of Shangqiu, Shangqiu, China
| | - Qin Wang
- The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Tian Chen
- The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Jiayin Li
- The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Yingjie Wang
- The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Liuyan Zhang
- The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Li Su
- The Third People's Hospital of Zhengzhou, Zhengzhou, China
| | - Lanqing Li
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, China
| | - Qinqin Lou
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, China
| | - Fang Li
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, China
| | - Jiali Zhao
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, China
| | - Junli Gao
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, China
| | - Junshun Gao
- Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, China
| | - Huiqin Li
- The Third People's Hospital of Zhengzhou, Zhengzhou, China
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Westeel V, Zalcman G, Scherpereel A, Milleron B, Barlesi F. Thoracic CT follow-up after non-small-cell lung cancer resection – Authors' reply. Lancet Oncol 2022; 23:e486. [DOI: 10.1016/s1470-2045(22)00646-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022]
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Poon C, Haderi A, Roediger A, Yuan M. Should we screen for lung cancer? A 10-country analysis identifying key decision-making factors. Health Policy 2022; 126:879-888. [DOI: 10.1016/j.healthpol.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 11/04/2022]
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Goudemant C, Durieux V, Grigoriu B, Berghmans T. [Lung cancer screening with low dose computed tomography : a systematic review]. Rev Mal Respir 2021; 38:489-505. [PMID: 33994043 DOI: 10.1016/j.rmr.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/26/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bronchial cancer, often diagnosed at a late stage, is the leading cause of cancer death. As early detection could potentially lead to curative treatment, several studies have evaluated low-dose chest CT (LDCT) as a screening method. The main objective of this work is to determine the impact of LDCT screening on overall mortality of a smoking population. METHODS Systematic review of randomised controlled screening trials comparing LDCT with no screening or chest x-ray. RESULTS Thirteen randomised controlled trials were identified, seven of which reported mortality results. NSLT showed a significant reduction of 6.7% in overall mortality and 20% in lung cancer mortality after 6.5 years of follow-up. NELSON showed a significant reduction in lung cancer mortality of 24% at 10 years among men. LUSI and MILD showed a reduction in lung cancer mortality of 69% at 8 years among women and 39% at 10 years, respectively. CONCLUSION Screening for bronchial cancer is a complex issue. Clarification is needed regarding the selection of individuals, the definition of a positive result and the attitude towards a suspicious nodule.
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Affiliation(s)
- C Goudemant
- Département des soins intensifs & urgences oncologiques et clinique d'oncologie thoracique, institut Jules-Bordet, Rue Héger-Bordet 1, 1000 Bruxelles, Belgique.
| | - V Durieux
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles
| | - B Grigoriu
- Département des soins intensifs & urgences oncologiques et clinique d'oncologie thoracique, institut Jules-Bordet, Rue Héger-Bordet 1, 1000 Bruxelles, Belgique
| | - T Berghmans
- Département des soins intensifs & urgences oncologiques et clinique d'oncologie thoracique, institut Jules-Bordet, Rue Héger-Bordet 1, 1000 Bruxelles, Belgique
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Wu X, Peng H, Wen Y, Cai X, Li C, Zhong R, Huang Y, Chen J, Huo Z, Wang R, Feng Y, Ge F, He J, Liang W. Rheumatoid arthritis and risk of lung cancer: Meta-analysis and Mendelian randomization study. Semin Arthritis Rheum 2021; 51:565-575. [PMID: 33932788 DOI: 10.1016/j.semarthrit.2021.03.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/10/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Observational studies suggest that rheumatoid arthritis (RA) may be associated with lung cancer (LC) risk, while the evidence is inconsistent. We conducted a meta-analysis and a Mendelian randomization study to investigate the association and causality between RA and the LC risk. METHODS We conducted a systematic search of cohort studies and performed a meta-analysis (PROSPERO ID CRD42020159082) to calculate the relative risks (RRs) and their 95% confidence intervals (95%CIs). Subgroup analyses based on sex and initiation year of follow-up were carried out. E-values of each study were calculated to evaluate if existing studies were sensitive to unmeasured confounding. Furthermore, we investigated the correlation between genetically predisposed RA and LC risk using summary statistics from the International Lung Cancer Consortium (11,348 cases and 15,861 controls) and 90 RA-related single nucleotide polymorphisms from European and East Asian descent as instrumental variables. A two-sample Mendelian randomization (MR) analysis was performed to detect the findings based on LC and histological subtypes. Sensitivity analyses were performed to test the robustness of our findings. RESULTS In the meta-analysis of 11 cohort studies involving 183,888 patients, an increased risk of LC was observed among RA patients (RR = 1.44, 95%CI = 1.31-1.57). Subgroup analyses suggested that male patients have a relatively higher LC risk than female patients, and an increased incidence of LC in RA patients was found from 1950 to 2010. Conversely, in the MR analysis, we found that genetically predisposed RA was associated with a decreased risk of LC overall, while neither causally associated with the risk of lung adenocarcinoma nor squamous cell lung cancer. Nevertheless, genetically predisposed RA was associated with a decreased LC risk among the East Asian population, but not in Europeans. These results were robust against extensive sensitivity analyses. CONCLUSION Our meta-analysis suggested that although RA was associated with a relatively higher LC risk, the causal relationship between genetically predisposed RA and LC risk was not supported by the MR study. Further studies are warranted to elucidate the possible association between RA and the risk of LC, as well as its underlying mechanisms.
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Affiliation(s)
- Xiangrong Wu
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Nanshan School, Guangzhou Medical University, Xinzao Road, Panyu District, Guangzhou 511436, China
| | - Haoxin Peng
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Nanshan School, Guangzhou Medical University, Xinzao Road, Panyu District, Guangzhou 511436, China
| | - Yaokai Wen
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Nanshan School, Guangzhou Medical University, Xinzao Road, Panyu District, Guangzhou 511436, China
| | - Xiuyu Cai
- Department of General Internal Medicine, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangzhou 510060, China
| | - Caichen Li
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Ran Zhong
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yueting Huang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Nanshan School, Guangzhou Medical University, Xinzao Road, Panyu District, Guangzhou 511436, China
| | - Jiana Chen
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Nanshan School, Guangzhou Medical University, Xinzao Road, Panyu District, Guangzhou 511436, China
| | - Zhenyu Huo
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Nanshan School, Guangzhou Medical University, Xinzao Road, Panyu District, Guangzhou 511436, China
| | - Runchen Wang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Nanshan School, Guangzhou Medical University, Xinzao Road, Panyu District, Guangzhou 511436, China
| | - Yi Feng
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; Nanshan School, Guangzhou Medical University, Xinzao Road, Panyu District, Guangzhou 511436, China
| | - Fan Ge
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China; First Clinical School, Guangzhou Medical University, Xinzao Road, Panyu District, Guangzhou 511436, China
| | - Jianxing He
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
| | - Wenhua Liang
- Department of Thoracic Oncology and Surgery, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
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Viatgé T, Villeneuve T, D'Aure D, Mazières J, Plat G, Hermant C, Guibert N. Confocal laser endomicroscopy to guide sampling of a pure ground-glass opacity. ERJ Open Res 2021; 7:00910-2020. [PMID: 33834056 PMCID: PMC8021808 DOI: 10.1183/23120541.00910-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/19/2021] [Indexed: 11/25/2022] Open
Abstract
Confocal laser endomicroscopy imaging of lepidic adenocarcinomas is feasible. This technique should be further evaluated as a realtime guiding tool during virtual electromagnetic navigation bronchoscopy for ground-glass opacities https://bit.ly/3uzTcMU.
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Affiliation(s)
- Thibault Viatgé
- Pulmonology Dept, Larrey University Hospital, Toulouse, France
- These authors contributed equally to this work
| | - Thomas Villeneuve
- Pulmonology Dept, Larrey University Hospital, Toulouse, France
- These authors contributed equally to this work
| | - Dominique D'Aure
- Pathology Dept, Cancer University Institute of Toulouse, Oncopole, Toulouse, France
| | - Julien Mazières
- Pulmonology Dept, Larrey University Hospital, Toulouse, France
| | - Gavin Plat
- Pulmonology Dept, Larrey University Hospital, Toulouse, France
| | | | - Nicolas Guibert
- Pulmonology Dept, Larrey University Hospital, Toulouse, France
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Couraud S, Ferretti G, Milleron B, Cortot A, Girard N, Gounant V, Laurent F, Leleu O, Quoix E, Revel MP, Wislez M, Westeel V, Zalcman G, Scherpereel A, Khalil A. [Recommendations of French specialists on screening for lung cancer]. Rev Mal Respir 2021; 38:310-325. [PMID: 33637394 DOI: 10.1016/j.rmr.2021.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 01/25/2021] [Indexed: 12/17/2022]
Affiliation(s)
- S Couraud
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, hospices civils de Lyon, hôpital Lyon Sud, Pierre-Bénite, France; Intergroupe francophone de cancérologie thoracique, Paris, France.
| | - G Ferretti
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de radiologie diagnostique et interventionnel, CHU de Grenoble-Alpes, Grenoble, France
| | - B Milleron
- Intergroupe francophone de cancérologie thoracique, Paris, France
| | - A Cortot
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie et oncologie thoracique, CHU de Lille, Lille, France
| | - N Girard
- Intergroupe francophone de cancérologie thoracique, Paris, France; Unité d'oncologie thoracique, institut Curie, Paris, France
| | - V Gounant
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service d'oncologie thoracique, groupe hospitalier Bichat-Claude-Bernard, AP-HP, Paris, France
| | - F Laurent
- Service de radiologie, CHU de Bordeaux, Pessac, France
| | - O Leleu
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie, centre hospitalier Abbeville, Abbeville, France
| | - E Quoix
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie, CHRU Strasbourg, Strasbourg, France
| | - M-P Revel
- Service de radiologie, hôpital Cochin, Paris, France
| | - M Wislez
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service d'oncologie thoracique, hôpital Cochin, Paris, France
| | - V Westeel
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie et cancérologie thoracique, CHU de Besançon, Besançon, France
| | - G Zalcman
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service d'oncologie thoracique, groupe hospitalier Bichat-Claude-Bernard, AP-HP, Paris, France
| | - A Scherpereel
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de pneumologie et oncologie thoracique, CHU de Lille, Lille, France
| | - A Khalil
- Intergroupe francophone de cancérologie thoracique, Paris, France; Service de radiologie, groupe hospitalier Bichat-Claude-Bernard, AP-HP, Paris, France
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Intergroupe francophone de cancérologie thoracique, Société de pneumologie de langue française, and Société d'imagerie thoracique statement paper on lung cancer screening. Diagn Interv Imaging 2021; 102:199-211. [PMID: 33648872 DOI: 10.1016/j.diii.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 01/21/2021] [Accepted: 01/29/2021] [Indexed: 12/17/2022]
Abstract
Following the American National Lung Screening Trial results in 2011 a consortium of French experts met to edit a statement. Recent results of other randomized trials gave the opportunity for our group to meet again in order to edit updated guidelines. After literature review, we provide here a new update on lung cancer screening in France. Notably, in accordance with all international guidelines, the experts renew their recommendation in favor of individual screening for lung cancer in France as per the conditions laid out in this document. In addition, the experts recommend the very rapid organization and funding of prospective studies, which, if conclusive, will enable the deployment of lung cancer screening organized at the national level.
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12
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Sands J, Tammemägi MC, Couraud S, Baldwin DR, Borondy-Kitts A, Yankelevitz D, Lewis J, Grannis F, Kauczor HU, von Stackelberg O, Sequist L, Pastorino U, McKee B. Lung Screening Benefits and Challenges: A Review of The Data and Outline for Implementation. J Thorac Oncol 2021; 16:37-53. [PMID: 33188913 DOI: 10.1016/j.jtho.2020.10.127] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for almost a fifth of all cancer-related deaths. Annual computed tomographic lung cancer screening (CTLS) detects lung cancer at earlier stages and reduces lung cancer-related mortality among high-risk individuals. Many medical organizations, including the U.S. Preventive Services Task Force, recommend annual CTLS in high-risk populations. However, fewer than 5% of individuals worldwide at high risk for lung cancer have undergone screening. In large part, this is owing to delayed implementation of CTLS in many countries throughout the world. Factors contributing to low uptake in countries with longstanding CTLS endorsement, such as the United States, include lack of patient and clinician awareness of current recommendations in favor of CTLS and clinician concerns about CTLS-related radiation exposure, false-positive results, overdiagnosis, and cost. This review of the literature serves to address these concerns by evaluating the potential risks and benefits of CTLS. Review of key components of a lung screening program, along with an updated shared decision aid, provides guidance for program development and optimization. Review of studies evaluating the population considered "high-risk" is included as this may affect future guidelines within the United States and other countries considering lung screening implementation.
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Affiliation(s)
- Jacob Sands
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Sebastien Couraud
- Acute Respiratory Disease and Thoracic Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon Cancer Institute; EMR-3738 Therapeutic Targeting in Oncology, Lyon Sud Medical Faculty, Lyon 1 University, Lyon, France
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Andrea Borondy-Kitts
- Lung Cancer and Patient Advocate, Consultant Patient Outreach & Research Specialist, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - David Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer Lewis
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Fred Grannis
- City of Hope National Medical Center, Duarte, California
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology and Translational Lung Research Center, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology and Translational Lung Research Center, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Lecia Sequist
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Ugo Pastorino
- Thoracic Surgery Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Brady McKee
- Division of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts
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13
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Peiffer G, Underner M, Perriot J, Ruppert AM, Tiotiu A. [Smoking cessation and lung cancer screening]. Rev Mal Respir 2020; 37:722-734. [PMID: 33129612 DOI: 10.1016/j.rmr.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
Several studies have shown that lung cancer screening, using annual low-dose computed tomography (CT) scan in a targeted population of smokers and ex-smokers reduces overall and lung cancer specific mortality rates. This form of screening strategy is not currently established for use in France by the French High Authority for Health. Quitting smoking is the most important measure in reducing mortality from lung cancer. The maximum benefit in reducing mortality from lung cancer should be seen through an effective combination of smoking cessation intervention and chest CT screening to identify early, curable disease. However, current data to guide clinicians in the choice of smoking cessation interventions in this specific context are limited due to the small number of randomized studies that have been carried out. The optimal approach to smoking cessation during lung cancer screening needs to be clarified by new studies comparing different motivation strategies, establishing the ideal moment to propose stopping smoking and the most effective therapies to use.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, CHR de Metz-Thionville, 1, allée du Château, 57085 Metz, France.
| | - M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, université de Poitiers, 86021 Poitiers, France
| | - J Perriot
- CLAT 63, dispensaire Emile-Roux, centre de tabacologie, 63100 Clermont-Ferrand, France
| | - A-M Ruppert
- Unité de tabacologie, service de pneumologie, hôpital Tenon, Assistance publique-Hôpitaux de Paris, 4, rue de la Chine, 75970 Paris cedex 20, France
| | - A Tiotiu
- Département de pneumologie, CHRU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
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14
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Marquette CH, Boutros J, Benzaquen J, Ferreira M, Pastre J, Pison C, Padovani B, Bettayeb F, Fallet V, Guibert N, Basille D, Ilie M, Hofman V, Hofman P. Circulating tumour cells as a potential biomarker for lung cancer screening: a prospective cohort study. THE LANCET RESPIRATORY MEDICINE 2020; 8:709-716. [PMID: 32649919 DOI: 10.1016/s2213-2600(20)30081-3] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer screening with low-dose chest CT (LDCT) reduces the mortality of eligible individuals. Blood signatures might act as a standalone screening tool, refine the selection of patients at risk, or help to classify undetermined nodules detected on LDCT. We previously showed that circulating tumour cells (CTCs) could be detected, using the isolation by size of epithelial tumour cell technique (ISET), long before the cancer was diagnosed radiologically. We aimed to test whether CTCs could be used as a biomarker for lung cancer screening. METHODS We did a prospective, multicentre, cohort study in 21 French university centres. Participants had to be eligible for lung cancer screening as per National Lung Screening Trial criteria and have chronic obstructive pulmonary disease with a fixed airflow limitation defined as post-bronchodilator FEV1/FVC ratio of less than 0·7. Any cancer, other than basocellular skin carcinomas, detected within the previous 5 years was the main exclusion criterion. Participants had three screening rounds at 1-year intervals (T0 [baseline], T1, and T2), which involved LDCT, clinical examination, and a blood test for CTCs detection. Participants and investigators were masked to the results of CTC detection, and cytopathologists were masked to clinical and radiological findings. Our primary objective was to test the diagnostic performance of CTC detection using the ISET technique in lung cancer screening, compared with cancers diagnosed by final pathology, or follow up if pathology was unavailable as the gold standard. This study is registered with ClinicalTrials.gov identifier, number NCT02500693. FINDINGS Between Oct 30, 2015, and Feb 2, 2017, we enrolled 614 participants, predominantly men (437 [71%]), aged 65·1 years (SD 6·5), and heavy smokers (52·7 pack-years [SD 21·5]). 81 (13%) participants dropped out between baseline and T1, and 56 (11%) did between T1 and T2. Nodules were detected on 178 (29%) of 614 baseline LDCTs. 19 participants (3%) were diagnosed with a prevalent lung cancer at T0 and 19 were diagnosed with incident lung cancer (15 (3%) of 533 at T1 and four (1%) of 477 at T2). Extrapulmonary cancers were diagnosed in 27 (4%) of participants. Overall 28 (2%) of 1187 blood samples were not analysable. At baseline, the sensitivity of CTC detection for lung cancer detection was 26·3% (95% CI 11·8-48·8). ISET was unable to predict lung cancer or extrapulmonary cancer development. INTERPRETATION CTC detection using ISET is not suitable for lung cancer screening. FUNDING French Government, Conseil Départemental 06, Fondation UNICE, Fondation Aveni, Fondation de France, Ligue Contre le Cancer-Comité des Alpes-Maritimes, ARC (Canc'Air Genexposomics), Claire de Divonne-Pollner, Enca Faidhi, Basil Faidhi, Fabienne Mourou, Michel Mourou, Leonid Fridlyand, cogs4cancer, and the Fondation Masikini.
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Affiliation(s)
- Charles-Hugo Marquette
- Department of Pulmonary Medicine and Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, University Hospital Federation OncoAge, Nice, France; Institute of Research on Cancer and Aging, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France.
| | - Jacques Boutros
- Department of Pulmonary Medicine and Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, University Hospital Federation OncoAge, Nice, France
| | - Jonathan Benzaquen
- Department of Pulmonary Medicine and Oncology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, University Hospital Federation OncoAge, Nice, France; Institute of Research on Cancer and Aging, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Marion Ferreira
- Department of Pulmonary Medicine, Centre Hospitalier Régional Universitaire Tours, Tours, France
| | - Jean Pastre
- Department of Pulmonary Medicine, Hôpital Européen Georges Pompidou, Paris, France
| | - Christophe Pison
- Centre Hospitalier Universitaire Grenoble Alpes, Service Hospitalier Universitaire Pneumologie Physiologie, Université Grenoble Alpes, Grenoble, France
| | - Bernard Padovani
- Department of Radiology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Faiza Bettayeb
- Clinique des bronches, allergies, et sommeil, Centre Hospitalier Universitaire de Marseille, Institut National de la Santé et de la Recherche Médicale, Centre Recherche en Cardiovasculaire et Nutrition, Aix Marseille Université, Marseille, France
| | - Vincent Fallet
- Sorbonne Université, Groupe de Recherche Clinique 4, Theranoscan, Assistance Publique - Hôpitaux de Paris, Service de Pneumologie, Hôpital Tenon, Paris, France
| | - Nicolas Guibert
- Department of Pulmonary Medicine, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Damien Basille
- Department of Pulmonary Medicine, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Marius Ilie
- Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, University Hospital Federation OncoAge, Nice, France; Hospital-Related Biobank, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, University Hospital Federation OncoAge, Nice, France; Institute of Research on Cancer and Aging, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Véronique Hofman
- Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, University Hospital Federation OncoAge, Nice, France; Hospital-Related Biobank, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, University Hospital Federation OncoAge, Nice, France; Institute of Research on Cancer and Aging, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, University Hospital Federation OncoAge, Nice, France; Hospital-Related Biobank, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, University Hospital Federation OncoAge, Nice, France; Institute of Research on Cancer and Aging, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Nice, France
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15
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Leleu O, Vincent G, Auquier M, Basille D, Clarot C, Hoguet E, Pétigny V, Duban P, Zerkly S, Ganry O, Chauffert B, Berna P, Jounieaux V. Predictive factors for the participation of general practitioners in lung cancer screening by low-dose CT scan in the Somme department in northern France. Respir Med Res 2020; 77:95-99. [PMID: 32512523 DOI: 10.1016/j.resmer.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/24/2019] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION A study on lung cancer screening using low-dose computed tomography (DEP KP80) was conducted in the Somme department in northern France between May 2016 and December 2018. We conducted a cross-sectional survey of family physicians in that department to identify potential predictive factors for their participation in this pilot study. METHODS A survey questionnaire was sent to the 545 general practitioners (GPs) of the Somme department. This survey rendered it possible to identify the investigators who were active in the DEP KP80 study. The questionnaire's content was focused on the socio-demographic conditions of GPs, their professional practices, and their medical practice situations. RESULTS The response rate was 38% (206 completed questionnaires). Active investigators in DEP KP80 accounted for 55% (n=113) of the GPs surveyed, and non-investigators for 45% (n=93). Age, gender, or medical practice situation were not related to the active GPs' participation in DEP KP80. A multivariate analysis revealed that two factors were correlated with active participation in organized screening: (1) prescription of nicotine replacement therapy; (2) smoking history of the GP. CONCLUSIONS Securing the active involvement of family physicians and of the French regional cancer screening coordination centers seems essential for the future organization of lung cancer screening on a regional or national level. Our results demonstrate that incorporating smoking cessation support structures into the program would maximize the mechanism's potential.
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Affiliation(s)
- O Leleu
- Department of Pulmonology and Thoracic Oncology, Abbeville Hospital Center, Abbeville, France.
| | - G Vincent
- Maison Médicale, Bray-sur-Somme, France
| | - M Auquier
- Department of Radiology, CHU Amiens, Amiens, France
| | - D Basille
- Department of Pulmonology, CHU Amiens, Amiens, France
| | - C Clarot
- Department of Pulmonology and Thoracic Oncology, Abbeville Hospital Center, Abbeville, France
| | - E Hoguet
- Department of Pulmonology and Thoracic Oncology, Abbeville Hospital Center, Abbeville, France
| | | | - P Duban
- Maison Médicale, Bray-sur-Somme, France
| | - S Zerkly
- Department of Hospital Epidemiology, CHU Amiens, Amiens, France
| | - O Ganry
- Department of Hospital Epidemiology, CHU Amiens, Amiens, France
| | - B Chauffert
- Department of Medical Oncology, CHU Amiens, Amiens, France
| | - P Berna
- Department of Thoracic Surgery, CHU Amiens, Amiens, France
| | - V Jounieaux
- Department of Pulmonology, CHU Amiens, Amiens, France
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16
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Leleu O, Basille D, Auquier M, Clarot C, Hoguet E, Pétigny V, Addi AA, Milleron B, Chauffert B, Berna P, Jounieaux V. Lung Cancer Screening by Low-Dose CT Scan: Baseline Results of a French Prospective Study. Clin Lung Cancer 2020; 21:145-152. [DOI: 10.1016/j.cllc.2019.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/06/2019] [Accepted: 10/18/2019] [Indexed: 12/24/2022]
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17
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Triphuridet N, Henschke C. Landscape on CT screening for lung cancer in Asia. LUNG CANCER (AUCKLAND, N.Z.) 2019; 10:107-124. [PMID: 31686936 PMCID: PMC6777900 DOI: 10.2147/lctt.s192643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022]
Abstract
Lung cancer remains the leading cause of cancer incidence and mortality worldwide. Approximately 60% of the world's new cases of lung cancer and deaths from it are expected in Asia in 2018. Currently, lung cancer screening using low-dose computed tomography (LDCT) is recommended for heavy smokers in North America, Europe and some countries in Asia. Tobacco smoking being the major risk factor for lung cancer, but in Asia, lung cancer in never-smokers (LCINS) is also a concern. This paper reviews on lung cancer incidence, mortality, etiology, smoking in Asia, and systematic reviews on LDCT lung cancer screening studies, including ongoing projects and recommendation on lung cancer screening in Asia. Some of the earliest studies of LDCT lung cancer screening worldwide were in Asia. Many countries in Asia have developed LDCT screening studies in various high-risk participants. Currently, there are several ongoing large-scale lung cancer screening trials to evaluate the efficacy of LDCT screening for never-smokers and light smokers, as well as heavy smokers, and to evaluate the feasibility of population-based LDCT lung cancer screening.
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Affiliation(s)
- Natthaya Triphuridet
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Yannoutsos A, Fontaine M, Galloula A, Damotte D, Chatellier G, Paterlini-Bréchot P, Meyer G, Pastre J, Duchatelle V, Marini V, Schwering KL, Lazareth I, Ghaffari P, Stansal A, Sanson H, Labrousse C, Beaussier H, Nasr NB, Zins M, Salmeron S, Messas E, Lajonchère JP, Emmerich J, Priollet P, Trédaniel J. Peripheral arterial disease and systematic detection of circulating tumor cells: rationale and design of the DETECTOR prospective cohort study. BMC Cardiovasc Disord 2019; 19:212. [PMID: 31519196 PMCID: PMC6743149 DOI: 10.1186/s12872-019-1193-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Smoking is a strong risk factor for cancer and atherosclerosis. Cancer mortality, especially from lung cancer, overtakes cardiovascular (CV) death rate in patients with peripheral arterial disease (PAD). Only a few patients with lung cancer after PAD management may benefit from surgical excision. Circulating tumor cells (CTC) associated with low-dose chest CT (LDCT) may improve early cancer detection. This study focuses on a screening strategy that can address not only lung cancer but all tobacco-related cancers in this high-risk population. METHODS DETECTOR Project is a prospective cohort study in two French University hospitals. Participants are smokers or former smokers (≥30 pack-years, quitted ≤15 years), aged ≥55 to 80 years, with atherosclerotic PAD or abdominal aortic aneurysm. After the first screening round combining LDCT and CTC search on a blood sample, two other screening rounds will be performed at one-year interval. Incidental lung nodule volume, volume doubling time and presence of CTC will be taken into consideration for adapted diagnostic management. In case of negative LDCT and presence of CTC, a contrast enhanced whole-body PET/CT will be performed for extra-pulmonary malignancy screening. Psychological impact of this screening strategy will be evaluated in population study using a qualitative methodology. Assuming 10% prevalence of smoking-associated cancer in the studied population, a total of at least 300 participants will be enrolled. DISCUSSION Epidemiological data underline an increase incidence in cancer and related death in the follow-up of patients with PAD, compared with the general population, particularly for tobacco-related cancers. The clinical benefit of a special workup for neoplasms in patients with PAD and a history of cigarette smoking has never been investigated. By considering CTCs detection in this very high-risk selected PAD population for tobacco-induced cancer, we expect to detect earlier pulmonary and extra-pulmonary malignancies, at a potentially curable stage. TRIAL REGISTRATION The study was registered in the French National Agency for Medicines and Health Products Safety (No N° EUDRACT_ID RCB: 2016-A00657-44) and was approved by the ethics Committee for Persons Protection (IRB number 1072 and n° initial agreement 2016-08-02; ClinicalTrials.gov identifier NCT02849041).
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Affiliation(s)
- Alexandra Yannoutsos
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Unité INSERM UMR 1153-CRESS, Paris, France
| | | | - Alexandre Galloula
- Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 75014, Paris, France
| | - Diane Damotte
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Hôpital Cochin, Assistance Publique - Hôpitaux de Paris, 75014, Paris, France.,Unité INSERM U1138, Centre de Recherche des Cordeliers, Paris, France
| | - Gilles Chatellier
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 75014, Paris, France
| | | | - Guy Meyer
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 75014, Paris, France
| | - Jean Pastre
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 75014, Paris, France
| | - Véronique Duchatelle
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Valéria Marini
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | | | - Isabelle Lazareth
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Parinaz Ghaffari
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Audrey Stansal
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Hélène Sanson
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Cécile Labrousse
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Hélène Beaussier
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Nesrine Ben Nasr
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Marc Zins
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Sergio Salmeron
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Emmanuel Messas
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, 75014, Paris, France
| | | | - Joseph Emmerich
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Unité INSERM UMR 1153-CRESS, Paris, France
| | - Pascal Priollet
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France
| | - Jean Trédaniel
- Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, 75 014, Paris, France. .,Université Paris Descartes, Sorbonne Paris Cité, Paris, France. .,Unité INSERM UMR-S 1124, Toxicologie, pharmacologie et signalisation cellulaire, Paris, France.
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19
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Delva F, Laurent F, Paris C, Belacel M, Brochard P, Bylicki O, Chouaïd C, Clin B, Dewitte JD, Le Denmat V, Gehanno JF, Lacourt A, Margery J, Verdun-Esquer C, Mathoulin-Pélissier S, Pairon JC. LUCSO-1-French pilot study of LUng Cancer Screening with low-dose computed tomography in a smokers population exposed to Occupational lung carcinogens: study protocol. BMJ Open 2019; 9:e025026. [PMID: 30904859 PMCID: PMC6475342 DOI: 10.1136/bmjopen-2018-025026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Guidelines concerning the follow-up of subjects occupationally exposed to lung carcinogens, published in France in 2015, recommended the setting up of a trial of low-dose chest CT lung cancer screening in subjects at high risk of lung cancer. OBJECTIVE To evaluate the organisation of low-dose chest CT lung cancer screening in subjects occupationally exposed to lung carcinogens and at high risk of lung cancer. METHODS AND ANALYSIS This trial will be conducted in eight French departments by six specialised reference centres (SRCs) in occupational health. In view of the exploratory nature of this trial, it is proposed to test initially the feasibility and acceptability over the first 2 years in only two SRCs then in four other SRCs to evaluate the organisation. The target population is current or former smokers with more than 30 pack-years (who have quit smoking for less than 15 years), currently or previously exposed to International Agency for Research on Cancer group 1 lung carcinogens, and between the ages of 55 and 74 years. The trial will be conducted in the following steps: (1) identification of subjects by a screening invitation letter; (2) evaluation of occupational exposure to lung carcinogens; (3) evaluation of the lung cancer risk level and verification of eligibility; (4) screening procedure: annual chest CT scans performed by specialised centres and (5) follow-up of CT scan abnormalities. ETHICS AND DISSEMINATION This protocol study has been approved by the French Committee for the Protection of Persons. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER NCT03562052; Pre-results.
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Affiliation(s)
- Fleur Delva
- Service de médecine du travail et de pathologies professionnelles, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- EPICENE, INSERM U1219, Bordeaux, France
| | - François Laurent
- Service de médecine du travail et de pathologies professionnelles, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Milia Belacel
- Centre Hospitalier Intercommunal de Creteil, Creteil, Île-de-France, France
| | | | - Olivier Bylicki
- Department of Pneumologie, Hopital d’Instruction des Armees Percy, Clamart, France
| | - Christos Chouaïd
- Centre Hospitalier Intercommunal de Creteil, Creteil, Île-de-France, France
| | | | | | | | | | | | - Jacques Margery
- Department of Pneumologie, Hopital d’Instruction des Armees Percy, Clamart, France
| | - Catherine Verdun-Esquer
- Service de médecine du travail et de pathologies professionnelles, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Jean-Claude Pairon
- Pneumologie et pathologie professionnelle, Centre Hospitalier Intercommunal de Créteil, Créteil Cedex, France
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Current and Former Smokers: Who Wants To Be Screened? Clin Lung Cancer 2018; 19:493-501. [PMID: 30107977 DOI: 10.1016/j.cllc.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Lung cancer (LC) screening (LCS) with annual low-dose computed tomography scans has been seen to reduce the specific and overall mortality in selected populations. However, participation is key to successful screening programs. The EDIFICE (etude sur le dépistage des cancers et ses facteurs de compliance [survey on cancer screening and compliance factors]) nationwide observational surveys are used to assess behavior related to cancer screening programs in France. MATERIALS AND METHODS Using comprehensive multivariate stepwise logistic regression analyses of data from current and former cigarette smokers, we sought to identify the explanatory factors associated with the intention to participate in an LCS program. RESULTS Of the 1463 respondents with no personal history of cancer, 263 (36.4%) of the current cigarette smokers and 170 (26.3%) of the former cigarette smokers stated their willingness to participate in an LCS program. The explanatory factors differed between current cigarette smokers (already screened for LC: odds ratio [OR], 2.81; < 30 pack-years: OR, 2.69; intention to quit smoking: OR, 1.96; no social vulnerability: OR, 2.15) and former cigarette smokers (comorbidities: OR, 0.31). The usual eligibility criteria were not significantly explanatory. CONCLUSION Our findings highlight the discrepancy that exists between target populations and individuals who actually intend to participate in a screening program for LC, with subsequent potential effects on the participation rates and, thus, on the efficacy of screening.
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Triphuridet N, Vidhyarkorn S, Worakitsitisatorn A, Sricharunrat T, Teerayathanakul N, Auewarakul C, Chungklay N, Krongthong W, Luengingkasoot S, Sornsamdang G, Patumanond J, Sritipsukho P. Screening values of carcinoembryonic antigen and cytokeratin 19 fragment for lung cancer in combination with low-dose computed tomography in high-risk populations: Initial and 2-year screening outcomes. Lung Cancer 2018; 122:243-248. [PMID: 30032839 DOI: 10.1016/j.lungcan.2018.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess added screening value of Carcinoembryonic Antigen (CEA) and Cytokeratin 19 Fragment (CYFRA 21-1) in combination with LDCT beyond LDCT alone and likelihood ratio of positive (LHR+) of their combination for lung cancer in high-risk populations with indeterminate and positive LDCT after initial screening and 2-year follow up. MATERIALS AND METHODS LDCT was performed annually at baseline and for 2 years in 634 heavy smokers (>30 pack-years) who were aged 50-70 years, and it was classified as negative, indeterminate, or positive (suspicious for lung cancer). Serum CEA and CYFRA 21-1 were examined and followed with LDCT in the indeterminate and positive LDCT groups and defined as positive with an abnormal level of either CEA or CYFRA 21-1. RESULTS A total of 17 lung cancer cases were diagnosed (9 from initial screening and 8 from follow-up cycles). Seventy and 22 patients had indeterminate and positive baseline LDCT, respectively. Among indeterminate baseline LDCT, the LHR+ for lung cancer diagnosed after initial screening with a positive marker was 6.61 (p = .039) and 1.51 (p = .502) with a negative marker. After 2 years follow up, the LHR+ was 6.31 (p = .004) and 0.86 (p = .677), respectively. Among positive baseline LDCT, the LHR+ for lung cancer diagnosed after initial round with positive and negative markers was 69.44 (p < 0.001) and 11.57 (p = .015), respectively. The corresponding LHR+ after 2-year round was 13.61 (p = .002) and 18.15 (p = .001), respectively. The combinations of CEA/CYFRA 21-1 and LDCT, and CEA and LDCT had crude and adjusted added value beyond LDCT alone (crude: 8%, p = .033 and 7%, p = .038; adjusted: 4%, p = .019 and 4%, p = .029, respectively). CONCLUSIONS CEA in combination with LDCT significantly increases the value of lung cancer screening compared with using LDCT alone particularly in participants with indeterminate baseline LDCT in both initial and 2-year screening outcomes.
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Affiliation(s)
- Natthaya Triphuridet
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, 10210, Thailand.
| | | | | | | | | | - Chirayu Auewarakul
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, 10210, Thailand
| | - Naree Chungklay
- Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, 10210, Thailand
| | | | - Supapun Luengingkasoot
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, 10210, Thailand
| | | | - Jayanton Patumanond
- Center of Excellence in Applied Epidemiology, Thammasat University, Bangkok, 12121, Thailand
| | - Paskorn Sritipsukho
- Center of Excellence in Applied Epidemiology, Thammasat University, Bangkok, 12121, Thailand
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Do doctors understand the test characteristics of lung cancer screening? Wien Klin Wochenschr 2018; 130:238-246. [PMID: 29372409 DOI: 10.1007/s00508-017-1305-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 12/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Screening for lung cancer with a low-dose computed tomography (CT) scan is estimated to prevent 3 deaths per 1000 individuals at high risk; however, false positive results and radiation exposure are relevant harms and deserve careful consideration. Screening candidates can only make an autonomous decision if doctors correctly inform them of the pros and cons of the method; therefore, this study aimed to evaluate whether doctors understand the test characteristics of lung cancer screening. METHODS In a randomized trial 556 doctors (members of the Austrian Respiratory Society) were invited to answer questions regarding lung cancer screening based on online case vignettes. Half of the participants were randomized to the group 'solutions provided' and received the correct solutions in advance. The group 'solutions withheld' had to rely on prior knowledge or estimates. The primary endpoint was the between-group difference in the estimated number of deaths preventable by screening. Secondary endpoints were the between-group differences in the prevalence of lung cancer, prevalence of a positive screening results, sensitivity, specificity, positive predictive value, and false negative rate. Estimations were also compared with current data from the literature. RESULTS The response rate was 29% in both groups. The reduction in the number of deaths due to screening was overestimated six-fold (95% confidence interval CI: 4-8) compared with the actual data, and there was no effect of group allocation. Providing the correct solutions to doctors had no systematic effect on their answers. CONCLUSION Doctors poorly understand the test characteristics of lung cancer screening. Providing the correct solutions in advance did not improve the answers. Continuing education regarding lung cancer screening and the interpretation of test characteristics may be a simple remedy. CLINICAL TRIAL REGISTRATION Clinical trial registered with www.clinicaltrials.gov (NCT02542332).
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Leroy S, Benzaquen J, Mazzetta A, Marchand-Adam S, Padovani B, Israel-Biet D, Pison C, Chanez P, Cadranel J, Mazières J, Jounieaux V, Cohen C, Hofman V, Ilie M, Hofman P, Marquette CH. Circulating tumour cells as a potential screening tool for lung cancer (the AIR study): protocol of a prospective multicentre cohort study in France. BMJ Open 2017; 7:e018884. [PMID: 29282271 PMCID: PMC5770962 DOI: 10.1136/bmjopen-2017-018884] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/28/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Lung cancer (LC) is the leading cause of death from cancer. Early diagnosis of LC is of paramount importance in terms of prognosis. The health authorities of most countries do not accept screening programmes based on low-dose chest CT (LDCT), especially in Europe, because they are flawed by a high rate of false-positive results, leading to a large number of invasive diagnostic procedures. These authorities advocated further research, including companion biological tests that could enhance the effectiveness of LC screening. The present project aims to validate early diagnosis of LC by detection and characterisation of circulating tumour cells (CTCs) in a peripheral blood sample taken from a prospective cohort of persons at high-risk of LC. METHODS AND ANALYSIS The AIR Project is a prospective, multicentre, double-blinded, cohort study conducted by a consortium of 21 French university centres. The primary objective is to determine the operational values of CTCs for the early detection of LC in a cohort of asymptomatic participants at high risk for LC, that is, smokers and ex-smokers (≥30 pack-years, quitted ≤15 years), aged ≥55 years, with chronic obstructive pulmonary disease (COPD). The study participants will undergo yearly screening rounds for 3 years plus a 1-year follow-up. Each round will include LDCT plus peripheral blood sampling for CTC detection. Assuming 5% prevalence of LC in the studied population and a 10% dropout rate, a total of at least 600 volunteers will be enrolled. ETHICS AND DISSEMINATION The study sponsor is the University Hospital of Nice. The study was approved for France by the ethical committee CPP Sud-Méditerranée V and the ANSM (Ministry of Health) in July 2015. The findings of the trial will be disseminated through peer-reviewed journals and national and international conference presentations. TRIAL REGISTRATION NUMBER NCT02500693.
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Affiliation(s)
- Sylvie Leroy
- Department of Pulmonary Medicine and Thoracic Oncology, Centre Hospitalier Universitaire de Nice, Nice, France
- CNRS, INSERM, IPMC, FHU-OncoAge, Université Côte d'Azur, Valbonne, France
| | - Jonathan Benzaquen
- Department of Pulmonary Medicine and Thoracic Oncology, Centre Hospitalier Universitaire de Nice, Nice, France
- Laboratory of Clinical and Experimental Pathology, Hospital-Related Biobank (BB-0033-00025), IRCAN, FHU OncoAge, Nice, France
| | - Andrea Mazzetta
- Department of Pulmonary Medicine and Thoracic Oncology, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | | | | | - Christophe Pison
- Department of Pulmonary Medicine, CHU de Grenoble, Grenoble, France
| | - Pascal Chanez
- Department of Pulmonary Medicine, CHU de Marseille, Marseille, France
| | | | - Julien Mazières
- Department of Pulmonary Medicine, CHU Toulouse, Toulouse, France
| | | | - Charlotte Cohen
- Department of Thoracic Surgery, CHU de Nice, FHU OncoAge, Nice, France
| | - Véronique Hofman
- Laboratory of Clinical and Experimental Pathology, Hospital-Related Biobank (BB-0033-00025), IRCAN, FHU OncoAge, Nice, France
| | - Marius Ilie
- Laboratory of Clinical and Experimental Pathology, Hospital-Related Biobank (BB-0033-00025), IRCAN, FHU OncoAge, Nice, France
| | - Paul Hofman
- Laboratory of Clinical and Experimental Pathology, Hospital-Related Biobank (BB-0033-00025), IRCAN, FHU OncoAge, Nice, France
| | - Charles Hugo Marquette
- Department of Pulmonary Medicine and Thoracic Oncology, Centre Hospitalier Universitaire de Nice, Nice, France
- Laboratory of Clinical and Experimental Pathology, Hospital-Related Biobank (BB-0033-00025), IRCAN, FHU OncoAge, Nice, France
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Modélisation de l’impact économique d’un dépistage organisé du cancer du poumon en France. Rev Mal Respir 2017; 34:717-728. [DOI: 10.1016/j.rmr.2015.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/05/2015] [Indexed: 12/27/2022]
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25
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Garrido P, Sánchez M, Belda Sanchis J, Moreno Mata N, Artal Á, Gayete Á, Matilla González JM, Galbis Caravajal JM, Isla D, Paz-Ares L, Seijo LM. Reflections on the Implementation of Low-Dose Computed Tomography Screening in Individuals at High Risk of Lung Cancer in Spain. Arch Bronconeumol 2017; 53:568-573. [PMID: 28416207 DOI: 10.1016/j.arbres.2017.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 12/17/2022]
Abstract
Lung cancer (LC) is a major public health issue. Despite recent advances in treatment, primary prevention and early diagnosis are key to reducing the incidence and mortality of this disease. A recent clinical trial demonstrated the efficacy of selective screening by low-dose computed tomography (LDCT) in reducing the risk of both lung cancer mortality and all-cause mortality in high-risk individuals. This article contains the reflections of an expert group on the use of LDCT for early diagnosis of LC in high-risk individuals, and how to evaluate its implementation in Spain. The expert group was set up by the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Radiology (SERAM) and the Spanish Society of Medical Oncology (SEOM).
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Affiliation(s)
- Pilar Garrido
- Servicio de Oncología Médica, Hospital Ramón y Cajal, Madrid, España.
| | - Marcelo Sánchez
- Servicio de Radiodiagnóstico, Hospital Clínic, Barcelona, España
| | - José Belda Sanchis
- Servicio Mancomunado de Cirugía Torácica, Hospitales Universitari Mútua Terrassa, Sant Pau i Santa Creu y Mar, Barcelona, España
| | - Nicolás Moreno Mata
- Servicio de Cirugía Torácica, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Ángel Artal
- Servicio de Oncología Médica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Ángel Gayete
- Servicio de Radiodiagnóstico, Hospital del Mar, Barcelona, España
| | | | | | - Dolores Isla
- Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Luis Paz-Ares
- Servicio de Oncología Médica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Luis M Seijo
- Servicio de Neumología, Hospital Universitario Fundación Jiménez Díaz, Instituto de Investigación Sanitaria, CIBERES, Madrid, España
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Fontaine-Delaruelle C, Souquet PJ, Gamondes D, Pradat E, de Leusse A, Ferretti GR, Couraud S. [Predictive factors of complications during CT-guided transthoracic biopsy]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:61-67. [PMID: 28063634 DOI: 10.1016/j.pneumo.2016.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 11/11/2016] [Accepted: 12/07/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION CT-guided transthoracic core-needle biopsy (TTNB) is frequently used for the diagnosis of lung nodules. The aim of this study is to describe TTNBs' complications and to investigate predictive factors of complications. METHODS All consecutive TTNBs performed in three centers between 2006 and 2012 were included. Binary logistic regression was used for multivariate analysis. RESULTS Overall, 970 TTNBs were performed in 929 patients. The complication rate was 34% (life-threatening complication in 6%). The most frequent complications were pneumothorax (29% included 4% which required chest-tube) and hemoptysis (5%). The mortality rate was 0.1% (n=1). In multivariate analysis, predictive factor for a complication was small target size (AOR=0.984; 95% CI [0.976-0.992]; P<0.001). This predictive factor was also found for occurrence of life-threatening complication (AOR=0.982; [0.965-0.999]; P=0.037), of pneumothorax (AOR=0.987; [0.978-0.995]; P=0.002) and of hemoptysis (AOR=0.973; [0.951-0.997]; P=0.024). CONCLUSION One complication occurred in one-third of TTNBs. The proportion of life-threatening complication was 6%. A small lesion size was predictive of complication occurrence.
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Affiliation(s)
- C Fontaine-Delaruelle
- Service de pneumologie aiguë spécialisée et oncologie thoracique, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; Faculté de médecine Lyon Sud, université Lyon 1, 69600 Oullins, France.
| | - P-J Souquet
- Service de pneumologie aiguë spécialisée et oncologie thoracique, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; EMR 3738, ciblage thérapeutique en oncologie, faculté de médecine Lyon Sud, université Lyon 1, 69600 Oullins, France
| | - D Gamondes
- Service d'imagerie, hospices civils de Lyon, centre hospitalier Louis-Pradel, 69500 Bron, France
| | - E Pradat
- DiM, centre hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - A de Leusse
- Service d'imagerie, hospices civils de Lyon, centre hospitalier Lyon Sud, 69495 Pierre-Bénite, France
| | - G R Ferretti
- Clinique universitaire de radiologie et imagerie médicale, centre hospitalier universitaire Grenoble, 38043 Grenoble, France; Université Grenoble Alpes, 38000 Grenoble, France; Inserm U 823, institut A.-Bonniot, 38700 la Tronche, France
| | - S Couraud
- Service de pneumologie aiguë spécialisée et oncologie thoracique, hospices civils de Lyon, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France; EMR 3738, ciblage thérapeutique en oncologie, faculté de médecine Lyon Sud, université Lyon 1, 69600 Oullins, France
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27
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Delva F, Margery J, Laurent F, Petitprez K, Pairon JC. Medical follow-up of workers exposed to lung carcinogens: French evidence-based and pragmatic recommendations. BMC Public Health 2017; 17:191. [PMID: 28193266 PMCID: PMC5307847 DOI: 10.1186/s12889-017-4114-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 02/06/2017] [Indexed: 12/18/2022] Open
Abstract
Background The aim of this work was to establish recommendations for the medical follow-up of workers currently or previously exposed to lung carcinogens. Methods A critical synthesis of the literature was conducted. Occupational lung carcinogenic substances were listed and classified according to their level of lung cancer risk. A targeted screening protocol was defined. Results A clinical trial, National Lung Screnning Trial (NLST), showed the efficacy of chest CAT scan (CT) screening for populations of smokers aged 55–74 years with over 30 pack-years of exposure who had stopped smoking for less than 15 years. To propose screening in accordance with NLST criteria, and to account for occupational risk factors, screening among smokers and former smokers needs to consider the types of occupational exposure for which the risk level is at least equivalent to the risk of the subjects included in the NLST. The working group proposes an algorithm that estimates the relative risk of each occupational lung carcinogen, taking into account exposure to tobacco, based on available data from the literature. Conclusion Given the lack of data on bronchopulmonary cancer (BPC) screening in occupationally exposed workers, the working group proposed implementing a screening experiment for bronchopulmonary cancer in subjects occupationally exposed or having been occupationally exposed to lung carcinogens who are confirmed as having high risk factors for BPC. A specific algorithm is proposed to determine the level of risk of BPC, taking into account the different occupational lung carcinogens and tobacco smoking at the individual level. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4114-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fleur Delva
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team HEALTHY, UMR 1219, Bordeaux, F-33000, France. .,CHU de Bordeaux, Pole de sante publique, Service de médecine du travail et de pathologies professionnelle, F-33000, Bordeaux, France. .,Clinical epidemiology and research, Institute Bergonié, Bordeaux, France.
| | - Jacques Margery
- Respiratory Medicine Department, Percy Military Hospital, Clamart, France.,French Military Health Service Academy, École du Val de Grâce, Paris, France.,Groupe d'Oncologie de Langue Française (GOLF), Société de Pneumologie de Langue Française (SPLF), Paris, France
| | - François Laurent
- Department of Cardiovascular Imaging, Hôpital Cardiologique du Haut-Lévêque, CHU de Bordeaux, Pessac, France.,Institut Liryc/Equipex Music, Université de Bordeaux-Inserm U1045, Pessac, France.,Société de Radiologie Française (SFR), Paris, France
| | - Karine Petitprez
- Service des bonnes pratiques professionnelles, Haute Autorité de Santé (HAS), Saint Denis-La Plaine, France
| | - Jean-Claude Pairon
- INSERM U955, Université Paris Est Créteil, Créteil, France.,Institut Santé-Travail Paris-Est, Centre Hospitalier Intercommunal, Créteil, France.,Société Française de Médecine du Travail (SFMT), Paris, France
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Abstract
The NLST study found in more than 53,000 (former-) heavy smokers that annual screening with low-dose CT-scan (LDCT) reduced lung cancer mortality and overall mortality by 20% and 6.7% respectively. However, several potential harms of such screening strategy were underlined: over-diagnosis bias, irradiation risk, and the high rate of false-positive results that could lead to futile invasive (and potentially harmful) exams, to impact quality of life, to increase patient's anxiety and costs. All these concerns were largely debated in several recent publications. Most of them concluded in a risk/benefit ratio favoring screening strategy by LDCT. Conversely, most of American academic societies currently recommend LDCT-based lung cancer screening. In France, a taskforce edited a common statement recommending screening smokers or ex-smokers, from 55 to 75years old who have smoked at least 30packs/year. The taskforce also underlined the need for clinical trials aiming to translate screening strategy to the French setting. However, the French Health Authority recently claimed that lung cancer screening was not relevant in the current setting.
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Affiliation(s)
- B Milleron
- Service de pneumologie, hôpital Tenon, AP-HP, 75020 Paris, France; Service d'oncologie thoracique, CIC 1425, CLIP2 Paris-Nord, hôpital Bichat, AP-HP, 75018 Paris, France.
| | - V Gounant
- Service d'oncologie thoracique, CIC 1425, CLIP2 Paris-Nord, hôpital Bichat, AP-HP, 75018 Paris, France
| | - A Khalil
- Service de radiologie, hôpital Bichat, AP-HP, 75018 Paris, France
| | - S Couraud
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon Sud, institut de cancérologie des hospices civils de Lyon, 69495 Pierre-Bénite, France; EMR 3738 ciblage thérapeutique en oncologie, faculté de médecine et de maïeutique Lyon Sud Charles-Mérieux, université Lyon 1, 69600 Oullins, France
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Stang A, Schuler M, Kowall B, Darwiche K, Kühl H, Jöckel KH. Lung Cancer Screening Using Low Dose CT Scanning in Germany. Extrapolation of results from the National Lung Screening Trial. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:637-44. [PMID: 26429636 DOI: 10.3238/arztebl.2015.0637] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/08/2015] [Accepted: 07/08/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND It is now debated whether the screening of heavy smokers for lung cancer with low dose computed tomography (low dose CT) might lower their mortality due to lung cancer. We use data from the National Lung Screening Trial (NLST) in the USA to predict the likely effects of such screening in Germany. METHODS The number of heavy smokers aged 55-74 in Germany was extrapolated from survey data obtained by the Robert Koch Institute. Published data from the NLST were then used to estimate the likely effects of low dose CT screening of heavy smokers in Germany. RESULTS If low dose CT screening were performed on 50% of the heavy smokers in Germany aged 55-74, an estimated 1 329 506 persons would undergo such screening. If the screening were repeated annually, then, over three years, 916 918 screening CTs would reveal suspect lesions, and the diagnosis of lung cancer would be confirmed thereafter in 32 826 persons. At least one positive test result in three years would be obtained in 39.1% of the participants (519 837 persons). 4155 deaths from lung cancer would be prevented over 6.5 years, and the number of persons aged 55-74 who die of lung cancer in Germany would fall by 2.6%. 12 449 persons would have at least one complication, and 1074 persons would die in the 60 days following screening. CONCLUSION The screening of heavy smokers for lung cancer can lower their risk of dying of lung cancer by 20% in relative terms, corresponding to an absolute risk reduction of 0.3 percentage points. These figures can provide the background for a critical discussion of the putative utility of this type of screening in Germany.
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Affiliation(s)
- Andreas Stang
- Center for Clinical Epidemiology; Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, School of Public Health, Department of Epidemiology, Boston University, USA, German Cancer Consortium (DKTK), Heidelberg, West German Cancer Center, Clinic for Internal Medicine (Tumor Research), University Hospital Essen, Department of Thoracic Oncology, Ruhrlandklinik, University Hospital Essen, Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen
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Karachaliou N, Sosa AE, Rosell R. Annual or biennial lung cancer CT screening? J Thorac Dis 2016; 8:2424-2426. [PMID: 27746993 DOI: 10.21037/jtd.2016.09.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Niki Karachaliou
- Dr Rosell Oncology Institute, University Hospital Sagrat Cor, Barcelona, Spain
| | - Aaron E Sosa
- Dr Rosell Oncology Institute, University Hospital Sagrat Cor, Barcelona, Spain
| | - Rafael Rosell
- Germans Trias i Pujol Health Sciences Institute and Hospital, Badalona, Spain;; Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain
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31
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Leleu O, Auquier M, Carre O, Chauffert B, Dubreuil A, Petigny V, Trancart B, Berna P, Jounieaux V. [Lung cancer screening with low-dose thoracic CT-scan in the Somme area]. Rev Mal Respir 2016; 34:262-267. [PMID: 27743826 DOI: 10.1016/j.rmr.2016.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/02/2016] [Indexed: 12/17/2022]
Abstract
RATIONALE This feasibility trial proposes to set up in the department of the Somme an annual screening for lung cancer with low-dose thoracic CT. It responds to the first objective of the third cancer plan and follows the publication of the results of the National Lung Screening Trial in 2011. METHODS The method of this study is to use the existing networks among and between healthcare professionals and the departmental cancer screening structure. The inclusion criteria will be those of the National Lung Screening Trial. Screening will be proposed by treating physicians and chest physicians. The CT-scan will be performed in radiological centers that adhere to the good practice charter for low radiation scanning. A copy of CT results will be sent to the departmental structure of cancer screening (ADEMA80) which will ensure traceability and will perform statistical analysis. The study received funding from the Agence régionale de santé de la Picardie and la ligue contre le cancer. EXPECTED RESULTS The primary endpoints of this screening will be the number of cancers diagnosed and the survival of the patients. The follow-up of positive examinations, delays in management and the level of participation will also be assessed.
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Affiliation(s)
- O Leleu
- Service de pneumologie, centre hospitalier d'Abbeville, 43, rue de l'Isle, 80100 Abbeville, France.
| | - M Auquier
- Service de radiologie, CHU d'Amiens, 80000 Amiens, France
| | - O Carre
- Service de pneumologie, clinique de l'Europe, 5, allée des Pays-Bas, 80000 Amiens, France
| | - B Chauffert
- Service d'oncologie médicale, CHU d'Amiens, 80000 Amiens, France
| | - A Dubreuil
- Association pour le dépistage des maladies de la somme (ADEMA80), 7, rue Jean-Calvin, 80000 Amiens, France
| | - V Petigny
- Association pour le dépistage des maladies de la somme (ADEMA80), 7, rue Jean-Calvin, 80000 Amiens, France
| | - B Trancart
- Service de radiologie, clinique Sainte-Isabelle, 236, route d'Amiens, 80103 Abbeville, France
| | - P Berna
- Service de chirurgie thoracique, CHU d'Amiens, 80000 Amiens, France
| | - V Jounieaux
- Service de pneumologie et réanimation respiratoire, CHU d'Amiens, 80000 Amiens, France
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Cohen JG, Reymond E, Jankowski A, Brambilla E, Arbib F, Lantuejoul S, Ferretti GR. Lung adenocarcinomas: correlation of computed tomography and pathology findings. Diagn Interv Imaging 2016; 97:955-963. [PMID: 27639313 DOI: 10.1016/j.diii.2016.06.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/13/2022]
Abstract
Adenocarcinoma is the most common histologic type of lung cancer. Recent lung adenocarcinoma classifications from the International Association for the Study of Lung cancer, the American Thoracic Society and the European Respiratory Society (IASLC/ETS/ERS, 2011) and World Health Organization (WHO, 2015) define a wide range of adenocarcinoma types and subtypes featuring different prognosis and management. This spectrum of lesions translates into various CT presentations and features, which generally show good correlation with histopathology, stressing the key role of the radiologist in the diagnosis and management of those patients. This review aims at helping radiologists to understand the basics of the up-to-date adenocarcinoma pathological classifications, radio-pathological correlations and how to use them in the clinical setting, as well as other imaging-related correlations (radiogenomics, quantitative analysis, PET-CT).
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Affiliation(s)
- J G Cohen
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France; Université Grenoble-Alpes, 38000 Grenoble, France.
| | - E Reymond
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France.
| | - A Jankowski
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France.
| | - E Brambilla
- Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France; Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France.
| | - F Arbib
- Clinique universitaire de pneumologie, pôle d'oncologie, CHU A.-Michallon, 38043 Grenoble, France.
| | - S Lantuejoul
- Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France; Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France.
| | - G R Ferretti
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France; Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France.
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Chassagnon G, Revel MP. Lung cancer screening: Current status and perspective. Diagn Interv Imaging 2016; 97:949-953. [PMID: 27527243 DOI: 10.1016/j.diii.2016.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/30/2022]
Abstract
Lung cancer screening by low-dose computed tomography (CT) has been proven to reduce lung cancer-related mortality by 20%, in the National Lung cancer Screening Trial (NLST). Low-dose CT acquisition protocols should result in effective dose not exceeding 1.5mSv, and should be read by radiologists who have an expertise in the field. A volumetry-based approach similar to that used in the NELSON study allows reducing the rate of positive screens around 2%. The major harm of screening is overdiagnosis, which correspond to the detection of indolent tumours that would not cause the subject death. Ongoing research for the development of useful biomarkers to be combined to imaging could improve the accuracy of lung cancer screening.
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Affiliation(s)
- G Chassagnon
- Radiology department, Cochin Hospital, Paris Descartes University, 75004 Paris, France
| | - M-P Revel
- Radiology department, Cochin Hospital, Paris Descartes University, 75004 Paris, France.
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Couraud S, Milleron B. Lung cancer screening: what is new since the NLST results? CURRENT PULMONOLOGY REPORTS 2016. [DOI: 10.1007/s13665-016-0139-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Brinchault G, Diot P, Dixmier A, Goupil F, Guillais P, Gut-Gobert C, Leroyer C, Marchand-Adam S, Meurice JC, Morel H, Person C, Cavaillès A. [Comorbidities of COPD]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:342-349. [PMID: 26585876 DOI: 10.1016/j.pneumo.2015.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
COPD is a slowly progressive chronic respiratory disease causing an irreversible decrease in air flow. The main cause is smoking, which provokes inflammatory phenomena in the respiratory tract. COPD is a serious public health issue, causing high morbidity, mortality and disability. Related comorbidities are linked to ageing, common risk factors and genetic predispositions. A combination of comorbidities increases healthcare costs. For instance, patients with more than two comorbidities represent a quarter of all COPD sufferers but account for half the related health costs. Our review describes different comorbidities and their impact on the COPD prognosis. The comorbidities include: cardiovascular diseases, osteoporosis, denutrition, obesity, ageing, anemia, sleeping disorders, diabetes, metabolic syndrome, anxiety-depression and lung cancer. The prognosis worsens with one or more comorbidities. Clinicians are faced with the challenge of finding practical and appropriate ways of treating these comorbidities, and there is increasing interest in developing a global, multidisciplinary approach to management. Managing this chronic disease should be based on a holistic, patient-centred approach and smoking cessation remains the key factor in the care of COPD patients.
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Affiliation(s)
- G Brinchault
- Service de pneumologie, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex, France
| | - P Diot
- Service de pneumologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - A Dixmier
- Service de pneumologie et oncologie thoracique, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
| | - F Goupil
- Service de pneumologie, CH Le Mans, 194, avenue Rubillard, 72037 Le Mans cedex, France
| | - P Guillais
- CHP Saint-Martin, 18, rue des Roquemonts, 14000 Caen, France
| | - C Gut-Gobert
- Département de pneumologie et médecine interne, CHRU la Cavale-Blanche, boulevard Tanguy-Prigent, 29609 Brest cedex 2, France
| | - C Leroyer
- UBO, EA3878 (GETBO) IFR 148, département de médecine interne et de pneumologie, CHU de la Cavale-Blanche, université européenne de Bretagne, 29609 Brest, France
| | - S Marchand-Adam
- UMR 1100, service de pneumologie et explorations fonctionnelles respiratoires, université François-Rabelais, CHRU de Tours, 37032 Tours, France; UMR 1100/EA6305, Inserm, centre d'étude des pathologies respiratoires, 37032 Tours, France
| | - J-C Meurice
- Service de pneumologie du CHU de Poitiers, faculté de médecine et pharmacie de Poitiers, 2, rue de la Milétrie, 86000 Poitiers, France
| | - H Morel
- Service de pneumologie et oncologie thoracique, centre hospitalier régional d'Orléans, 14, avenue de l'Hôpital, 45067 Orléans cedex 2, France
| | - C Person
- Département de pneumologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Cavaillès
- Service de pneumologie, l'institut du thorax, CHU de Nantes, boulevard Jacques-Monod, 44093 Nantes cedex 1, France.
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Couraud S, Girard P, Girard N, Souquet PJ, Coiffard B, Charlin B, Milleron B. [Script concordance test for knowledge assessment of lung cancer screening]. Rev Mal Respir 2015; 33:333-42. [PMID: 26603957 DOI: 10.1016/j.rmr.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 07/28/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Annual screening for lung cancer using low-dose CT-scans is associated with decreased mortality. A survey conducted in Rhône-Alpes area in France found that clinicians need education and information on this topic. Script concordance tests (SCT) are a tool for assessing clinical reasoning in situations of uncertainty. They have not previously been used in France in the context of continuing medical education. METHOD We created a questionnaire with 5 multiple-choice questions (MCQ) and two SCT scenarios. The questionnaire was sent to all clinicians and residents who are members of French-Speaking Respiratory Society or the French Young Pulmonologist Association. RESULTS One hundred and ninety answers were analyzed. Seventy percent stated that decreasing mortality was the best criterion for assessing the effectiveness of a cancer screening policy, and 75% that low-dose CT scan was the best test to achieve this in lung cancer screening. Forty-five percent knew the eligibility criteria of the population, and 62% that low-dose CT scan should be performed annually. Participation in tumor boards and certification in oncology were significantly associated with a better score at MCQ and SCT. SCT and MCQ scores were significantly correlated (Spearman's Rho 0.339; P<0.0001). CONCLUSION SCT are feasible by electronic survey and seem relevant. Improving knowledge of clinicians on lung cancer screening is still critical.
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Affiliation(s)
- S Couraud
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon Sud, institut du cancer des hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France; Faculté de médecine et de maïeutique Lyon Sud Charles-Mérieux, université Lyon 1, 69600 Oullins, France.
| | - P Girard
- Département thoracique, institut mutualiste Montsouris, 75014 Paris, France
| | - N Girard
- Service de pneumologie, hôpital Louis-Pradel, hospices civils de Lyon, 69500 Bron, France; Faculté de médecine Lyon Est, université Lyon 1, 69100 Villeurbanne, France
| | - P-J Souquet
- Service de pneumologie aiguë spécialisée et cancérologie thoracique, centre hospitalier Lyon Sud, institut du cancer des hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France
| | - B Coiffard
- Association des jeunes pneumologues (AJPO2), groupe de travail de la Société de pneumologie de langue française, 66, boulevard Saint-Michel, 75006 Paris, France
| | - B Charlin
- Département recherche et développement, centre de pédagogie appliquée aux sciences de la santé, université de Montréal, Montréal, QC, Canada
| | - B Milleron
- Intergroupe francophone de cancérologie thoracique, 75010 Paris, France
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Sharma D, Newman TG, Aronow WS. Lung cancer screening: history, current perspectives, and future directions. Arch Med Sci 2015; 11:1033-43. [PMID: 26528348 PMCID: PMC4624749 DOI: 10.5114/aoms.2015.54859] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/07/2013] [Accepted: 09/11/2013] [Indexed: 12/19/2022] Open
Abstract
Lung cancer has remained the leading cause of death worldwide among all cancers. The dismal 5-year survival rate of 16% is in part due to the lack of symptoms during early stages and lack of an effective screening test until recently. Chest X-ray and sputum cytology were studied extensively as potential screening tests for lung cancer and were conclusively proven to be of no value. Subsequently, a number of studies compared computed tomography (CT) with the chest X-ray. These studies did identify lung cancer in earlier stages. However, they were not designed to prove a reduction in mortality. Later trials have focused on low-dose CT (LDCT) as a screening tool. The largest US trial - the National Lung Screening Trial (NLST) - enrolled approximately 54,000 patients and revealed a 20% reduction in mortality. While a role for LDCT in lung cancer screening has been established, the issues of high false positive rates, radiation risk, and cost effectiveness still need to be addressed. The guidelines of the international organizations that now include LDCT in lung cancer screening are reviewed. Other methods that may improve earlier detection such as positron emission tomography, autofluorescence bronchoscopy, and molecular biomarkers are also discussed.
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Affiliation(s)
- Divakar Sharma
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Thomas G. Newman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Metropolitan Hospital Center, New York, NY, USA
| | - Wilbert S. Aronow
- Divisions of Cardiology, and Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla NY, USA
- Divisions of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla NY, USA
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Blanchard D, Barry B, De Raucourt D, Choussy O, Dessard-Diana B, Hans S, Lafarge D. Guidelines update: Post-treatment follow-up of adult head and neck squamous cell carcinoma: Screening for metastasis and metachronous esophageal and bronchial locations. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:217-21. [DOI: 10.1016/j.anorl.2015.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Fontaine-Delaruelle C, Souquet PJ, Gamondes D, Pradat E, De Leusse A, Ferretti GR, Couraud S. Negative Predictive Value of Transthoracic Core-Needle Biopsy. Chest 2015; 148:472-480. [DOI: 10.1378/chest.14-1907] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Pairon JC, Andujar P, Rinaldo M, Ameille J, Brochard P, Chamming’s S, Clin B, Ferretti G, Gislard A, Laurent F, Luc A, Wild P, Paris C. Asbestos Exposure, Pleural Plaques, and the Risk of Death from Lung Cancer. Am J Respir Crit Care Med 2014; 190:1413-20. [DOI: 10.1164/rccm.201406-1074oc] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tammemägi MC, Church TR, Hocking WG, Silvestri GA, Kvale PA, Riley TL, Commins J, Berg CD. Evaluation of the lung cancer risks at which to screen ever- and never-smokers: screening rules applied to the PLCO and NLST cohorts. PLoS Med 2014; 11:e1001764. [PMID: 25460915 PMCID: PMC4251899 DOI: 10.1371/journal.pmed.1001764] [Citation(s) in RCA: 234] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/21/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lung cancer risks at which individuals should be screened with computed tomography (CT) for lung cancer are undecided. This study's objectives are to identify a risk threshold for selecting individuals for screening, to compare its efficiency with the U.S. Preventive Services Task Force (USPSTF) criteria for identifying screenees, and to determine whether never-smokers should be screened. Lung cancer risks are compared between smokers aged 55-64 and ≥ 65-80 y. METHODS AND FINDINGS Applying the PLCO(m2012) model, a model based on 6-y lung cancer incidence, we identified the risk threshold above which National Lung Screening Trial (NLST, n = 53,452) CT arm lung cancer mortality rates were consistently lower than rates in the chest X-ray (CXR) arm. We evaluated the USPSTF and PLCO(m2012) risk criteria in intervention arm (CXR) smokers (n = 37,327) of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO). The numbers of smokers selected for screening, and the sensitivities, specificities, and positive predictive values (PPVs) for identifying lung cancers were assessed. A modified model (PLCOall2014) evaluated risks in never-smokers. At PLCO(m2012) risk ≥ 0.0151, the 65th percentile of risk, the NLST CT arm mortality rates are consistently below the CXR arm's rates. The number needed to screen to prevent one lung cancer death in the 65th to 100th percentile risk group is 255 (95% CI 143 to 1,184), and in the 30th to <65th percentile risk group is 963 (95% CI 291 to -754); the number needed to screen could not be estimated in the <30th percentile risk group because of absence of lung cancer deaths. When applied to PLCO intervention arm smokers, compared to the USPSTF criteria, the PLCO(m2012) risk ≥ 0.0151 threshold selected 8.8% fewer individuals for screening (p<0.001) but identified 12.4% more lung cancers (sensitivity 80.1% [95% CI 76.8%-83.0%] versus 71.2% [95% CI 67.6%-74.6%], p<0.001), had fewer false-positives (specificity 66.2% [95% CI 65.7%-66.7%] versus 62.7% [95% CI 62.2%-63.1%], p<0.001), and had higher PPV (4.2% [95% CI 3.9%-4.6%] versus 3.4% [95% CI 3.1%-3.7%], p<0.001). In total, 26% of individuals selected for screening based on USPSTF criteria had risks below the threshold PLCO(m2012) risk ≥ 0.0151. Of PLCO former smokers with quit time >15 y, 8.5% had PLCO(m2012) risk ≥ 0.0151. None of 65,711 PLCO never-smokers had PLCO(m2012) risk ≥ 0.0151. Risks and lung cancers were significantly greater in PLCO smokers aged ≥ 65-80 y than in those aged 55-64 y. This study omitted cost-effectiveness analysis. CONCLUSIONS The USPSTF criteria for CT screening include some low-risk individuals and exclude some high-risk individuals. Use of the PLCO(m2012) risk ≥ 0.0151 criterion can improve screening efficiency. Currently, never-smokers should not be screened. Smokers aged ≥ 65-80 y are a high-risk group who may benefit from screening. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Martin C. Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
- * E-mail:
| | - Timothy R. Church
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | | | - Gerard A. Silvestri
- Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Paul A. Kvale
- Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, Michigan, United States of America
| | - Thomas L. Riley
- Information Management Systems, Rockville, Maryland, United States of America
| | - John Commins
- Information Management Systems, Rockville, Maryland, United States of America
| | - Christine D. Berg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medicine, Baltimore, Maryland, United States of America
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Fu C, Liu Z, Zhu F, Li S, Jiang L. A meta-analysis: is low-dose computed tomography a superior method for risky lung cancers screening population? CLINICAL RESPIRATORY JOURNAL 2014; 10:333-41. [PMID: 25307063 DOI: 10.1111/crj.12222] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/30/2014] [Accepted: 09/29/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Low-dose computed tomography (LDCT) has been proposed to be a new screening method to discover lung cancers in an early stage, especially those patients who are in a high risk of lung cancer. The primary objective of this meta-analysis is to systematically review the effect of LDCT on screening for lung cancers among the risky population who are older than 49 years old and with smoking exposure. METHODS We searched randomized controlled clinical trials (RCTs) about comparing LDCT and chest X-ray or usual caring from MEDLINE, EMBASE, and the Cochrane Library, Web of Knowledge and SpringerLink databases (January 1994 to September 2013). RESULTS Nine RCTs met criteria for inclusion. Screening for lung cancer using LDCT resulted in a significantly higher number of stage I lung cancers [odds ratio (OR) 2.15, 95% confidence interval (CI) 1.88-2.47], higher number of total lung cancers (OR 1.31, 95% CI 1.20-1.43) than the control. Four of the nine studies indicated that the screening method did not decrease all-cause mortality (OR 0.96, 95% CI 0.90-1.02), but decreased lung cancer-specific mortality (OR 0.84, 95% CI 0.74-0.96). Five studies showed that LDCT had higher false-positive rates (OR 8.7, 95% CI 7.43-10.19) than the group of control. CONCLUSION Among the risky population, LDCT screening find out more stage I lung cancers and total lung cancers compared with chest X-ray or no screening, and also shows advantages in decreasing lung cancer-specific mortality, but the screening method does not decrease all-cause mortality and have a higher false-positive rates in diagnosis.
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Affiliation(s)
- Cuiping Fu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zilong Liu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fen Zhu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shanqun Li
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liyan Jiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
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Sánchez González M. Cribado del cáncer de pulmón. RADIOLOGIA 2014; 56:385-9. [DOI: 10.1016/j.rx.2013.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/18/2013] [Accepted: 04/06/2013] [Indexed: 11/25/2022]
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Lung Cancer in Combined Pulmonary Fibrosis and Emphysema: A Series of 47 Western Patients. J Thorac Oncol 2014; 9:1162-70. [DOI: 10.1097/jto.0000000000000209] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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46
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Quoix E, Mennecier B, Milleron B. CT lung cancer screening: where are we heading to? Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Lung cancer screening has been the subject of controversies since the 1970s. After failure of chest x-ray and sputum cytology examination to decrease lung cancer mortality, there was a 15-year period of disillusion. Low-dose CT scan of the thorax provided a renewal of interest with prospective studies followed by randomized trials of which four have been published. Only one, the NLST trial involving 53,000 participants is positive with a 20% reduction in lung cancer specific mortality rate. The European studies are by far smaller, the largest being the Nelson study with 15,000 participants. There are some shortcomings and biases that must be known and well explained to the future participants to a lung cancer screening program. The cost/benefit ratio remains to be better analyzed.
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Affiliation(s)
- Elisabeth Quoix
- Department of Thoracic diseases, University Hospital of Strasbourg, 1 place de l'hôpital, 67091 Strasbourg Cedex, France
- IFCT, 10 rue de la Grange Batelière, 75009 Paris, France
| | - Bertrand Mennecier
- Department of Thoracic diseases, University Hospital of Strasbourg, 1 place de l'hôpital, 67091 Strasbourg Cedex, France
| | - Bernard Milleron
- IFCT, 10 rue de la Grange Batelière, 75009 Paris, France
- Department of Thoracic diseases, University Hospital Tenon, APHP, Paris, France
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Kołaczyk K, Walecka A, Grodzki T, Alchimowicz J, Smereczyński A, Kiedrowicz R. The assessment of the role of baseline low-dose CT scan in patients at high risk of lung cancer. Pol J Radiol 2014; 79:210-8. [PMID: 25057333 PMCID: PMC4106928 DOI: 10.12659/pjr.890103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 03/05/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Despite the progress in contemporary medicine comprising diagnostic and therapeutic methods, lung cancer is still one of the biggest health concerns in many countries of the world. The main purpose of the study was to evaluate the detection rate of pulmonary nodules and lung cancer in the initial, helical low-dose CT of the chest as well as the analysis of the relationship between the size and the histopathological character of the detected nodules. MATERIAL/METHODS We retrospectively evaluated 1999 initial, consecutive results of the CT examinations performed within the framework of early lung cancer detection program initiated in Szczecin. The project enrolled persons of both sexes, aged 55-65 years, with at least 20 pack-years of cigarette smoking or current smokers. The analysis included assessment of the number of positive results and the evaluation of the detected nodules in relationship to their size. All of the nodules were classified into I of VI groups and subsequently compared with histopathological type of the neoplastic and nonneoplastic pulmonary lesions. RESULTS Pulmonary nodules were detected in 921 (46%) subjects. What is more, malignant lesions as well as lung cancer were significantly, more frequently discovered in the group of asymptomatic nodules of the largest dimension exceeding 15 mm. CONCLUSIONS The initial, low-dose helical CT of the lungs performed in high risk individuals enables detection of appreciable number of indeterminate pulmonary nodules. In most of the asymptomatic patients with histopathologically proven pulmonary nodules greater than 15 mm, the mentioned lesions are malignant, what warrants further, intensified diagnostics.
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Affiliation(s)
- Katarzyna Kołaczyk
- Department of Diagnostic Imaging and Interventional Radiology PUM, Independent Public Clinical Hospital No. 1, Szczecin, Poland
| | - Anna Walecka
- Department of Diagnostic Imaging and Interventional Radiology PUM, Independent Public Clinical Hospital No. 1, Szczecin, Poland
| | - Tomasz Grodzki
- Clinical Division of Thoracic Surgery PUM, Specialist Hospital, prof. Alfred Sokołowski Scales, Szczecin, Poland
| | - Jacek Alchimowicz
- Clinical Division of Thoracic Surgery PUM, Specialist Hospital, prof. Alfred Sokołowski Scales, Szczecin, Poland
| | - Andrzej Smereczyński
- Department of Gastroenterology PUM, Independent Public Clinical Hospital No. 1, Szczecin, Poland
| | - Radosław Kiedrowicz
- Department of Cardiology PUM, Independent Public Clinical Hospital No. 2, Szczecin, Poland
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Frauenfelder T, Puhan M, Lazor R, von Garnier C, Bremerich J, Niemann T, Christe A, Montet X, Gautschi O, Weder W, Kohler M. Early Detection of Lung Cancer: A Statement from an Expert Panel of the Swiss University Hospitals on Lung Cancer Screening. Respiration 2014; 87:254-64. [DOI: 10.1159/000357049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/19/2013] [Indexed: 11/19/2022] Open
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Girard N, Gounant V, Mennecier B, Greillier L, Cortot A, Couraud S, Besse B, Brouchet L, Castelnau O, Ferretti G, Frappé P, Khalil A, Lefebure P, Laurent F, Liebart S, Margery J, Molinier O, Quoix E, Revel MP, Stach B, Souquet PJ, Thomas P, Trédaniel J, Lemarié E, Zalcman G, Barlési F, Milleron B. Le dépistage individuel du cancer broncho-pulmonaire en pratique. Perspectives sur les propositions du groupe de travail pluridisciplinaire de l’Intergroupe francophone de cancérologie thoracique, de la Société d’imagerie thoracique et du Groupe d’oncologie de langue française. Rev Mal Respir 2014; 31:91-103. [DOI: 10.1016/j.rmr.2013.10.641] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 09/18/2013] [Indexed: 12/21/2022]
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Lederlin M, Revel MP, Khalil A, Ferretti G, Milleron B, Laurent F. Management strategy of pulmonary nodule in 2013. Diagn Interv Imaging 2013; 94:1081-94. [PMID: 24034970 DOI: 10.1016/j.diii.2013.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- M Lederlin
- Service d'imagerie médicale, Université Bordeaux Segalen, CHU Bordeaux Groupe Sud, avenue de Magellan, 33600 Pessac, France.
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