Stage of Lung Cancer in Relation to Its Size*

Implementation of low-dose CT screening in two different health care systems: Mount Sinai Healthcare System and Phoenix VA Health Care System

Implementation of lung screening (LS) programs is challenging even among health care organizations that have the motivation, the resources, and more importantly, the goal of providing for life-saving early detection, diagnosis, and treatment of lung cancer. We provide a case study of LS implementation in different healthcare systems, at the Mount Sinai Healthcare System (MSHS) in New York City, and at the Phoenix Veterans Affairs Health Care System (PVAHCS) in Phoenix, Arizona. This will illustrate the commonalities and differences of the LS implementation process in two very different health care systems in very different parts of the United States. Underlying the successful implementation of these LS programs was the use of a comprehensive management system, the Early Lung Cancer Action Program (ELCAP) Management System^TM. The collaboration between MSHS and PVAHCS over the past decade led to the ELCAP Management System^TM being gifted by the Early Diagnosis and Treatment Research Foundation to the PVAHCS, to develop a “VA-ELCAP” version. While there remain challenges and opportunities to continue improving LS and its implementation, there is an increasing realization that most patients who are diagnosed with lung cancer as a result of annual LS can be cured, and that of all the possible risks associated with LS, the greater risk of all is for heavy cigarette smokers not to be screened. We identified 10 critical components in implementing a LS program. We provided the details of each of these components for the two healthcare systems. Most importantly, is that continual re-evaluation of the screening program is needed based on the ongoing quality assurance program and database of the actual screenings. At minimum, there should be an annual review and updating. As early diagnosis of lung cancer must be followed by optimal treatment to be effective, treatment advances for small, early lung cancers diagnosed as a result of screening also need to be assessed and incorporated into the entire screening and treatment program.

Correlation between Skip N2 Metastases and SUVmax, Long Diameter of Tumor, and Ki67 Expression in Patients with Non-Small-Cell Lung Cancer

Background

We aim at investigating the correlation between skip N2 metastases (SN2) and SUV_max, long diameter of tumor mass after ¹⁸F-FDG PET/CT, and pathological Ki67 expression in patients with non-small-cell lung cancer (NSCLC).

Methods and Results

We retrospectively analyzed the factors that might affect the pathogenesis of SN2 in these patients. The clinical SN2 symptoms in patients with squamous carcinoma or adenocarcinoma were investigated. The work curve was utilized to analyze the optimal cutoff value for the SUV_max and long diameter of tumor. Multivariate analysis revealed that high expression of Ki67 was a risk factor for mediastinal SN2 (OR = 1.042, 95% CI: 1.009-1.076). Subgroup analysis indicated that the SUV_max of the non-SN2 group was significantly higher than that of the SN2 group in patients with squamous carcinoma (16.3 ± 6.0 vs. 10.7 ± 5.6, P = 0.026). In the patients with adenocarcinoma, the long diameter of tumor in the SN2 group was significantly longer than that of the non-SN2 group (43.8 ± 16.3 mm vs. 30.1 ± 13.8 mm, P = 0.032). The Ki67 expression in the SN2 group was significantly higher than that of the non-SN2 group (51.7 ± 24.0 vs. 30.0 ± 19.2, P = 0.028).

Conclusions

The differences of clinical features of the patients in the SN2 group and non-SN2 group in the NSCLC patients were associated with the pathological subtypes, which were featured by lower SUV_max in the SN2 of the squamous carcinoma, and longer diameter of SN2 in the adenocarcinoma patients.

Lung nodule CAD software as a second reader: a multicenter study

RATIONALE AND OBJECTIVES

The purpose of this multicenter, multireader study was to evaluate the performance of computed tomography (CT) lung nodule computer-aided detection (CAD) software as a second reader.

METHODS AND MATERIALS

The study involved 109 patients from four sites. The data were collected from a variety of multidetector CT scanners and had different scan parameters. Each chest CT scan was divided into four quadrants. A group of three expert thoracic radiologists identified nodules between 4 and 30 mm in maximum diameter within each quadrant. The standard of reference was established by a consensus read of these experienced radiologists. The cases were then interpreted by 10 other radiologist readers with varying degrees of experience, without and then with CAD software. These readers identified nodules and assigned an actionability rating to each quadrant before and after using CAD software. Receiver operating characteristic curves were used to measure the performance of the readers without and with CAD software.

RESULTS

The average increase in area under the curve for the 10 readers with CAD software was 1.9% for a 95% confidence interval (0.8-8.0%). The area under the curve without CAD software was 86.7% and with CAD software was 88.7%. A nonsignificant correlation was observed between the improvement in sensitivity and experience of the radiologists. The readers also showed a greater improvement in patients with cancer as compared to those without cancer.

CONCLUSIONS

In this multicenter trial, CAD software was shown to be effective as a second reader by improving the sensitivity of the radiologists in detecting pulmonary nodules.

The Role of CT Screening for Lung Cancer

A person who is at high-risk for lung cancer and asymptomatic, and who is interested in potentially being screened should be fully apprized of the implications of screening and of the treatment that may result. In light of this, it is reasonable for the individual to choose to be screened by a multidisciplinary medical team with experience in performing such screenings, using a well-defined CT regimen of screening, and having appropriate quality assurance procedures in place.