Prevalence of Pulmonary Nodules Detected by Computed Tomography in World Trade Center Rescue and Recovery Workers

Prevalence and management of pulmonary nodules: a systematic review and meta-analysis

Background

Pulmonary nodules are small, focal lesions often identified via computed tomography (CT) scans. Although the majority are benign, a small percentage of them may be malignant or potentially become malignant, underscoring the importance of early detection and effective management. This study systematically reviews the epidemiology, risk factors, and management strategies for pulmonary nodules, comparing findings across Chinese and non-Chinese populations to better inform the actuarial calculations for predicting the demand of medical services for patients with pulmonary nodules.

Methods

We performed a systematic analysis of the PubMed and China Knowledge Infrastructure (CNKI) databases for studies reporting the detection rate of pulmonary nodules through CT scans. Both cross-sectional studies and the baseline data from longitudinal studies were included. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias and random effect models were used to estimate the overall prevalence.

Results

We identified 32 studies and included 24 of them in our meta-analysis. Pooled analysis showed that the overall prevalence of pulmonary nodules was 0.27 (95% confidence interval: 0.25-0.29) after outliers removal. Subgroup analysis showed that there was no significant difference for prevalence between Chinese and non-Chinese populations. Males (0.38) were shown to have slightly higher prevalence compared to females (0.36), but not significant (P=0.88). Age and smoking are the most frequently reported risk factors by studies.

Conclusions

Overall, 27% of participants were positive for pulmonary nodules. Advancing age and smoking were consistently identified as a key risk factor for the incidence of pulmonary nodules. Although the management strategies are different across studies, recent guidelines recommend personalized management strategies, prioritizing nodule size, characteristics, and individual risk factors to optimize outcomes.

[Low-dose Spiral Computed Tomography in Lung Cancer Screening]

Lung cancer is one of the malignant tumors with the highest morbidity and mortality in the world. The low early diagnosis rate and poor prognosis of patients have caused serious social burden. Regular screening of high-risk population by low-dose spiral computed tomography (LDCT) can significantly improve the early diagnosis rate of lung cancer and bring new opportunities for the diagnosis and treatment of lung cancer. In recent years, LDCT lung cancer screening programs have been carried out in many countries around the world and achieved good results, but there are still some controversies in the selection of screening subjects, screening frequency, cost effectiveness and other aspects. In this paper, the key factors of LDCT lung cancer screening, screening effect, pulmonary nodule management and artificial intelligence contribution to the development of LDCT will be reviewed, and the application progress of LDCT in lung cancer screening will be discussed.
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Low-dose computed tomography lung cancer screening: Clinical evidence and implementation research

Lung cancer causes more deaths than breast, cervical, and colorectal cancer combined. Nevertheless, population-based lung cancer screening is still not considered standard practice in most countries worldwide. Early lung cancer detection leads to better survival outcomes: patients diagnosed with stage 1A lung cancer have a >75% 5-year survival rate, compared to <5% at stage 4. Low-dose computed tomography (LDCT) thorax imaging for the secondary prevention of lung cancer has been studied at length, and has been shown to significantly reduce lung cancer mortality in high-risk populations. The US National Lung Screening Trial reported a 20% overall reduction in lung cancer mortality when comparing LDCT to chest X-ray, and the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial more recently reported a 24% reduction when comparing LDCT to no screening. Hence, the focus has now shifted to implementation research. Consequently, the 4-IN-THE-LUNG-RUN consortium based in five European countries, has set up a large-scale multicenter implementation trial. Successful implementation of and accessibility to LDCT lung cancer screening are dependent on many factors, not limited to population selection, recruitment strategy, computed tomography screening frequency, lung-nodule management, participant compliance, and cost effectiveness. This review provides an overview of current evidence for LDCT lung cancer screening, and draws attention to major factors that need to be addressed to successfully implement standardized, effective, and accessible screening throughout Europe. Evidence shows that through the appropriate use of risk-prediction models and a more personalized approach to screening, efficacy could be improved. Furthermore, extending the screening interval for low-risk individuals to reduce costs and associated harms is a possibility, and through the use of volumetric-based measurement and follow-up, false positive results can be greatly reduced. Finally, smoking cessation programs could be a valuable addition to screening programs and artificial intelligence could offer a solution to the added workload pressures radiologists are facing.

Lung cancer incidence among world trade center rescue and recovery workers

Background

Many World Trade Center disaster (WTC) rescue and recovery workers (WTC RRWV) were exposed to toxic inhalable particles. The impact of WTC exposures on lung cancer risk is unclear.

Methods

Data from the WTC Health Program General Responders Cohort (WTCGRC) were linked to health information from a large New York City health system to identify incident lung cancer cases. Incidence rates for lung cancer were then calculated. As a comparison group, we created a microsimulation model that generated expected lung cancer incidence rates for a WTC‐ and occupationally‐unexposed cohort with similar characteristics. We also fitted a Poisson regression model to determine specific lung cancer risk factors for WTC RRWV.

Results

The incidence of lung cancer for WTC RRWV was 39.5 (95% confidence interval [CI]: 30.7–49.9) per 100,000 person‐years. When compared to the simulated unexposed cohort, no significant elevation in incidence was found among WTC RRWV (incidence rate ratio [IRR] 1.34; 95% CI: 0.92–1.96). Predictors of lung cancer incidence included age, smoking intensity, and years since quitting for former smokers. In adjusted models evaluating airway obstruction and individual pre‐WTC occupational exposures, only mineral dust work was associated with lung cancer risk (IRR: 2.03; 95% CI: 1.07–3.86).

Discussion

In a sample from a large, prospective cohort of WTC RRWV we found a lung cancer incidence rate that was similar to that expected of a WTC‐ and occupationally‐unexposed cohort with similar individual risk profiles. Guideline‐concordant lung cancer surveillance and periodic evaluations of population‐level lung cancer risk should continue in this group.

Outstanding negative prediction performance of solid pulmonary nodule volume AI for ultra-LDCT baseline lung cancer screening risk stratification

OBJECTIVE

To evaluate performance of AI as a standalone reader in ultra-low-dose CT lung cancer baseline screening, and compare it to that of experienced radiologists.

METHODS

283 participants who underwent a baseline ultra-LDCT scan in Moscow Lung Cancer Screening, between February 2017-2018, and had at least one solid lung nodule, were included. Volumetric nodule measurements were performed by five experienced blinded radiologists, and independently assessed using an AI lung cancer screening prototype (AVIEW LCS, v1.0.34, Coreline Soft, Co. ltd, Seoul, Korea) to automatically detect, measure, and classify solid nodules. Discrepancies were stratified into two groups: positive-misclassification (PM); nodule classified by the reader as a NELSON-plus /EUPS-indeterminate/positive nodule, which at the reference consensus read was < 100 mm3, and negative-misclassification (NM); nodule classified as a NELSON-plus /EUPS-negative nodule, which at consensus read was ≥ 100 mm3.

RESULTS

1149 nodules with a solid-component were detected, of which 878 were classified as solid nodules. For the largest solid nodule per participant (n = 283); 61 [21.6 %; 53 PM, 8 NM] discrepancies were reported for AI as a standalone reader, compared to 43 [15.1 %; 22 PM, 21 NM], 36 [12.7 %; 25 PM, 11 NM], 29 [10.2 %; 25 PM, 4 NM], 28 [9.9 %; 6 PM, 22 NM], and 50 [17.7 %; 15 PM, 35 NM] discrepancies for readers 1, 2, 3, 4, and 5 respectively.

CONCLUSION

Our results suggest that through the use of AI as an impartial reader in baseline lung cancer screening, negative-misclassification results could exceed that of four out of five experienced radiologists, and radiologists' workload could be drastically diminished by up to 86.7%.

Association of low FVC spirometric pattern with WTC occupational exposures

BACKGROUND

A reduced forced vital capacity without obstruction (low FVC) is the predominant spirometric abnormality reported in workers and volunteers exposed to dust, gases, and fumes at the World Trade Center (WTC) disaster site in 2001-2002. While low FVC has been associated with obesity and metabolic syndrome, its association with WTC occupational exposures has not been demonstrated. We estimated the prevalence of this abnormality and examined its association with WTC exposure level.

METHODS

Longitudinal study of the relation between arrival at the WTC site within 48 h and FVC below the lower limit of normal (FVC < LLN, with normal FEV1/FVC ratio) at any time in 10,284 workers with at least two spirometries between 2002 and 2018. Logistic regression and linear mixed models were used for the multivariable analyses.

RESULTS

The prevalence of low FVC increased from 17.0% (95% CI 15.4%, 18.5%) in June 2003, to 26.4% (95% CI 24.8%, 28.1%) in June 2018, and exceeded at both times that of obstruction. The rate of FVC decline was -43.7 ml/year during the study period. In a multivariable analysis adjusting for obesity, metabolic syndrome indicators, and other factors, early arrival at the WTC disaster site was significantly associated with low FVC, but only among men (ORadj = 1.29, 95% CI 1.17, 1.43). Longitudinal FVC rate of decline did not differ by WTC site arrival time.

CONCLUSIONS

Among WTC workers, the prevalence of low FVC increased over a 16-year period. Early arrival to the WTC disaster site was significantly associated with low FVC in males.