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Parsa S, Saleh A, Raygor V, Hoeting N, Rao A, Navar AM, Rohatgi A, Kay F, Abbara S, Khera A, Joshi PH. Measurement and Application of Incidentally Detected Coronary Calcium: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:1557-1567. [PMID: 38631775 DOI: 10.1016/j.jacc.2024.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 04/19/2024]
Abstract
Coronary artery calcium (CAC) scoring is a powerful tool for atherosclerotic cardiovascular disease risk stratification. The nongated, noncontrast chest computed tomography scan (NCCT) has emerged as a source of CAC characterization with tremendous potential due to the high volume of NCCT scans. Application of incidental CAC characterization from NCCT has raised questions around score accuracy, standardization of methodology including the possibility of deep learning to automate the process, and the risk stratification potential of an NCCT-derived score. In this review, the authors aim to summarize the role of NCCT-derived CAC in preventive cardiovascular health today as well as explore future avenues for eventual clinical applicability in specific patient populations and broader health systems.
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Affiliation(s)
- Shyon Parsa
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA; Department of Internal Medicine, Stanford University Hospital, Stanford, California, USA
| | - Adam Saleh
- Texas A&M University, Engineering Medicine, Houston, Texas, USA
| | - Viraj Raygor
- Sutter Health, Cardiovascular Health, Palo Alto, California, USA
| | - Natalie Hoeting
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Anjali Rao
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Ann Marie Navar
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Anand Rohatgi
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Fernando Kay
- Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Suhny Abbara
- Department of Radiology, Division of Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit Khera
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA
| | - Parag H Joshi
- Department of Internal Medicine, Division of Cardiology, the UT Southwestern Medical Center, Dallas, Texas, USA.
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Hardavella G, Frille A, Chalela R, Sreter KB, Petersen RH, Novoa N, de Koning HJ. How will lung cancer screening and lung nodule management change the diagnostic and surgical lung cancer landscape? Eur Respir Rev 2024; 33:230232. [PMID: 38925794 PMCID: PMC11216686 DOI: 10.1183/16000617.0232-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/16/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Implementation of lung cancer screening, with its subsequent findings, is anticipated to change the current diagnostic and surgical lung cancer landscape. This review aimed to identify and present the most updated expert opinion and discuss relevant evidence regarding the impact of lung cancer screening and lung nodule management on the diagnostic and surgical landscape of lung cancer, as well as summarise points for clinical practice. METHODS This article is based on relevant lectures and talks delivered during the European Society of Thoracic Surgeons-European Respiratory Society Collaborative Course on Thoracic Oncology (February 2023). Original lectures and talks and their relevant references were included. An additional literature search was conducted and peer-reviewed studies in English (December 2022 to June 2023) from the PubMed/Medline databases were evaluated with regards to immediate affinity of the published papers to the original talks presented at the course. An updated literature search was conducted (June 2023 to December 2023) to ensure that updated literature is included within this article. RESULTS Lung cancer screening suspicious findings are expected to increase the number of diagnostic investigations required therefore impacting on current capacity and resources. Healthcare systems already face a shortage of imaging and diagnostic slots and they are also challenged by the shortage of interventional radiologists. Thoracic surgery will be impacted by the wider lung cancer screening implementation with increased volume and earlier stages of lung cancer. Nonsuspicious findings reported at lung cancer screening will need attention and subsequent referrals where required to ensure participants are appropriately diagnosed and managed and that they are not lost within healthcare systems. CONCLUSIONS Implementation of lung cancer screening requires appropriate mapping of existing resources and infrastructure to ensure a tailored restructuring strategy to ensure that healthcare systems can meet the new needs.
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Affiliation(s)
- Georgia Hardavella
- 4th-9th Department of Respiratory Medicine, "Sotiria" Athens' Chest Diseases Hospital, Athens, Greece
| | - Armin Frille
- Department of Respiratory Medicine, University of Leipzig, Leipzig, Germany
| | - Roberto Chalela
- Department of Respiratory Medicine: Lung Cancer and Endoscopy Unit, Hospital del Mar - Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Katherina B Sreter
- Department of Pulmonology, University Hospital Centre "Sestre Milosrdnice", Zagreb, Croatia
| | - Rene H Petersen
- Department of Cardiothoracic Surgery, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Nuria Novoa
- Department of Thoracic Surgery, University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Djuric O, Giorgi Rossi P, Ivanciu EC, Cardellicchio S, Cresci C, Carozzi L, Pistelli F, Bessi V, Gai P, Galli V, Lavacchini G, Bricci C, Gorini G, Bosi S, Paci E. Motivation, acceptability and attitudes toward lung cancer screening among persons who attend a tobacco cessation program: A multicenter survey in Italy. Prev Med Rep 2023; 35:102272. [PMID: 37384117 PMCID: PMC10293766 DOI: 10.1016/j.pmedr.2023.102272] [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: 12/05/2022] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
This study aimed to evaluate smoking cessation (SC) motivation and the acceptability of a lung cancer screening (LCS) program with low-dose computed tomography (LDCT) among people who attend SC programs. A multicenter survey was conducted in the period January-December 2021 involving 197 people who attended group or individual SC courses in Reggio Emilia and Tuscany. Questionnaires, information sheets, and decision aids about the potential benefits and harms of LCS with LDCT were distributed at different time points during the course. The wish to protect own health (66%) was the most frequent reason given for quitting smoking, followed by cigarette dependence (40.6%) and current health problems (30.5%). Half of the participants (56%) considered periodic health checks including LDCT, as an advantageous activity. The great majority of participants were in favor of LCS (92%), with only 8% being indifferent, and no one was against these programs. Interestingly, those with sufficiently high smoking-related LC risk to be eligible for LCS and those attending the individual course were less in favor of LCS but also less concerned about the possible harms associated with LCS. The type of counseling was a significant predictor for both LCS acceptability and perceived harm of LCS. The favorable perception of LCS in people attending SC courses, despite the considerable preoccupation with potential harms, is an important finding of this study. Introducing a discussion on the benefits and harms of LCS in SC programs may prepare persons who smoke to make informed decisions on utilizing LCS.
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Affiliation(s)
- Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Biomedical, Metabolic and Neural Sciences, Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Public Health Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Camelia Ivanciu
- Public Health Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Chiara Cresci
- Antismoking Center, Florence-Careggi University Hospital, Florence, Italy
| | - Laura Carozzi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Francesco Pistelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Valentina Bessi
- Cardiothoracic and Vascular Department, Pisa University Hospital, Pisa, Italy
| | - Patrizia Gai
- Antismoking Center, Azienda Unità Sanitaria Locale Toscana Center, Italy
| | - Valentina Galli
- Antismoking Center, Prato, Azienda Unità Sanitaria Locale Toscana Center, Italy
| | - Giacomo Lavacchini
- Antismoking Center, Borgo San Lorenzo, Azienda Unità Sanitaria Locale Toscana Center, Italy
| | - Claudia Bricci
- Italian League against Cancer (LILT), Reggio Emilia, Italy
| | - Giuseppe Gorini
- Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy
| | - Sandra Bosi
- Italian League against Cancer (LILT), Reggio Emilia, Italy
| | - Eugenio Paci
- Italian League against Cancer (LILT), Florence, Italy
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Moura Cabral S, Abreu I, Madama D, Estevão A, Cordeiro E, Pimentel J, Miranda N, Ferreira AJ, Robalo Cordeiro C. Lung Cancer Screening: Low-Dose Thoracic Computed Tomography Performed in a High-Risk Portuguese Population. ACTA MEDICA PORT 2023; 36:559-566. [PMID: 37658722 DOI: 10.20344/amp.16847] [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: 07/10/2021] [Accepted: 12/02/2022] [Indexed: 09/03/2023]
Abstract
INTRODUCTION The Urgeiriça mines were once the main uranium producer in Portugal. The aim of this study was to estimate the benefit of low-dose chest computed tomography (LDCT) for lung cancer screening in former miners that were considered as being at high-risk. METHODS A subgroup of former miners of the Uranium National Company exposed to uranium and with a smoking load greater than 20 pack-years, agreed to perform a LDCT. The Fleischner Society Guidelines were used to classify the nodules and establish follow-up. RESULTS Initially, 265 former employees of the Uranium National Company were included. The mean time of employment was 15 (0 - 45) years. The non-smokers represented 50.9% and 30.2% were ever smokers; the remaining chose not to respond. One diagnosis of lung cancer was initially made. In the second phase, a subgroup of 66 former miner underwent a LDCT, 37 of whom presented pulmonary nodules. Most computed tomography (CT) scans revealed one single nodule (n = 13) and the mean size was 5 (1 - 16) mm. A suspicious 16 mm spiculated nodule was evaluated with PET/CT, and percutaneous and surgical biopsies, ultimately revealing a benign lesion. CONCLUSION The data highlights the importance of lung cancer screening in high-risk populations. This was, to the best of our knowledge, the first study performed in Portugal and can act as a bridge towards a wider implementation in the country.
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Affiliation(s)
- Sara Moura Cabral
- Pulmonology Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Inês Abreu
- Radiology Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Daniela Madama
- Pulmonology Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Amélia Estevão
- Radiology Department. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Eugénio Cordeiro
- Department of Public Health. Administração Regional de Saúde do Centro. Coimbra. Portugal
| | - João Pimentel
- Department of Public Health. Administração Regional de Saúde do Centro. Coimbra. Portugal
| | - Nuno Miranda
- Haematology Department. Instituto Português de Oncologia de Lisboa. National Programme for Oncological Diseases. Lisboa. Portugal
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Ward B, Koziar Vašáková M, Robalo Cordeiro C, Yorgancioğlu A, Chorostowska-Wynimko J, Blum TG, Kauczor HU, Samarzija M, Henschke C, Wheelock C, Grigg J, Andersen ZJ, Koblížek V, Májek O, Odemyr M, Powell P, Seijo LM. Important steps towards a big change for lung health: a joint approach by the European Respiratory Society, the European Society of Radiology and their partners to facilitate implementation of the European Union's new recommendations on lung cancer screening. ERJ Open Res 2023; 9:00026-2023. [PMID: 37228272 PMCID: PMC10204812 DOI: 10.1183/23120541.00026-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/21/2023] [Indexed: 05/27/2023] Open
Abstract
Enormous progress has been made on the epic journey towards implementation of lung cancer screening in Europe. A breakthrough for lung health has been achieved with the EU proposal for a Council recommendation on cancer screening. https://bit.ly/3J4O0Jb.
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Affiliation(s)
- Brian Ward
- Advocacy Department, European Respiratory Society, Brussels, Belgium
- These authors contributed equally
| | - Martina Koziar Vašáková
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University, Thomayer University Hospital, Prague, Czech Republic
- These authors contributed equally
| | | | - Arzu Yorgancioğlu
- Chest Disease, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Miroslav Samarzija
- Clinical Department for Respiratory Diseases Jordanovac, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Claudia Henschke
- Department of Radiology, Mount Sinai Health System, New York, NY, USA
| | - Craig Wheelock
- Unit of Integrative Metabolomics, Institute of Environmental Medicine (IMM), Karolinska Institutet, Stockholm, Sweden
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Vladimír Koblížek
- University Hospital, Pulmonary Department, Charles University, Hradec Kralove, Czech Republic
| | - Ondřej Májek
- National Screening Centre, Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Mikaela Odemyr
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | | | - Luis M. Seijo
- Department of Pulmonary Medicine, Clínica Universidad de Navarra, Madrid, Spain
- Ciberes, Madrid, Spain
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Qingya P, Yizhong F, Fuke Z, Shengjie L, Linzhao T, Yuling L. STANDARD-DEVIATION BASED CONFORMITY INDEX FOR EVALUATING TREATMENT PLAN OF INTENSITY MODULATED RADIOTHERAPY IN LUNG CANCER. RADIATION PROTECTION DOSIMETRY 2023; 199:87-94. [PMID: 36420536 DOI: 10.1093/rpd/ncac228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/13/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
This paper attempts to find a new conformity index (CI) calculation method with slice and angle information for evaluating lung cancer radiation treatment plan. A total of 20 lung cancer patients in 2016-2019 were selected. Treatment plans were made for each patient. Parameters used in the process of making treatment plans were set the same. The CI and the standard-deviation based CI (SDCI) that contains angle and slice information were calculated. Comparison of results calculated with SDCI and CI were made. The results of the two methods for the patients showed the same trend. Different shapes of simulated dose distribution line shows SDCI can provide more detail information about the target area. Special shapes of simulated dose distribution line for SDCI showed inaccuracy in angle information. The parameter SDCI has more advantage towards the traditional CI for it can provide angle and slice information. However, more angles need to be calculated.
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Affiliation(s)
- Pan Qingya
- Department of Chemo-Radiotherapy Oncology, QingHe Center Hospital, 80 SanYang Road, Qinghe, 054800 HeBei, China
| | - Fan Yizhong
- Department of Chemo-Radiotherapy Oncology, QingHe Center Hospital, 80 SanYang Road, Qinghe, 054800 HeBei, China
| | - Zhang Fuke
- Department of Chemo-Radiotherapy Oncology, QingHe Center Hospital, 80 SanYang Road, Qinghe, 054800 HeBei, China
| | - Luan Shengjie
- Department of Chemo-Radiotherapy Oncology, QingHe Center Hospital, 80 SanYang Road, Qinghe, 054800 HeBei, China
| | - Tian Linzhao
- Department of Chemo-Radiotherapy Oncology, QingHe Center Hospital, 80 SanYang Road, Qinghe, 054800 HeBei, China
| | - Lv Yuling
- Department of Chemo-Radiotherapy Oncology, QingHe Center Hospital, 80 SanYang Road, Qinghe, 054800 HeBei, China
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Shen YY, Jiang J, Zhao J, Song J. Lung squamous cell carcinoma presenting as rare clustered cystic lesions: A case report and review of literature. World J Clin Cases 2022; 10:13006-13014. [PMID: 36569005 PMCID: PMC9782924 DOI: 10.12998/wjcc.v10.i35.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/17/2022] [Accepted: 11/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death. Early diagnosis is critical to improving a patient’s chance of survival. However, lung cancer associated with cystic airspaces is often misdiagnosed or underdiagnosed due to the absence of clinical symptoms, poor imaging specificity, and high risk of biopsy-related complications.
CASE SUMMARY We report an unusual case of cancer in a 55-year-old man, in which the lesion evolved from a small solitary thin-walled cyst to lung squamous cell carcinoma (SCC) with metastases in both lungs. The SCC manifested as rare clustered cystic lesions, detected on chest computed tomography. There were air-fluid levels, compartments, and bronchial arteries in the cystic lesions. Additionally, there was no clear extrathoracic metastasis. After chemotherapy, the patient achieved a partial response, type I respiratory failure was relieved, and the lung lesions became a clustered thin-walled cyst.
CONCLUSION Pulmonary cystic lesions require regular imaging follow-up. Lung SCC should be a diagnostic consideration in cases of thin-walled cysts as well as multiple clustered cystic lesions.
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Affiliation(s)
- Yu-Yao Shen
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
| | - Jing Jiang
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
| | - Jing Zhao
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Jie Song
- Department of Pulmonary and Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated Hospital of Qingdao University, Yantai 264000, Shandong Province, China
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Deval JC, Benito MB, Cuesta JCP, Pérez EM, Contreras SS, Mojarrieta JC, Quevedo KDA, Martínez MA, Arana E. [Translated article] Lung Cancer Screening: Survival in an Extensive Early Detection Program in Spain (I-ELCAP). Arch Bronconeumol 2022. [PMID: 35525715 DOI: 10.1016/j.arbres.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lung cancer (LC) is usually diagnosed at advanced stages with only a 12% 5-year survival. Trials as NLST and NELSON show a mortality decrease, which justifies implementation of lung cancer screening in risk population. Our objective was to show survival results of the largest LC screening program in Spain with low dosage computed tomography (LDCT). METHODS Clinical records from International Early Lung Cancer Detection Program (IELCAP) at Valencia, Spain were analyzed. This program recruited volunteers, ever-smokers aged 40-80 years, since 2008. Results are compared to those from other similar sizeable programs. RESULTS A total of 8278 participants were screened with at least two-rounds until November 2020. A mean of 6 annual screening rounds were performed. We detected 239 tumors along 12-year follow-up. Adenocarcinoma was the most common histology, being 61.3% at stage I. The lung cancer prevalence and incidence proportion was 1.5% and 1.4%, respectively with an annual detection rate of 0.17. One-year survival and 10-year survival were 90% and 80.1%, respectively. Adherence was 96.84%. CONCLUSION Largest lung cancer screening in Spain shows that survival is improved when is performed in multidisciplinary team experienced in management of LC, and is comparable to similar screening programs.
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Affiliation(s)
- José Cervera Deval
- Servicio de Radiodiagnóstico, Fundación Instituto Valenciano de Oncología, Profesor Beltrán Báguena, 8, 46009 Valencia, Spain.
| | - María Barrios Benito
- Servicio de Radiodiagnóstico, Fundación Instituto Valenciano de Oncología, Profesor Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Juan Carlos Peñalver Cuesta
- Servicio de Cirugía Torácica. Fundación Instituto Valenciano de Oncología, Profesor Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Encarnación Martínez Pérez
- Unidad de Neumología, Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología, Profesor Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Sergio Sandiego Contreras
- Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Profesor Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Julia Cruz Mojarrieta
- Servicio de Anatomía Patológica, Fundación Instituto Valenciano de Oncología, Profesor Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Karol de Aguiar Quevedo
- Servicio de Cirugía Torácica. Fundación Instituto Valenciano de Oncología, Profesor Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Miguel Arraras Martínez
- Servicio de Cirugía Torácica. Fundación Instituto Valenciano de Oncología, Profesor Beltrán Báguena, 8, 46009 Valencia, Spain
| | - Estanislao Arana
- Servicio de Radiodiagnóstico, Fundación Instituto Valenciano de Oncología, Profesor Beltrán Báguena, 8, 46009 Valencia, Spain
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Bertolaccini L, Casiraghi M, Petrella F, Rampinelli C, Tessitore A, Spaggiari L. A methodological quality evaluation of the published guidelines and recommendations about the lung cancer screening. Eur J Cancer Prev 2022; 31:19-25. [PMID: 34519689 DOI: 10.1097/cej.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A project to assess the existing literature and to benchmark the quality of past guidelines and recommendations on lung cancer screening projects was developed with a particular focus on the assessment of the methodology used in producing them. METHODS Each guideline was assessed in the different items and domains with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument and scored on a seven-point scale. RESULTS Eight guidelines matched the inclusion criteria and were assessed. A multinational collaboration produced three out of five guidelines. The multivariable analysis shows that improved scores of stakeholders' involvement were related to internationally developed guidelines. Improved methodological quality was related to the involvement of scientific societies due to the better rigor of development and editorial independence. Countries with higher expenditure on healthcare produced significantly better guidelines. CONCLUSIONS Assessed by the AGREE II criteria, the methodological quality of previous guidelines was relatively low. Nevertheless, the National Comprehensive Cancer Network Guidelines should be recommended as a model for the development of best methodological quality guidelines.
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Affiliation(s)
| | | | - Francesco Petrella
- Division of Thoracic Surgery
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | | | - Lorenzo Spaggiari
- Division of Thoracic Surgery
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Jacobs C, Setio AAA, Scholten ET, Gerke PK, Bhattacharya H, M Hoesein FA, Brink M, Ranschaert E, de Jong PA, Silva M, Geurts B, Chung K, Schalekamp S, Meersschaert J, Devaraj A, Pinsky PF, Lam SC, van Ginneken B, Farahani K. Deep Learning for Lung Cancer Detection on Screening CT Scans: Results of a Large-Scale Public Competition and an Observer Study with 11 Radiologists. Radiol Artif Intell 2021; 3:e210027. [PMID: 34870218 DOI: 10.1148/ryai.2021210027] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/15/2022]
Abstract
Purpose To determine whether deep learning algorithms developed in a public competition could identify lung cancer on low-dose CT scans with a performance similar to that of radiologists. Materials and Methods In this retrospective study, a dataset consisting of 300 patient scans was used for model assessment; 150 patient scans were from the competition set and 150 were from an independent dataset. Both test datasets contained 50 cancer-positive scans and 100 cancer-negative scans. The reference standard was set by histopathologic examination for cancer-positive scans and imaging follow-up for at least 2 years for cancer-negative scans. The test datasets were applied to the three top-performing algorithms from the Kaggle Data Science Bowl 2017 public competition: grt123, Julian de Wit and Daniel Hammack (JWDH), and Aidence. Model outputs were compared with an observer study of 11 radiologists that assessed the same test datasets. Each scan was scored on a continuous scale by both the deep learning algorithms and the radiologists. Performance was measured using multireader, multicase receiver operating characteristic analysis. Results The area under the receiver operating characteristic curve (AUC) was 0.877 (95% CI: 0.842, 0.910) for grt123, 0.902 (95% CI: 0.871, 0.932) for JWDH, and 0.900 (95% CI: 0.870, 0.928) for Aidence. The average AUC of the radiologists was 0.917 (95% CI: 0.889, 0.945), which was significantly higher than grt123 (P = .02); however, no significant difference was found between the radiologists and JWDH (P = .29) or Aidence (P = .26). Conclusion Deep learning algorithms developed in a public competition for lung cancer detection in low-dose CT scans reached performance close to that of radiologists.Keywords: Lung, CT, Thorax, Screening, Oncology Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Colin Jacobs
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Arnaud A A Setio
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Ernst T Scholten
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Paul K Gerke
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Haimasree Bhattacharya
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Firdaus A M Hoesein
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Monique Brink
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Erik Ranschaert
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Pim A de Jong
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Mario Silva
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Bram Geurts
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Kaman Chung
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Steven Schalekamp
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Joke Meersschaert
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Anand Devaraj
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Paul F Pinsky
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Stephen C Lam
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Bram van Ginneken
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Keyvan Farahani
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.A.A.S., E.T.S., P.K.G., H.B., M.B., B.G., S.S., B.v.G.); Department of Digital Technology & Innovation, Siemens Healthineers, Erlangen, Germany (A.A.A.S.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (F.A.M.H., P.A.d.J.); ETZ (Elisabeth-TweeSteden Ziekenhuis), Tilburg, the Netherlands (E.R.); Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy (M.S.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (K.C., S.S.); Department of Radiology, AZ Zeno, Knokke-Heist, Belgium (J.M.); Department of Imaging, Royal Brompton Hospital, London, England (A.D.); Division of Cancer Prevention (P.F.P.) and Center for Biomedical Informatics & Information Technology (K.F.), National Cancer Institute, National Institutes of Health, Bethesda, Md; British Columbia Cancer Agency and the University of British Columbia, Vancouver, Canada (S.C.L.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
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Kleine pleurapulmonale Knoten in der Screening-CT – was tun? ROFO-FORTSCHR RONTG 2021. [DOI: 10.1055/a-1395-1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Byrne SC, Hammer MM. Use of Diagnostic CT and Patient Retention in a Lung Cancer Screening Program. J Am Coll Radiol 2021; 19:47-52. [PMID: 34752759 DOI: 10.1016/j.jacr.2021.09.027] [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: 06/23/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE The aims of this study were to assess the rate of subsequent diagnostic chest CT examinations in a lung cancer screening (LCS) program and examine the effect on retention of patients in the program. METHODS Patients who underwent LCS CT between June 2011 and August 2018 were included. The occurrence of patients' being subsequently imaged with diagnostic CT versus LCS CT and the effect this had on patients' returning for LCS CT (patient retention) were evaluated. Multivariable logistic regression was used to evaluate variables associated with undergoing diagnostic CT and risk factors associated with loss of patient retention. RESULTS Of the 5,912 patients who underwent LCS CT, 2,756 underwent subsequent diagnostic or LCS chest CT. Increasing Lung-RADS® score was more likely to lead to subsequent diagnostic chest CT (P < .0001). A total of 1,240 patients underwent at least three chest CT examinations in the time interval. For the 711 patients whose subsequent CT studies were for LCS, 585 (82%) were retained, whereas of the 529 patients who underwent subsequent diagnostic CT, only 208 (39%) were retained (P < .0001). For the 197 subsequent diagnostic CT examinations performed for pulmonary nodule or screening indications, 81 patients (41%) returned for LCS CT, compared with 498 of 612 patients (81%) who underwent subsequent LCS CT (P < .0001). In multivariable analysis, subsequent diagnostic chest CT and increasing Lung-RADS score were associated with loss of retention. CONCLUSIONS A higher Lung-RADS score is a risk factor for subsequent diagnostic chest CT, and this is an independent risk factor for loss from the LCS program.
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Affiliation(s)
- Suzanne C Byrne
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Mark M Hammer
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Cervera Deval J, Barrios Benito M, Peñalver Cuesta JC, Martínez Pérez E, Sandiego Contreras S, Cruz Mojarrieta J, de Aguiar Quevedo K, Arraras Martínez M, Arana E. Cribado de cáncer de pulmón: Supervivencia en un amplio programa de detección precoz en España (I-ELCAP). Arch Bronconeumol 2021; 58:406-411. [DOI: 10.1016/j.arbres.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/07/2021] [Accepted: 10/26/2021] [Indexed: 11/02/2022]
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Hunger T, Wanka-Pail E, Brix G, Griebel J. Lung Cancer Screening with Low-Dose CT in Smokers: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11061040. [PMID: 34198856 PMCID: PMC8228723 DOI: 10.3390/diagnostics11061040] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/21/2021] [Accepted: 06/01/2021] [Indexed: 02/06/2023] Open
Abstract
Lung cancer continues to be one of the main causes of cancer death in Europe. Low-dose computed tomography (LDCT) has shown high potential for screening of lung cancer in smokers, most recently in two European trials. The aim of this review was to assess lung cancer screening of smokers by LDCT with respect to clinical effectiveness, radiological procedures, quality of life, and changes in smoking behavior. We searched electronic databases in April 2020 for publications of randomized controlled trials (RCT) reporting on lung cancer and overall mortality, lung cancer morbidity, and harms of LDCT screening. A meta-analysis was performed to estimate effects on mortality. Forty-three publications on 10 RCTs were included. The meta-analysis of eight studies showed a statistically significant relative reduction of lung cancer mortality of 12% in the screening group (risk ratio = 0.88; 95% CI: 0.79-0.97). Between 4% and 24% of screening-LDCT scans were classified as positive, and 84-96% of them turned out to be false positive. The risk of overdiagnosis was estimated between 19% and 69% of diagnosed lung cancers. Lung cancer screening can reduce disease-specific mortality in (former) smokers when stringent requirements and quality standards for performance are met.
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15
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Li N, Wang L, Hu Y, Han W, Zheng F, Song W, Jiang J. Global evolution of research on pulmonary nodules: a bibliometric analysis. Future Oncol 2021; 17:2631-2645. [PMID: 33880950 DOI: 10.2217/fon-2020-0987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: To provide a historical and global picture of research concerning lung nodules, compare the contributions of major countries and explore research trends over the past 10 years. Methods: A bibliometric analysis of publications from Scopus (1970-2020) and Web of Science (2011-2020). Results: Publications about pulmonary nodules showed an enormous growth trend from 1970 to 2020. There is a high level of collaboration among the 20 most productive countries and regions, with the USA located at the center of the collaboration network. The keywords 'deep learning', 'artificial intelligence' and 'machine learning' are current hotspots. Conclusions: Abundant research has focused on pulmonary nodules. Deep learning is emerging as a promising tool for lung cancer diagnosis and management.
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Affiliation(s)
- Ning Li
- Department of Epidemiology & Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Lei Wang
- Department of Epidemiology & Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Yaoda Hu
- Department of Epidemiology & Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Wei Han
- Department of Epidemiology & Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Fuling Zheng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wei Song
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jingmei Jiang
- Department of Epidemiology & Biostatistics, Institute of Basic Medicine Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
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16
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Hunger T, Nekolla E, Griebel J, Brix G. [Scientific assessment and regulatory approval of radiological screening examinations in Germany]. Radiologe 2021; 61:21-27. [PMID: 33044561 DOI: 10.1007/s00117-020-00758-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Radiologic imaging technologies like computed tomography (CT) have the potential to screen for various diseases. The potential benefits of screening are always associated with risks, particularly from the application of ionizing radiation. MATERIALS AND METHODS The International Basic Safety Standards as well as the Council Directive 2013/59/Euratom have set guidelines for the application of ionizing radiation in early detection which were transposed into the German Radiation Protection Law. Accordingly, the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU) approves screening examinations on a generic level, based on a scientific report provided by the German Federal Office for Radiation Protection (BfS), and defines in a federal statutory ordinance which type of screening is permissible for detecting a disease for a particular group of persons and under which conditions. RESULTS With exception of the mammography screening programme, no radiological examination for the early detection of disease has been approved in Germany to date. However, such screenings are currently being offered in Germany. The BfS is currently conducting a scientific evaluation for lung cancer screening with low-dose CT. CONCLUSIONS Screening examinations with radiological imaging can only be approved when studies with the highest level of evidence have demonstrated that the benefits outweigh the risks. To translate this favourable benefit-risk balance into general health care, strict requirements for the entire screening process including quality assurance must be defined.
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Affiliation(s)
- T Hunger
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland.
| | - E Nekolla
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland
| | - J Griebel
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland
| | - G Brix
- Abteilung Medizinischer und beruflicher Strahlenschutz, Bundesamt für Strahlenschutz, Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland
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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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Perret JL, Miles S, Brims F, Newbigin K, Davidson M, Jersmann H, Edwards A, Zosky G, Frankel A, Johnson AR, Hoy R, Reid DW, Musk AW, Abramson MJ, Edwards B, Cohen R, Yates DH. Respiratory surveillance for coal mine dust and artificial stone exposed workers in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 25:1193-1202. [PMID: 33051927 PMCID: PMC7702073 DOI: 10.1111/resp.13952] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
Coal mine lung dust disease (CMDLD) and artificial stone (AS) silicosis are preventable diseases which have occurred in serious outbreaks in Australia recently. This has prompted a TSANZ review of Australia's approach to respiratory periodic health surveillance. While regulating respirable dust exposure remains the foundation of primary and secondary prevention, identification of workers with early disease assists with control of further exposure, and with the aims of preserving lung function and decreasing respiratory morbidity in those affected. Prompt detection of an abnormality also allows for ongoing respiratory specialist clinical management. This review outlines a medical framework for improvements in respiratory surveillance to detect CMDLD and AS silicosis in Australia. This includes appropriate referral, improved data collection and interpretation, enhanced surveillance, the establishment of a nationwide Occupational Lung Disease Registry and an independent advisory group. These measures are designed to improve health outcomes for workers in the coal mining, AS and other dust-exposed and mining industries.
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Affiliation(s)
- Jennifer L. Perret
- Allergy and Lung Health Unit, Centre for Epidemiology and BiostatisticsThe University of MelbourneMelbourneVICAustralia
| | - Susan Miles
- Department of MedicineCalvary Mater NewcastleNewcastleNSWAustralia
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNSWAustralia
| | - Fraser Brims
- Curtin Medical SchoolCurtin UniversityPerthWAAustralia
- Department of Respiratory MedicineSir Charles Gairdner HospitalPerthWAAustralia
| | | | - Maggie Davidson
- Health and Management School of ScienceWestern Sydney UniversitySydneyNSWAustralia
| | - Hubertus Jersmann
- Department of Thoracic MedicineRoyal Adelaide HospitalAdelaideSAAustralia
| | - Adrienne Edwards
- Christchurch Public HospitalCanterbury District Health BoardChristchurchNew Zealand
| | - Graeme Zosky
- Menzies Institute for Medical Research, College of Health and MedicineUniversity of TasmaniaHobartTASAustralia
- School of Medicine, College of Health and MedicineUniversity of TasmaniaHobartTASAustralia
| | - Anthony Frankel
- Bankstown HospitalSouth Western Sydney Local Heath DistrictSydneyNSWAustralia
- Department of MedicineUniversity of New South WalesSydneyNSWAustralia
| | | | - Ryan Hoy
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - David W. Reid
- QIMR‐Berghofer Institute of Medical ResearchBrisbaneQLDAustralia
| | - A. William Musk
- Department of Respiratory MedicineSir Charles Gairdner HospitalPerthWAAustralia
- School of Population HealthUniversity of Western AustraliaPerthWAAustralia
| | - Michael J. Abramson
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Bob Edwards
- Wesley Dust Disease Research CentreBrisbaneQLDAustralia
| | - Robert Cohen
- School of Public Health, University of IllinoisChicagoILUSA
| | - Deborah H. Yates
- Department of Thoracic MedicineSt Vincent's HospitalSydneyNSWAustralia
- University of NSWSydneyNSWAustralia
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Accuracy of Pulmonary Nodule Volumetry Using Noise-Optimized Virtual Monoenergetic Image and Nonlinear Blending Image Algorithms in Dual-Energy Computed Tomography: A Phantom Study. J Comput Assist Tomogr 2020; 44:847-851. [PMID: 32976271 DOI: 10.1097/rct.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess accuracy of pulmonary nodule volumetry using noise-optimized virtual monoenergetic image (VMI+) and nonlinear blending image (NBI) algorithms in dual-energy computed tomography (DECT). METHODS An anthropomorphic chest phantom with 10 simulated nodules (5 solid nodules and 5 ground-glass opacities) was scanned using DECT80/Sn140kV, DECT100/Sn140kV, and single-energy CT (SECT120kV/200mAs), respectively. The dual-energy images were reconstructed using VMI+ (70 keV) and NBI algorithms. The contrast-to-noise ratio and absolute percentage error (APE) of nodule volume were measured to assess image quality and accuracy of nodule volumetry. The radiation dose was also estimated. RESULTS The contrast-to-noise ratio of SECT120kV/200mAs was significantly higher than that of NBI80/Sn140kV and VMI+80/Sn140kV (both corrected P < 0.05), whereas there were no significant differences between NBI100/sn140kV and SECT120kV/200mAs and between VMI+100/sn140kV and SECT120kV/200mAs (both corrected P > 0.05). The APE of SECT120kV/200mAs was significantly lower than that of NBI80/Sn140kV and VMI+80/Sn140kV in both types of nodules (all corrected P < 0.05), whereas there were no significant differences between VMI+100/sn140kV and SECT120kV/200mAs in solid nodules and between NBI100/Sn140kV and SECT120kV/200mAs in ground-glass opacities (both corrected P > 0.05). The radiation dose of DECT100/Sn140kV and DECT80/Sn140kV were significantly lower than that of SECT120kV/200mAs (both corrected P < 0.05). CONCLUSIONS The DECT100/sn140kV can ensure image quality and nodule volumetry accuracy with lower radiation dose compared with SECT120kV/200mAs. Specifically, the VMI+ algorithm could be used in solid nodules and NBI algorithm in ground-glass opacities.
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20
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Kats DJ, Adie Y, Tlimat A, Greco PJ, Kaelber DC, Tarabichi Y. Assessing Different Approaches to Leveraging Historical Smoking Exposure Data to Better Select Lung Cancer Screening Candidates: A Retrospective Validation Study. Nicotine Tob Res 2020; 23:1334-1340. [PMID: 32974635 DOI: 10.1093/ntr/ntaa192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 09/22/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION There is mounting interest in the use of risk prediction models to guide lung cancer screening. Electronic health records (EHRs) could facilitate such an approach, but smoking exposure documentation is notoriously inaccurate. While the negative impact of inaccurate EHR data on screening practices reliant on dichotomized age and smoking exposure-based criteria has been demonstrated, less is known regarding its impact on the performance of model-based screening. AIMS AND METHODS Data were collected from a cohort of 37 422 ever-smokers between the ages of 55 and 74, seen at an academic safety-net healthcare system between 1999 and 2018. The National Lung Cancer Screening Trial (NLST) criteria, PLCOM2012 and LCRAT lung cancer risk prediction models were validated against time to lung cancer diagnosis. Discrimination (area under the receiver operator curve [AUC]) and calibration were assessed. The effect of substituting the last documented smoking variables with differentially retrieved "history conscious" measures was also determined. RESULTS The PLCOM2012 and LCRAT models had AUCs of 0.71 (95% CI, 0.69 to 0.73) and 0.72 (95% CI, 0.70 to 0.74), respectively. Compared with the NLST criteria, PLCOM2012 had a significantly greater time-dependent sensitivity (69.9% vs. 64.5%, p < .01) and specificity (58.3% vs. 56.4%, p < .001). Unlike the NLST criteria, the performances of the PLCOM2012 and LCRAT models were not prone to historical variability in smoking exposure documentation. CONCLUSIONS Despite the inaccuracies of EHR-documented smoking histories, leveraging model-based lung cancer risk estimation may be a reasonable strategy for screening, and is of greater value compared with using NLST criteria in the same setting. IMPLICATIONS EHRs are potentially well suited to aid in the risk-based selection of lung cancer screening candidates, but healthcare providers and systems may elect not to leverage EHR data due to prior work that has shown limitations in structured smoking exposure data quality. Our findings suggest that despite potential inaccuracies in the underlying EHR data, screening approaches that use multivariable models may perform significantly better than approaches that rely on simpler age and exposure-based criteria. These results should encourage providers to consider using pre-existing smoking exposure data with a model-based approach to guide lung cancer screening practices.
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Affiliation(s)
- Daniel J Kats
- School of Medicine, Case Western Reserve University, Cleveland, OH.,Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH
| | - Yosra Adie
- Center for Reducing Health Disparities, The MetroHealth System, Cleveland, OH
| | - Abdulhakim Tlimat
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH
| | - Peter J Greco
- School of Medicine, Case Western Reserve University, Cleveland, OH.,Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH
| | - David C Kaelber
- School of Medicine, Case Western Reserve University, Cleveland, OH.,Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH
| | - Yasir Tarabichi
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH.,Division of Pulmonary, Critical Care, and Sleep Medicine, The MetroHealth System, Cleveland, OH
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21
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Wang S, Dong K, Chen W. Development of a hemoptysis risk prediction model for patients following CT-guided transthoracic lung biopsy. BMC Pulm Med 2020; 20:247. [PMID: 32938417 PMCID: PMC7496204 DOI: 10.1186/s12890-020-01282-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/07/2020] [Indexed: 12/18/2022] Open
Abstract
Background Computed tomography-guided transthoracic needle biopsy (CT-TNB) is a widely used method for diagnosis of lung diseases; however, CT-TNB-induced bleeding is usually unexpected and this complication can be life-threatening. The aim of this study was to develop and validate a predictive model for hemoptysis following CT-TNB. Methods A total of 436 consecutive patients who underwent CT-TNB from June 2016 to December 2017 at a tertiary hospital in China were divided into derivation (n = 307) and validation (n = 129) cohorts. We used LASSO regression to reduce the data dimension, select variables and determine which predictors were entered into the model. Multivariate logistic regression was used to develop the predictive model. The discrimination capacity of the model was evaluated by the area under the receiver operating characteristic curve (AUROC), the calibration curve was used to test the goodness-of-fit of the model, and decision curve analysis was conducted to assess its clinical utility. Results Five predictive factors (diagnosis of the lesion, lesion characteristics, lesion diameter, procedure time, and puncture distance) selected by LASSO regression analysis were applied to construct the predictive model. The AUC was 0.850 (95% confidence interval [CI], 0.808–0.893) in the derivation, and 0.767 (95% CI, 0.684–0.851) in the validation. The model showed good calibration consistency (p > 0.05). Moreover, decision curve analysis indicated its clinical usefulness. Conclusion We established a predictive model that incorporates lesion features and puncture parameters, which may facilitate the individualized preoperative prediction of hemoptysis following CT-TNB.
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Affiliation(s)
- Saibin Wang
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China.
| | - Ke Dong
- Department of Nuclear Medicine, Jinhua Municipal Central Hospital, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China
| | - Wei Chen
- Department of Radiology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, Zhejiang Province, China.
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22
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Abstract
Lung cancer is the first cause of death from malignant disease. The distressing epidemiological data show the increasing female to male incidence ratio for this tumor. A high incidence of lung cancer in never smokers with importance of environmental agents makes a problem among women. Adenocarcinoma (ADC) is noted in women with increasing rate and ethnic background impacts female lung cancer with differences in the incidence of genetic aberrations. The conception of different hormonal status is taken into consideration as potential explanation of variant cancer biology and clinical manifestation in women and men. The impact of 17-β-estradiol, estrogen receptors, aromatase expression, pituitary sex hormones receptors in carcinogenesis with relation between estrogens and genetic aberrations are investigated. The response to newest therapies among female is also different than in men. This overview summarizes currently available evidence on the specificity of female lung cancer and presents the direction of necessary studies.
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Affiliation(s)
- Joanna Domagala-Kulawik
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - Anna Trojnar
- Department of Internal Medicine, Pulmonary Diseases and Allergy, Medical University of Warsaw, Warsaw, Poland
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23
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Lee J, Kim Y, Suh M, Hong S, Choi KS. Examining the effect of underlying individual preferences for present over future on lung cancer screening participation: a cross-sectional analysis of a Korean National Cancer Screening Survey. BMJ Open 2020; 10:e035495. [PMID: 32709642 PMCID: PMC7380730 DOI: 10.1136/bmjopen-2019-035495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES This study aimed to examine the effect of underlying individual preferences for the present over that for the future on lung cancer screening participation. SETTING We analysed the data from the Korean National Cancer Screening Survey in 2018. PARTICIPANTS 4500 adults aged 20-74 years old participated in the study. DESIGN In this cross-sectional survey, multivariate logistic regression analysis was carried out to examine the association between subjects' intention to participate in lung cancer screening and individual preferences. The underlying individual preferences were measured on the basis of the self-reported general willingness to spend money now in order to save money in the future and general preferences with regard to financial planning. PRIMARY OUTCOME MEASURE Intention to participate in lung cancer screening. RESULTS Individuals eligible for lung cancer screening who place less value on their future were around four times less likely to report an intention to participate in lung cancer screening than were those who valued their future (OR 3.86, 95% CI 1.89 to 7.90). A present-biassed individual (one with a tendency for immediate gratification) was also about four times less likely to report an intention to participate in screening than an individual with no present bias (OR 0.26, 95% CI 0.12 to 0.57). CONCLUSIONS Underlying individual preferences regarding the present and future significantly affect individuals' intention to participate in lung cancer screening. Hence, provision of incentives may be necessary to encourage the targeted heavy smokers who may have a strong preferences for the present over future.
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Affiliation(s)
- Jaeho Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea (the Republic of)
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea (the Republic of)
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea (the Republic of)
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea (the Republic of)
| | - Seri Hong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea (the Republic of)
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea (the Republic of)
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea (the Republic of)
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Zhang H, Guang Y, He W, Cheng L, Yu T, Tang Y, Song H, Liu X, Zhang Y. Ultrasound-guided percutaneous needle biopsy skill for peripheral lung lesions and complications prevention. J Thorac Dis 2020; 12:3697-3705. [PMID: 32802449 PMCID: PMC7399405 DOI: 10.21037/jtd-2019-abc-03] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background To investigate puncture skills and complications prevention in ultrasound-guided percutaneous needle biopsy for peripheral lung lesions. Methods Ninety-two peripheral lung lesions in 92 patients, detected via computed tomography (CT) and also visible on ultrasound, were retrospectively analyzed. All patients underwent percutaneous peripheral lung lesion needle biopsy under traditional ultrasound or contrast enhanced ultrasound (CEUS) guidance paying attention to avoiding necrotic areas and large blood vessels. All the specimens were examined histopathologically. Preprocedure all 92 lesions were performed by traditional ultrasonography to evaluate the size, the echogenecity, liquefaction areas and blood flow on color Doppler imaging, some of which were performed by CEUS for evaluating non-enhanced necrosis areas, contrast agent arrival time (AT) and characteristics of blood perfusion. Results The histopathologic results of all 92 lesions were as follows: 67 malignant tumors (including 28 adenocarcinomas, 19 squamous cell carcinomas, 6 bronchoalveolar carcinomas, 5 small cell carcinomas, 5 metastatic cancers, 3 poorly differentiated cancers and 1 malignant mesothelioma), 20 benign lesions (including 9 pneumonia, 6 inflammatory pseudotumors and 5 tuberculomas), 5 undetermined lesions. Of 52 lesions by CEUS guidance, 7 lesions showed enhancement in the pulmonary arterial-phase (including 6 pneumonia and 1 malignant tumors), 45 lesions showed enhancement in the bronchial artery phase (including 37 malignant tumors, 3 inflammatory pseudotumors, 4 tuberculomas and 1 undetermined lesion). According to needle insertion angle along linear path, a total of 92 lesions were divided into two groups, 49 lesions at an angle of 70°-80° needle insertion and 43 lesions at an angle of 80°-90° needle insertion. In the study, linear and non-linear two puncture paths were used, we first tried to puncture along linear path in all lesions, if an attempt to insert into the lesions failed due to be blocked by the ribs and then changed to puncture along non-linear path instead. The success rate of biopsy procedure along linear puncture was significantly higher at an angle of 80°-90°group (93.0% vs. 20.4%, P<0.01), and the adoption rate of non-linear path biopsy for solving the puncture needle blocked by the ribs was significantly higher at angle of 70°-80°group (79.6% vs. 7.0%, P<0.01). Of 52 lesions by CEUS guidance, 27 (51.9%) showed non enhanced necrosis areas on CEUS, only 5 showed liquefaction necrosis areas on gray-scale ultrasound. Of 40 lesions by traditional ultrasound guidance, 4 showed necrosis areas on gray-scale ultrasound. There were no significant differences in lesion size, the average number of biopsy attempts and complication rates between CEUS guidance group and traditional ultrasound guidance group (P>0.05), the pathological confirmation rate in CEUS guidance group was higher than that in traditional ultrasound guidance group, but without significant difference (98.1% vs. 90.0%, P>0.05). Of all 92 cases, 3 cases (3.3%) had mild pneumothorax and 4 cases (4.3%) had hemoptysis. Conclusions In ultrasound-guided needle biopsy for peripheral lung lesions, using a combination of linear and non-linear puncture techniques and keeping away from necrotic areas and large blood vessels, may help to increase the success rate and reduce the incidence of complications further.
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Affiliation(s)
- Hongxia Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Guang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggang Cheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tengfei Yu
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Tang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haiman Song
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Liu
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yukang Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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25
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Conquering lung cancer: current status and prospects for the future. Pulmonology 2020; 26:283-290. [PMID: 32199906 DOI: 10.1016/j.pulmoe.2020.02.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 12/14/2022] Open
Abstract
Lung cancer is a major global health problem. Several strategies are required to conquer this cancer. Stricter implementations of tobacco control measures are necessary. Early detection programs should be implemented to decrease lung cancer mortality. Although chemotherapy remains a cornerstone of treatment, targeted therapies and immune checkpoint inhibitors improved treatment of metastatic cancers and are hoped to improve outcome of adjuvant and induction therapies. Novel immunotherapy approaches hold great promise. Better understanding of the molecular biology of lung cancer should lead to rational drug design.
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26
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Afthinos A, Antonakis E, Horti M, Markatis E, Pagratis K, Papanikolaou IC. An unusual disease with an interesting sign. Breathe (Sheff) 2020; 16:190302. [PMID: 32194763 PMCID: PMC7078733 DOI: 10.1183/20734735.0302-2019] [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] [Indexed: 11/05/2022] Open
Abstract
Acute interstitial pneumonias mimic infectious pneumonias. Radiology signs point to, but usually don't establish, diagnosis. http://bit.ly/3b3P1iK.
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Affiliation(s)
| | | | - Maria Horti
- Pathology Dept, Sismanoglio General Hospital, Athens,Greece
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27
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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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28
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Frille A, Hardavella G, Lee R. Lung cancer incidence and mortality with extended follow-up in the National LungScreening Trial. Breathe (Sheff) 2020; 16:190322. [PMID: 32194768 PMCID: PMC7078741 DOI: 10.1183/20734735.0322-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The extended follow-up of the NLST represents a timely and important update to the NLST data, alongside full results of the NELSON and the LUSI trials, as Europe begins to set out a vision for lung cancer screening. http://bit.ly/2MYXedI.
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Affiliation(s)
- Armin Frille
- Dept of Respiratory Medicine, University of Leipzig, Leipzig, Germany
- Integrated Research and Treatment Center (IFB) Adiposity Diseases, University Medical Center Leipzig, Leipzig, Germany
| | - Georgia Hardavella
- 10th Dept of Respiratory Medicine, Athens Chest Diseases Hospital, Athens, Greece
| | - Richard Lee
- Royal Marsden Hospital and Institute for Cancer Research NIHR Biomedical Research Centre, London, UK
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29
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Nardi Agmon I, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Respir J 2020; 55:13993003.00506-2019. [PMID: 32051182 DOI: 10.1183/13993003.00506-2019] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Dept of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, CH Lyon Sud, Pierre Bénite, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Dept of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Dept of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Dept of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Dept of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital Sotiria, Athens, Greece
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30
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Agmon IN, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Radiol 2020; 30:3277-3294. [PMID: 32052170 DOI: 10.1007/s00330-020-06727-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany.
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Department of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, Sud, Pierre Bénite, Lyon, CH, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Department of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Department of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
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Outcomes and cost of lung cancer patients treated surgically or medically in Catalunya: cost-benefit implications for lung cancer screening programs. Eur J Cancer Prev 2020; 29:486-492. [PMID: 32039928 DOI: 10.1097/cej.0000000000000566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer screening programs with computed tomography of the chest reduce mortality by more than 20%. Yet, they have not been implemented widely because of logistic and cost implications. Here, we sought to: (1) use real-life data to compare the outcomes and cost of lung cancer patients with treated medically or surgically in our region and (2) from this data, estimate the cost-benefit ratio of a lung cancer screening program (CRIBAR) soon to be deployed in our region (Catalunya, Spain). We accessed the Catalan Health Surveillance System (CHSS) and analysed data of all patients with a first diagnosis of lung cancer between 1 January 2014 and 31 December 2016. Analysis was carried forward until 30 months (t = 30) after lung cancer diagnosis. Main results showed that: (1) surgically treated lung cancer patients have better survival and return earlier to regular home activities, use less healthcare related resources and cost less tax-payer money and (2) depending on incidence of lung cancer identified and treated in the program (1-2%), the return on investment for CRIBAR is expected to break even at 3-6 years, respectively, after its launch. Surgical treatment of lung cancer is cheaper and offers better outcomes. CRIBAR is estimated to be cost-effective soon after launch.
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32
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Jensen MD, Siersma V, Rasmussen JF, Brodersen J. Direct and indirect healthcare costs of lung cancer CT screening in Denmark: a registry study. BMJ Open 2020; 10:e031768. [PMID: 31969362 PMCID: PMC7045232 DOI: 10.1136/bmjopen-2019-031768] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION A study based on the Danish Randomised Controlled Lung Cancer Screening Trial (DLCST) calculated the healthcare costs of lung cancer screening by comparing costs in an intervention group with a control group. Participants in both groups, however, experienced significantly increased negative psychosocial consequences after randomisation. Substantial participation bias has also been documented: The DLCST participants reported fewer negative psychosocial aspects and experienced better living conditions compared with the random sample. OBJECTIVE To comprehensively analyse the costs of lung cancer CT screening and to determine whether invitations to mass screening alter the utilisation of the healthcare system resulting in indirect costs. Healthcare utilisation and costs are analysed in the primary care sector (general practitioner psychologists, physiotherapists, other specialists, drugs) and the secondary care sector (emergency room contacts, outpatient visits, hospitalisation days, surgical procedures and non-surgical procedures). DESIGN To account for bias in the original trial, the costs and utilisation of healthcare by participants in DLCST were compared with a new reference group, selected in the period from randomisation (2004-2006) until 2014. SETTING Four Danish national registers. PARTICIPANTS DLCST included 4104 current or former heavy smokers, randomly assigned to the CT group or the control group. The new reference group comprised a random sample of 535 current or former heavy smokers in the general Danish population who were never invited to participate in a cancer screening test. MAIN OUTCOME MEASURES Total healthcare costs including costs and utilisation of healthcare in both the primary and the secondary care sector. RESULTS Compared with the reference group, the participants in both the CT group (offered annual CT screening, lung function test and smoking counselling) and the control group (offered annual lung function test and smoking counselling) had significantly increased total healthcare costs, calculated at 60% and 48% respectively. The increase in costs was caused by increased use of healthcare in both the primary and the secondary sectors. CONCLUSION CT screening leads to 60% increased total healthcare costs. Such increase would raise the expected annual healthcare cost per participant from EUR 2348 to EUR 3756. Cost analysis that only includes costs directly related to the CT scan and follow-up procedures most likely underestimates total costs. Our data show that the increased costs are not limited to the secondary sector. TRIAL REGISTRATION NUMBER NCT00496977.
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Affiliation(s)
- Manja Dahl Jensen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Fraes Rasmussen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Primary Healthcare Research Unit, Zealand Region, Copenhagen, Denmark
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33
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Haase R, Dodd JD, Kauczor HU, Kazerooni EA, Dewey M. Developing a lung nodule management protocol specifically for cardiac CT: Methodology in the DISCHARGE trial. Eur J Radiol Open 2020; 7:100235. [PMID: 32637465 PMCID: PMC7327416 DOI: 10.1016/j.ejro.2020.100235] [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: 03/20/2020] [Accepted: 04/26/2020] [Indexed: 12/03/2022] Open
Abstract
No lung nodule management algorithm exists specifically for cardiac CT. The DISCHARGE trial is a pragmatic prospective randomized trial currently being undertaken across 16 countries in Europe for patients with stable chest pain. As part of the trial a lung nodule algorithm is being evaluated based on modified lung-RADS nodule management algorithms. The methodology of this ‘Lung-RADS for cardiac CT’ algorithm is presented.
Purpose In this methodology paper we describe the development of a lung nodule management algorithm specifically for patients undergoing cardiac CT. Methods We modified the Lung-RADS algorithm specifically to manage lung nodules incidentally detected on cardiac CT (Lung-RADS for cardiac CT). We will evaluate the modified algorithm as part of the DISCHARGE trial (www.dischargetrial.eu) in which patients with suspected coronary artery disease are randomly assigned to cardiac CT or invasive coronary angiography across Europe at 16 sites involving 3546 patients. Patients will be followed for up to four years. Results The major adjustments to Lung-RADS specifically for cardiac CT relate to 1) incomplete coverage of the lungs by cardiac CT compared with chest CT, and when to order a completion chest CT versus a follow up chest CT, 2) cardiac CT findings will not trigger annual lung-cancer screening, and 3) a lower threshold of at least 10 mm for classifying new ground glass nodules as probably benign (category 3). Conclusions The DISCHARGE trial will assess a lung nodule management algorithm designed specifically for cardiac CT in patients with stable chest pain across Europe.
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Affiliation(s)
- Robert Haase
- Department of Radiology, Charité University Hospital, Chariteplatz 1, 10117, Berlin, Germany
| | - Jonathan D. Dodd
- Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
- Corresponding author at: Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin, Ireland.
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Ella A. Kazerooni
- Michigan Medicine - University of Michigan Medical School, Departments of Radiology & Internal Medicine, 1500 E. Medical Center Dr, RM 5482 Ann Arbor, MI, 48109, United States
| | - Marc Dewey
- Department of Radiology, Charité University Hospital, Chariteplatz 1, 10117, Berlin, Germany
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Whyte RI. Commentary: On-demand computed tomography screening for lung cancer-some surprising results. J Thorac Cardiovasc Surg 2019; 160:832-833. [PMID: 31926713 DOI: 10.1016/j.jtcvs.2019.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Richard I Whyte
- Harvard Medical School and Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Mass.
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35
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Kanellakis NI, Lamote K. Management of incidental nodules in lung cancer screening: ready for prime-time? Breathe (Sheff) 2019; 15:346-349. [PMID: 31803272 PMCID: PMC6885334 DOI: 10.1183/20734735.0247-2019] [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] [Indexed: 11/05/2022] Open
Abstract
Current clinical management of lung nodule patients is inefficient and therefore causes patient misclassification, which increases healthcare expenses. A precise and robust lung nodule classifier could minimise healthcare costs and discomfort for patients. http://bit.ly/2oMIEwQ.
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Affiliation(s)
- Nikolaos I Kanellakis
- Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Laboratory of Pleural and Lung Cancer Translational Research, Nuffield Dept of Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Kevin Lamote
- Laboratory Experimental Medicine and Pediatrics, Dept of Translational Research in Immunology and Inflammation, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Dept of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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36
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Effect of 5-Line Signs in the Prediction of Staging, Progression, and Prognosis of Peripheral Lung Carcinoma: Preliminary Observation Report. J Comput Assist Tomogr 2019; 44:295-304. [PMID: 31789681 DOI: 10.1097/rct.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The single line of the normal interlobar fissure shown on a thin section image can be reconstructed as a 5-line sign on axial maximal intensity projection. The line between the lung nodule and the pleura is called the pleural tail sign on thin image. On the axial maximal intensity projection, it can also be reconstructed as the 5-line sign or fewer than 5 lines. OBJECTIVE This study aimed to observe the effect of 5-line signs in staging, progression, and prognosis of peripheral lung carcinoma. MATERIALS AND METHODS This study included 132 patients with peripheral lung carcinoma. Among these patients, 93 were men and 39 were women, with an age range of 27 to 82 years and a lung nodule range of 0.98 to 8.75 cm. Maximal intensity projection was reconstructed based on 1.0 or 1.25 mm of thin-slice images in multislice spiral computed tomography. Five-line signs on the margin of the nodule (mass) were observed and were classified into grades 1 to 4 according to the sharpness of the 5-line signs. RESULTS Multivariate logistic regression analysis showed that the sharpness of the 5-line signs was correlated with N and TNM staging of peripheral lung carcinoma (P = 0.012, P = 0.016). The lower the sharpness of the 5-line signs, the greater the number of cases of progression of the tumor (P < 0.001), and thus the higher the mortality rate and the lower the survival rate (P = 0.001). The sensitivity and specificity of predicting tumor progression were 56.3% and 93.3%, and those of tumor prognosis were 61.1% and 82.4%, respectively. CONCLUSIONS The sharpness of the 5-line signs has certain effects on the prediction of invasion, progression, and prognosis of lung carcinoma, particularly of small lung cancer (≤3.0 cm).
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Martini K, Ottilinger T, Serrallach B, Markart S, Glaser-Gallion N, Blüthgen C, Leschka S, Bauer RW, Wildermuth S, Messerli M. Lung cancer screening with submillisievert chest CT: Potential pitfalls of pulmonary findings in different readers with various experience levels. Eur J Radiol 2019; 121:108720. [DOI: 10.1016/j.ejrad.2019.108720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 10/03/2019] [Accepted: 10/21/2019] [Indexed: 12/17/2022]
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Heidinger BH, Silva M, de Margerie-Mellon C, VanderLaan PA, Bankier AA. The natural course of incidentally detected, small, subsolid lung nodules-is follow-up needed beyond current guideline recommendations? Transl Lung Cancer Res 2019; 8:S412-S417. [PMID: 32038927 DOI: 10.21037/tlcr.2019.11.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Benedikt H Heidinger
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Mario Silva
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy.,Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Paul A VanderLaan
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alexander A Bankier
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Spiro SG, Shah PL, Rintoul RC, George J, Janes S, Callister M, Novelli M, Shaw P, Kocjan G, Griffiths C, Falzon M, Booton R, Magee N, Peake M, Dhillon P, Sridharan K, Nicholson AG, Padley S, Taylor MN, Ahmed A, Allen J, Ngai Y, Chinyanganya N, Ashford-Turner V, Lewis S, Oukrif D, Rabbitts P, Counsell N, Hackshaw A. Sequential screening for lung cancer in a high-risk group: randomised controlled trial: LungSEARCH: a randomised controlled trial of Surveillance using sputum and imaging for the EARly detection of lung Cancer in a High-risk group. Eur Respir J 2019; 54:13993003.00581-2019. [PMID: 31537697 PMCID: PMC6796151 DOI: 10.1183/13993003.00581-2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Low-dose computed tomography (LDCT) screening detects early-stage lung cancer and reduces mortality. We proposed a sequential approach targeted to a high-risk group as a potentially efficient screening strategy. METHODS LungSEARCH was a national multicentre randomised trial. Current/ex-smokers with mild/moderate chronic obstructive pulmonary disease (COPD) were allocated (1:1) to have 5 years surveillance or not. Screened participants provided annual sputum samples for cytology and cytometry, and if abnormal were offered annual LDCT and autofluorescence bronchoscopy (AFB). Those with normal sputum provided annual samples. The primary end-point was the percentage of lung cancers diagnosed at stage I/II (nonsmall cell) or limited disease (small cell). RESULTS 1568 participants were randomised during 2007-2011 from 10 UK centres. 85.2% of those screened provided an adequate baseline sputum sample. There were 42 lung cancers among 785 screened individuals and 36 lung cancers among 783 controls. 54.8% (23 out of 42) of screened individuals versus 45.2% (14 out of 31) of controls with known staging were diagnosed with early-stage disease (one-sided p=0.24). Relative risk was 1.21 (95% CI 0.75-1.95) or 0.82 (95% CI 0.52-1.31) for early-stage or advanced cancers, respectively. Overall sensitivity for sputum (in those randomised to surveillance) was low (40.5%) with a cumulative false-positive rate (FPR) of 32.8%. 55% of cancers had normal sputum results throughout. Among sputum-positive individuals who had AFB, sensitivity was 45.5% and cumulative FPR was 39.5%; the corresponding measures for those who had LDCT were 100% and 16.1%, respectively. CONCLUSIONS Our sequential strategy, using sputum cytology/cytometry to select high-risk individuals for AFB and LDCT, did not lead to a clear stage shift and did not improve the efficiency of lung cancer screening.
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Affiliation(s)
- Stephen G Spiro
- Dept of Respiratory Medicine, University College Hospital, London, UK.,These authors are joint lead authors
| | - Pallav L Shah
- Dept of Respiratory Medicine, Royal Brompton Hospital, Chelsea and Westminster Hospital and Imperial College London, London, UK
| | - Robert C Rintoul
- Dept of Oncology, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | - Jeremy George
- UCL Respiratory, Dept of Medicine, University College London, London, UK
| | - Samuel Janes
- UCL Respiratory, Dept of Medicine, University College London, London, UK
| | - Matthew Callister
- Dept of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marco Novelli
- Cellular Pathology, University College Hospital, London, UK
| | - Penny Shaw
- Radiology (Imaging), University College Hospital, London, UK
| | | | - Chris Griffiths
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mary Falzon
- Cellular Pathology, University College Hospital, London, UK
| | - Richard Booton
- Lung Cancer and Thoracic Surgery Directorate, Manchester University NHS Trust and University of Manchester, Manchester, UK
| | - Nicholas Magee
- Respiratory Medicine, Belfast City Hospital, Belfast, UK
| | - Michael Peake
- Dept of Immunity, Infection and Inflammation, University of Leicester, Leicester, UK.,Centre for Cancer Outcomes, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul Dhillon
- Respiratory Medicine, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Kishore Sridharan
- Dept of Thoracic Medicine, Sunderland Royal Hospital, Sunderland, UK
| | - Andrew G Nicholson
- Dept of Histopathology, Royal Brompton Hospital and Harefield NHS Foundation Trust and National Heart and Lung Institute, London, UK
| | - Simon Padley
- Radiology, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Magali N Taylor
- Radiology (Imaging), University College Hospital, London, UK
| | - Asia Ahmed
- Radiology (Imaging), University College Hospital, London, UK
| | - Jack Allen
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Yenting Ngai
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | | | | | - Sarah Lewis
- Research and Development, Royal Papworth Hospital, Cambridge, UK
| | - Dahmane Oukrif
- Dept of Pathology, University College Hospital, London, UK
| | - Pamela Rabbitts
- Leeds Institute of Cancer and Pathology (LICAP), University of Leeds, Leeds, UK
| | | | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, London, UK.,These authors are joint lead authors
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Pistelli F, Aquilini F, Falaschi F, Puliti D, Ocello C, Lopes Pegna A, Carozzi FM, Picozzi G, Zappa M, Mascalchi M, Paci E, Carrozzi L, Gorini G, Manneschi G, Visioli C, Cordopatri G, Giusti F, Esposito I, Bianchi R, Ronchi C, Cini S, De Santis M, Baliva F, Chella A, Tavanti L, Grazzini M, Innocenti F, Natali I, Bartolucci M, Crisci E, De Francisci A, Falchini M, Gabbrielli S, Roselli G, Masi A, Battolla L, De Liperi A, Spinelli C, Vannucchi L, Petruzzelli A, Gadda D, Neri AT, Niccolai F, Vaggelli L, Vella A, Maddau C, Bisanzi S, Janni A, Mussi A, Lucchi M, Comin C, Fontanini G, Tognetti AR, Iacuzio L, Caldarella A, Barchielli A, Goldoni CA. Smoking Cessation in the ITALUNG Lung Cancer Screening: What Does “Teachable Moment” Mean? Nicotine Tob Res 2019; 22:1484-1491. [DOI: 10.1093/ntr/ntz148] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/15/2019] [Indexed: 12/17/2022]
Abstract
Abstract
Background
Changes in smoking habits and predictors of smoking cessation were examined in the randomized ITALUNG lung cancer screening trial.
Methods
In three centers, eligible smokers or ex-smokers (55–69 years, ≥20 pack-years in the last 10 years) were randomized to receive annual invitation for low-dose computed tomography for 4 years or usual care. At invitation, subjects received written information for a free smoking cessation program. Quitting outcome was assessed at year 4.
Results
Among participants who completed baseline assessments and year 4 screening, higher quitting (20.8% vs. 16.7%, p = .029) and lower relapse (6.41% vs. 7.56%, p = .50) rates were observed in the active screening group as compared to the usual-care control group. Corresponding figures in the intention-to-treat analysis were as follows: 16.04% versus 14.64% (p = .059) and 4.88% versus 6.43% (p = .26). Quitting smoking was significantly associated to male gender, lower pack-years, and having pulmonary nodules at baseline. Center-specific analyses showed a threefold statistically significant higher probability to quit associated with participating in the smoking cessation program. A subsample of smokers of the scan group from one center showed higher quitting rates over 12-month follow-up as compared to matched controls from the general population who underwent the same smoking cessation program.
Conclusions
Consistently with previous reports, in the ITALUNG trial, screened subjects showed significantly higher quit rates than controls, and higher quit rates were associated with both the presence of pulmonary nodules and participating in a smoking cessation program. Maximal effect on quitting outcome was observed with the participation in the smoking cessation program.
Implications
Participating in lung cancer screening promotes smoking cessation. An effective “teachable moment” may be achieved when the smoking cessation intervention is structured as integral part of the screening clinical visits and conducted by a dedicated team of health care professionals. Standardized guidelines for smoking cessation interventions in lung cancer screening are needed.
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Affiliation(s)
- Francesco Pistelli
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Ferruccio Aquilini
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - Fabio Falaschi
- 2nd Radiodiagnostic Unit, Department of Diagnostic Imaging, University Hospital of Pisa, Pisa, Italy
| | - Donella Puliti
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Cristina Ocello
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Andrea Lopes Pegna
- Formerly Pneumonology Department, University Hospital Careggi, Florence, Italy
| | - Francesca Maria Carozzi
- Cancer Prevention Regional Laboratory, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Giulia Picozzi
- Clinical Breast Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy, Florence, Italy
| | - Marco Zappa
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Mario Mascalchi
- Formerly Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Eugenio Paci
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Laura Carrozzi
- Pulmonary Unit, Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
- Department of Surgical, Medical, and Molecular Pathology and Critical Care Medicine, University of Pisa
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[Lung cancer screening]. Radiologe 2019; 59:19-22. [PMID: 30542924 DOI: 10.1007/s00117-018-0478-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CLINICAL/METHODICAL ISSUE The National Lung Screening Trial (NLST) in 2011 was able to prove for the first time that screening with a low-dose CT can reduce lung carcinoma mortality by 20%. Despite the positive outcome of the NLST, there is-unlike in the USA-currently no systematic lung cancer screening in Europe. This is partly because several significantly smaller screening studies in Europe failed to show any improvement in lung cancer mortality. STANDARD RADIOLOGICAL METHODS On the other hand, Europe's healthcare systems differ substantially from those in the United States, so that a direct transfer of US experience to Europe is not possible. For this reason, guidelines for lung cancer screening must be developed in the individual European countries to ensure that lung cancer mortality can be reduced by means of a quality-assured and cost-effective lung cancer screening. PRACTICAL RECOMMENDATIONS The experience and the expected results of the European screening studies can provide valuable help for these purposes.
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Tolwin Y, Gillis R, Agmon IN, Shrem NS, Rosenbaum E, Peled N. Increased Incidence of Lung Cancer Among Patients With Superficial Transitional Cell Carcinoma: A Potential Risk Cohort for Lung Cancer Screening. Clin Lung Cancer 2019; 20:429-434. [PMID: 31303453 DOI: 10.1016/j.cllc.2019.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/27/2019] [Accepted: 06/07/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Smoking is a major risk factor for lung cancer (LC) and transitional cell carcinoma of the bladder (TCC). Current recommendations for LC screening do not include TCC as a risk factor for determining screening eligibility. In this study we aimed to evaluate whether TCC patients constitute a population who might benefit from LC screening. PATIENTS AND METHODS The Surveillance, Epidemiology, and End Results 18 database was used to determine the incidence, standardized incidence ratio (SIR), and the average time to diagnosis of LC in patients with localized TCC of the bladder (American Joint Committee on Cancer, sixth edition, stages 0-1). RESULTS On the basis of 91,606 patients with localized TCC, The SIR for LC in men was 1.89 (95% confidence interval [CI], 1.8-1.97), significantly different from the risk for all solid tumors. The SIR for LC in women was 2.43 (95% CI, 2.22-2.65), significantly higher than for men. The 5-year incidence of LC was 3.2%, and the 10-year incidence was 5.94%. The average time to diagnosis of LC was 3.4 years, with >80% of LC cases occurring within 5 years of TCC diagnosis. CONCLUSION Patients with localized TCC have a higher incidence of LC than the general population. The risk is significantly increased among women compared with men. Considering this increased risk, patients with early stage TCC might stand to benefit from LC screening. Additional differences were noted between male and female TCC patients, which bear further study.
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Affiliation(s)
| | - Roni Gillis
- The Legacy Heritage Center and Dr Larry Norton Institute, Soroka Medical Center, Beer Sheva, Israel; Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Inbar Nardi Agmon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Davidoff Cancer Center, Rabin Medical Center, Petach Tiqwa, Israel
| | - Noa Shani Shrem
- The Legacy Heritage Center and Dr Larry Norton Institute, Soroka Medical Center, Beer Sheva, Israel; Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Eli Rosenbaum
- Davidoff Cancer Center, Rabin Medical Center, Petach Tiqwa, Israel
| | - Nir Peled
- The Legacy Heritage Center and Dr Larry Norton Institute, Soroka Medical Center, Beer Sheva, Israel; Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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43
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Inter-observer agreement on the morphology of screening-detected lung cancer: beyond pulmonary nodules and masses. Eur Radiol 2019; 29:3862-3870. [DOI: 10.1007/s00330-019-06243-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/28/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
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44
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Screening for Early Lung Cancer, Chronic Obstructive Pulmonary Disease, and Cardiovascular Disease (the Big-3) Using Low-dose Chest Computed Tomography. J Thorac Imaging 2019; 34:160-169. [DOI: 10.1097/rti.0000000000000379] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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45
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Milanese G, Silva M, Frauenfelder T, Eberhard M, Sabia F, Martini C, Marchianò A, Prokop M, Sverzellati N, Pastorino U. Comparison of ultra-low dose chest CT scanning protocols for the detection of pulmonary nodules: a phantom study. TUMORI JOURNAL 2019; 105:394-403. [PMID: 31041885 DOI: 10.1177/0300891619847271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To test ultra-low-dose computed tomography (ULDCT) scanning protocols for the detection of pulmonary nodules (PN). METHODS A chest phantom containing 19 solid and 11 subsolid PNs was scanned on a third-generation dual-source computed tomography (CT) scanner. Five ULDCT scans (Sn100kVp and 120, 70, 50, 30, and 20 reference mAs, using tube current modulation), reconstructed with iterative reconstruction (IR) algorithm at strength levels 2, 3, 4, and 5, were compared with standard CT (120kVp, 150 reference mAs, using tube current modulation). PNs were subjectively assessed according to a 4-point scale: 0, nondetectable nodule; 1, detectable nodule, very unlikely to be correctly measured; 2, detectable nodule, likely to be correctly measured; 3, PN quality equal to standard of reference. PN scores were analysed according to the Lung Imaging Reporting and Data System (Lung-RADS), simulating detection of nodules at baseline and incidence screening round. RESULTS For the baseline round, there were 17 Lung-RADS 2, 4 Lung-RADS 3, 8 Lung-RADS 4A, and 1 Lung-RADS 4B PNs. They were detectable in any ULDCT protocol, with the exception of 1 nondetectable part-solid nodule in 1 scanning protocol (120 reference mAs; IR strength: 3). For the incidence round, there were 4 Lung-RADS 2, 14 Lung-RADS 3, 2 Lung-RADS 4A, and 10 Lung-RADS 4B PNs. Ten were nondetectable in at least one ULDCT dataset; however, they were at least detectable in ULDCT with 70 reference mAs (IR strength: 4 and 5). CONCLUSIONS ULDCT scanning protocols allowing the detection of PNs can be proposed for the purpose of lung cancer screening.
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Affiliation(s)
- Gianluca Milanese
- Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mario Silva
- Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy.,Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Thomas Frauenfelder
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Eberhard
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Federica Sabia
- Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alfonso Marchianò
- Department of Radiology, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mathias Prokop
- Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicola Sverzellati
- Division of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
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Martínez Pérez E, de Aguiar Quevedo K, Arrarás Martínez M, Cruz Mojarrieta J, Arana Fernández de Moya E, Barrios Benito M, Hinarejos Parga S, Cervera Deval J, Peñalver Cuesta JC. Lung Cancer Screening: Use of Low-Dose Computed Tomography. Arch Bronconeumol 2019; 55:526-531. [PMID: 31036378 DOI: 10.1016/j.arbres.2019.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The prognosis of lung cancer (LC) correlates directly with the stage of the disease at the time of diagnosis. MATERIAL AND METHODS We performed low-dose CT (LDCT) in asymptomatic individuals ≥50years old, smokers or former smokers of ≥10 pack-years, with no history of cancer. We followed an evaluation algorithm, according to the size and morphology of the nodules. The appropriate treatment for the LC diagnosis was given and patients were followed up for 5years. RESULTS We studied 4,951 individuals (65.4% males) with an average age of 56.89±5.26years; 550 presented nodules. Of the 3,891 nodules detected, 692 (19.57%) were considered positive, and 38 tumors (36LC) were identified. In the annual follow-up, nodules were found in 224 subjects, 288 (7.91%) of which were positive (13LC). In 80%, the study was performed with LDCT, and biopsy was indicated in 5.8% (baseline) and in 7.6% (annual) of the positive nodules. Prevalence was 0.89 and incidence was 0.1%. The sensitivity, specificity, PPV and NPV in the baseline study were 92.31, 89.54, 6.55 and 99.93%, respectively, and in the annual study, they were 76.92, 95.7, 4.52 and 99.94%, respectively. A total of 52 tumors were detected (49LC), 25 (52.08%) in stageI. The 5-year overall survival rate for LC was 58.5% and cancer-specific survival was 67.1% (75.8% in surgical patients). CONCLUSION LDCT integrated into an elaborate nodule detection and evaluation program is a useful tool for diagnosing early-stage LC.
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Affiliation(s)
- Encarnación Martínez Pérez
- Unidad de Neumología, Servicio de Cirugía Torácica, Fundación Instituto Valenciano de Oncología, Valencia, España.
| | | | | | - Julia Cruz Mojarrieta
- Servicio de Anatomía Patológica, Fundación Instituto Valenciano de Oncología, Valencia, España
| | | | - María Barrios Benito
- Servicio de Radiodiagnóstico, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - Susana Hinarejos Parga
- Unidad de Diagnóstico Precoz de Cáncer de Pulmón, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - José Cervera Deval
- Servicio de Radiodiagnóstico, Fundación Instituto Valenciano de Oncología, Valencia, España
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Wang S, Tu J, Dong K. Nomogram to predict postoperative PR in patients undergoing CT-guided transthoracic lung biopsy. J Thorac Dis 2019; 11:1705-1713. [PMID: 31179117 DOI: 10.21037/jtd.2019.01.60] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Pleural reaction (PR) frequently occurs following computed tomography-guided transthoracic needle biopsy (CT-TNB). The purpose of this study was to establish a predictive model for PR following CT-TNB. Methods In this study, a total of 436 patients who underwent CT-TNB between June 2016 and December 2017 at a tertiary hospital were consecutively included. Patient demographics, lesion features, laboratory tests, and biopsy parameters were collected. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were performed to establish a prediction model for post-CT-TNB PR, presented by a nomogram. Discrimination and calibration were assessed. For internal validation, a bootstrap resampling method was applied, and decision curve analysis (DCA) was used to evaluate its clinical utility. Results PR occurred in 7.8% (34/436) of patients. Four non-zero coefficient variables (gender, age, lesion location, and puncture position) were filtered by LASSO regression analysis and were used to establish a predictive model. The area under the curve in the derivation and validation was 0.840 (95% CI, 0.767-0.913) and 0.841 (95% CI, 0.769-0.912), respectively. The model was well-calibrated (P>0.05), and DCA indicated clinical efficacy. Conclusions In this study, we established a nomogram, including as parameters gender, age, lesion location, and puncture position, which may have great significance for individualized prediction of post-CT-TNB PR.
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Affiliation(s)
- Saibin Wang
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Junwei Tu
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Ke Dong
- Department of Nuclear Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
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48
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Papapietro VR, Milanese G, Borghesi A, Sverzellati N, Silva M. Look around your target: a new approach to early diagnosis of lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 6:S77. [PMID: 30613652 DOI: 10.21037/atm.2018.10.56] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Vito R Papapietro
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gianluca Milanese
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Borghesi
- Department of Radiology, University and Spedali Civili of Brescia, Brescia, Italy
| | - Nicola Sverzellati
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Parma, Italy
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49
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Broekhuizen H, Groothuis-Oudshoorn CGM, Vliegenthart R, Groen HJM, IJzerman MJ. Assessing Lung Cancer Screening Programs under Uncertainty in a Heterogeneous Population. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1269-1277. [PMID: 30442273 DOI: 10.1016/j.jval.2018.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 12/22/2017] [Accepted: 01/03/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Lung cancer screening can reduce cancer mortality. Most implementation studies focus only on low-dose computed tomography (LDCT) and clinical attributes of screening and do not include preferences of potential participants. In this study we evaluated the perceived value of screening programs based on LDCT, breath analysis (BA), or blood biomarkers (BB) according to the perspective of the target population. METHODS A multi-criteria decision analysis framework was adopted. The weights of seven attributes of screening (sensitivity, specificity, radiation burden, duration of screening process, waiting time until results are communicated, location of screening, and mode of screening) were obtained from an earlier study that included a broad sample from the Netherlands. Performance data for the screening modalities was obtained from clinical trials and expert opinion. Parameter uncertainty about clinical performances was incorporated probabilistically, while heterogeneity in preferences was analyzed through subgroup analyses. RESULTS The mean overall values were 0.58 (CI: 0.57 to 0.59), 0.57 (CI: 0.56 to 0.59), and 0.44 (CI: 0.43 to 0.45) for BB, BA, and LDCT, respectively. Seventy-seven per cent of respondents preferred BB or BA. For most subgroups, the overall values were similar to those of the entire sample. BA had the highest value for respondents who would have been eligible for earlier screening trials. DISCUSSION BB and BA seem valuable to participants because they can be applied in a primary care setting. Although LDCT still seems preferable given its strong and positive evidence base, it is important to take non-clinical attributes into account to maximize attendance.
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Affiliation(s)
- Henk Broekhuizen
- Radboud University Medical Center, Department of Health Evidence, Nijmegen, The Netherlands.
| | - Catharina G M Groothuis-Oudshoorn
- University of Twente, Faculty of Behavioural Management and Social Sciences, Technical Medical Centre, Department of Health Technology and Services Research, Enschede, The Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Harry J M Groen
- University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands
| | - Maarten J IJzerman
- Radboud University Medical Center, Department of Health Evidence, Nijmegen, The Netherlands; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences and Victorian Comprehensive Cancer Centre, Melbourne, Australia
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50
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Wallbridge P, Parry SM, Das S, Law C, Hammerschlag G, Irving L, Hew M, Steinfort D. Parasternal intercostal muscle ultrasound in chronic obstructive pulmonary disease correlates with spirometric severity. Sci Rep 2018; 8:15274. [PMID: 30323179 PMCID: PMC6189142 DOI: 10.1038/s41598-018-33666-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/01/2018] [Indexed: 12/16/2022] Open
Abstract
In chronic obstructive pulmonary disease (COPD), loss of computed tomography (CT)-measured intercostal mass correlates with spirometric severity. Intercostal muscle ultrasound offers a repeatable and radiation-free alternative, however requires validation. We aimed to determine the reliability of parasternal intercostal muscle ultrasound, and the concurrent validity of parasternal ultrasound with clinicometric parameters. Twenty stable COPD patients underwent ultrasound measurement of thickness and echogenicity of 2nd and 3rd parasternal intercostal muscles, dominant pectoralis major and quadriceps, and diaphragm thickness; spirometry; and chest CT. Intra-rater intraclass correlation (ICC) for ultrasound intercostal thickness was 0.87-0.97 depending on site, with echogenicity ICC 0.63-0.91. Inter-rater ICC was fair to excellent. Ultrasound intercostal thickness moderately correlated with FEV1% predicted (r = 0.33) and quadriceps thickness (r = 0.31). Echogenicity correlated negatively with FEV1% predicted (r = -0.32). CT-measured lateral intercostal mass correlate negatively with parasternal ultrasound intercostal thickness. These data confirm ultrasound of parasternal intercostal musculature is reproducible. Lower intercostal muscle quantity and quality reflects greater COPD spirometric severity. This novel tool may have biomarker potential for both the systemic effects of COPD on muscle as well as local disruption of respiratory mechanics. The negative correlation between CT and ultrasound measurements may reflect complex site-dependent interactions between respiratory muscles and the chest wall.
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Affiliation(s)
- Peter Wallbridge
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia. .,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.
| | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Parkville, Australia
| | - Sourav Das
- Melbourne EpiCentre, Melbourne Health and The University of Melbourne, Parkville, Australia
| | - Candice Law
- Department of Radiology, Royal Melbourne Hospital, Parkville, Australia
| | - Gary Hammerschlag
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Louis Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
| | - Mark Hew
- Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia.,Public Health and Preventative Medicine, Monash University, Clayton, Australia
| | - Daniel Steinfort
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Australia
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