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Reck M, Dettmer S, Kauczor HU, Kaaks R, Reinmuth N, Vogel-Claussen J. Lung Cancer Screening With Low-Dose Computed Tomography. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:387-392. [PMID: 37198995 PMCID: PMC10433361 DOI: 10.3238/arztebl.m2023.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/15/2022] [Accepted: 04/05/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Approximately 21 900 women and 35 300 men developed lung cancer in Germany in 2018, and 16 514 women and 28 365 men died of it. The outcome mainly depends on the tumor stage. In early stages (stage I or II), treatment can be curative; unfortunately, because early-stage lung cancers are generally asymptomatic, 74% of women and 77% of men already have advanced-stage disease (stage III or IV) at the time of diagnosis. Screening with low-dose computed tomography is an option enabling early diagnosis and curative treatment. METHODS This review is based on pertinent articles retrieved by a selective search of the literature on screening for lung cancer. RESULTS In the studies of lung cancer screening that have been published to date, sensitivity ranged from 68.5% to 93.8%, and specificity from 73.4% to 99.2%. A meta-analysis by the German Federal Office for Radiation Protection revealed a 15% reduction in lung cancer mortality when low-dose computed tomography was used in persons who were judged to be at high risk for lung cancer (risk ratio [RR] 0.85, 95% confidence interval [0.77; 0.95]). 1.9% of subjects died in the screening arm of the metaanalysis, and 2.2% in the control group. The observation periods ranged from 6.6 to 10 years; false-positive rates ranged from 84.9% to 96.4%. Malignant findings were confirmed in 45% to 70% of the biopsies or resective procedures that were performed. CONCLUSION Systematic lung cancer screening with low-dose CT lowers mortality from lung cancer in (current or former) heavy smokers. This benefit must be weighed against the high rate of false-positive findings and overdiagnoses.
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Affiliation(s)
- Martin Reck
- Lung Clinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL)
| | - Sabine Dettmer
- Institute for Diagnostic and Interventional Radiology, Hanover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH), German Center for Lung Research (DZL)
| | - Hans-Ulrich Kauczor
- Institute for Diagnostic and Interventional Radiology, Heidelberg University Hospital, Translational Lung Research Center (TLRC), German Center for Lung Research (DZL)
| | - Rudolf Kaaks
- German Cancer Research Center (DKFZ), Heidelberg, Translational Lung Research Center (TLRC), German Center for Lung Research (DZL)
| | - Niels Reinmuth
- Department for Thoracic Oncology, Asklepios Specialist Clinics Munich-Gauting, German Center for Lung Research (DZL)
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hanover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hanover (BREATH), German Center for Lung Research (DZL)
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Sun D, Gai Z, Wu J, Chen Q. Prognostic Impact of the Angiogenic Gene POSTN and Its Related Genes on Lung Adenocarcinoma. Front Oncol 2022; 12:699824. [PMID: 35832544 PMCID: PMC9271775 DOI: 10.3389/fonc.2022.699824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background The function of angiogenesis-related genes (ARGs) in lung adenocarcinoma (LUAD) remains poorly documented. This study was designed to reveal ARGs in LUAD and related networks. Methods We worked with sequencing data and clinical information pertaining to LUAD from public databases. ARGs were retrieved from the HALLMARK_ANGIOGENESIS gene set. Differential analysis and Kaplan–Meier (K–M) analysis were performed to authenticate the ARGs associated with LUAD. Weighted gene correlation network analysis was performed on the mining hub genes linked to the abovementioned genes, and functional enrichment analysis was done. Subsequently, Cox regression analyses were used to construct the prognostic gene. POSTN and microvessel density were detected using immunohistochemistry. Results POSTN, an ARG that was highly expressed in patients with LUAD and was closely associated with their weak overall survival was identified. Differentially expressed genes associated with POSTN were mainly enriched in entries related to the tubulointerstitial system, immune response, and epithelial cells. A positive correlation was demonstrated between POSTN expression and tumor microvessel density in LUAD. Subsequently, a prognostic gene signature was constructed and revealed that 4 genes may predict the survival of LUAD patients. Furthermore, the ESTIMATE and CIBERSORT analyses suggested that our risk scoring system may be implicated in altering the immune microenvironment of patients with LUAD. Finally, a ceRNA network was constructed based on the prognostic genes, and the regulatory networks were examined. Conclusion POSTN, a novel prognostic gene signature associated with ARGs, was constructed for the prognosis of patients with LUAD. This signature may alter the immune microenvironment by modulating the activation of the tubulointerstitial system, epithelial cells, and immune cells, ultimately affecting patient survival.
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Affiliation(s)
- Dongfeng Sun
- Department of Thoracic Surgery, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Emergency Medicine, Shandong Lung Cancer Institute, Shandong Institute of Respiratory Diseases, Jinan, China
- *Correspondence: Dongfeng Sun, ;Qingfa Chen,
| | - Zhibo Gai
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jie Wu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qingfa Chen
- Institute of Tissue Engineering and Regenerative Medicine, Liaocheng People’s Hospital, Liaocheng, China
- *Correspondence: Dongfeng Sun, ;Qingfa Chen,
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Zhang P, Li T, Tao X, Jin X, Zhao S. HRCT features between lepidic-predominant type and other pathological subtypes in early-stage invasive pulmonary adenocarcinoma appearing as a ground-glass nodule. BMC Cancer 2021; 21:1124. [PMID: 34666705 PMCID: PMC8524968 DOI: 10.1186/s12885-021-08821-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 10/01/2021] [Indexed: 01/15/2023] Open
Abstract
Background Different pathological subtypes of invasive pulmonary adenocarcinoma (IPA) have different surgical methods and heterogeneous prognosis. It is essential to clarify IPA subtypes before operation and high-resolution computed tomography (HRCT) plays a very important role in this regard. We aimed to investigate the HRCT features of lepidic-predominant type and other pathological subtypes of early-stage (T1N0M0) IPA appearing as a ground-glass nodule (GGN). Methods We performed a retrospective analysis on clinical data and HRCT features of 630 lesions in 589 patients with pathologically confirmed IPA (invasive foci > 5 mm) appearing as pure GGN (pGGN) and mixed GGN (mGGN) with consolidation-to-tumor ratio (CTR) ≤0.5 from January to December 2019. All GGNs were classified as lepidic-predominant adenocarcinoma (LPA) and nonlepidic-predominant adenocarcinoma (n-LPA) groups. Univariate analysis was performed to analyze the differences of clinical data and HRCT features between the LPA and n-LPA groups. Multivariate analysis was conducted to determine the variables to distinguish the LPA from n-LPA group independently. The diagnostic performance of different parameters was compared using receiver operating characteristic curves. Results In total, 367 GGNs in the LPA group and 263 GGNs in the n-LPA group were identified. In the univariate analysis, the CTR, mean CT values, and mean diameters as well as mixed GGN, deep lobulation, spiculation, vascular change, bronchial change, and tumor–lung interface were smaller in the LPA group than in the n-LPA group (P < 0.05). Logistic regression model was reconstructed including the mean CT value, CTR, deep lobulation, spiculation, vascular change, and bronchial change (P < 0.05). Area under the curve of the logistic regression model for differentiating LPA and n-LPA was 0.840 (76.4% sensitivity, 78.7% specificity), which was significantly higher than that of the mean CT value or CTR. Conclusions Deep lobulation, spiculation, vascular change, and bronchial change, CT value > − 472.5 HU and CTR > 27.4% may indicate nonlepidic predominant invasive pulmonary adenocarcinoma in GGNs.
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Affiliation(s)
- Pengju Zhang
- Department of Radiology, Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Beijing, 100048, China
| | - Tianran Li
- Department of Radiology, Fourth Medical Center of PLA General Hospital, 51 Fucheng Road, Beijing, 100048, China
| | - Xuemin Tao
- Department of Radiology, First Medical Center of PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xin Jin
- Department of Radiology, First Medical Center of PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shaohong Zhao
- Department of Radiology, First Medical Center of PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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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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Dührsen U, Deppermann KM, Pox C, Holstege A. Evidence-Based Follow-up for Adults With Cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:663-669. [PMID: 31658935 DOI: 10.3238/arztebl.2019.0663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 04/10/2019] [Accepted: 07/19/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND The objectives of follow-up care for cancer patients include psycho- social assistance and the detection of health problems. The concept of follow-up care rests on the assumption that the early detection of cancer recurrences and disease- or treatment-related complications is beneficial to patients. In this article, we provide an overview of the scientific evidence supporting current recommen- dations for the follow-up care of patients with colorectal cancer, lung cancer, and lymphoma. METHODS This review is based on pertinent publications that were retrieved by a selective search in PubMed, supplemented by the authors' own experience in patient care and guideline creation. RESULTS As recurrences usually arise soon after initial treatment, the recommended follow-up interval is shorter in the first two years (3-6 months) and longer thereafter (6-12 months). The question of which particular follow-up studies should be per- formed has only been systematically analyzed in a few cases. For patients with colorectal cancer, colonoscopy is the most important study. Intensive follow-up care is associated with a statistically non-significant increase in the survival rate compared to minimal follow-up care (77.5% versus 75.8%). Intensive diagnostic follow-up studies have been found to lead to a doubling of the frequency of operations for recurrence with curative intent, yet without any effect on the average survival time. The findings in lung cancer are similar. However, after tumor resection with curative intent, regularly repeated CT scanning leads to a survival advantage. In lymphoma patients, the longer the interval from primary treatment, the greater the likelihood of treatment-related secondary illnesses. It is not yet known how follow-up care should be provided to these patients in order to help them best. CONCLUSION The evidence supporting the efficacy of currently recommended modalities of follow-up care for cancer patients is weak. Until more data from clinical studies become available, the current guidelines should be followed.
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Affiliation(s)
- Ulrich Dührsen
- Department of Haematology, University Hospital Essen; Department of Pneumology, Sana Kliniken Düsseldorf; Medical Clinic, Krankenhaus St. Josef-Stift Bremen; Medical Clinic 1, Klinikum Landshut
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Raez LE, Nogueira A, Santos ES, dos Santos RS, Franceschini J, Ron DA, Block M, Yamaguchi N, Rolfo C. Challenges in Lung Cancer Screening in Latin America. J Glob Oncol 2018; 4:1-10. [PMID: 30241252 PMCID: PMC6223408 DOI: 10.1200/jgo.17.00040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Lung cancer is the deadliest cancer worldwide and is of particular concern for Latin America. Its rising incidence in this area of the world poses myriad challenges for the region's economies, which are already struggling with limited resources to meet the health care needs of low- and middle-income populations. In this environment, we are concerned that regional governments are relatively unaware of the pressing need to implement effective strategies for the near future. Low-dose chest computed tomography (LDCT) for screening, and routine use of minimally invasive techniques for diagnosis and staging remain uncommon. According to results of the National Lung Screening Trial, LDCT lung cancer screening provided a 20% relative reduction in mortality rates among at-risk individuals. Nevertheless, this issue is still a matter of debate, particularly in developing countries, and it is not fully embraced in developing countries. The aim of this article is to provide an overview of what the standard of care is for lung cancer computed tomography screening around the world and to aid understanding of the challenges and potential solutions that can help with the implementation of LDCT in Latin America.
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Affiliation(s)
- Luis E. Raez
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Amanda Nogueira
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Edgardo S. Santos
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Ricardo Sales dos Santos
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Juliana Franceschini
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - David Arias Ron
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mark Block
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Nise Yamaguchi
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Christian Rolfo
- Luis E. Raez and Mark Block, Memorial Healthcare System, Hollywood; Edgardo S. Santos, Boca Raton Regional Hospital, Boca Raton, FL; Amanda Nogueira, David Arias Ron, and Christian Rolfo, Antwerp University Hospital, Edegem, Belgium; Ricardo Sales Dos Santos, Juliana Franceschini, and Nise Yamaguchi, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Wang ZX, Li L, Zhang Z, Wang GH, Kong DM, Wang XD, Wang F. High-resolution computed tomography features and CT-guided microcoil localization of subcentimeter pulmonary ground-glass opacities: radiological processing prior to video-assisted thoracoscopic surgery. J Thorac Dis 2018; 10:2676-2684. [PMID: 29997929 DOI: 10.21037/jtd.2018.04.87] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background With the rapid development of high-resolution computed tomography (HRCT), low-dose CT scanning and video-assisted thoracoscopic surgery (VATS), smaller pulmonary nodules can be detected. Subcentimeter ground-glass opacities (GGOs) are extremely difficult to diagnose and accurately locate during VATS and in surgically resected specimens. Methods From September 2013 to September 2017, 42 subcentimeter GGO lesions (≤1 cm) in 31 patients who underwent CT-guided microcoil insertion followed by VATS resection were included. All HRCT images were assessed by two experienced radiologists, and CT-guided microcoil localization procedures were performed by two experienced interventional radiologists. Results A total of 42 subcentimeter GGOs included 28 malignancies (66.7%) and 14 benign lesions (33.3%). The diameter of malignant GGOs (8.52±1.46 mm) was significantly larger than that of benign lesions (7.04±1.52 mm) (P<0.05). Seven patients had more than one GGO nodule. There were no significant differences in the location, composition, shape, margins, presence of air bronchograms, presence of the pleural indentation sign and presence of the vascular convergence sign between benign and malignant GGOs (P>0.05). All the localization procedures were performed successfully. A small pneumothorax occurred in 9 patients (21.4%), and minor hemorrhage in the lung parenchyma occurred in 8 patients (19.0%). All GGOs were easily identified during VATS and were definitively diagnosed. Conclusions Common HRCT features cannot be used as criteria for the differential diagnosis of subcentimeter benign and malignant pulmonary GGOs. CT-guided microcoil marking of these lesions prior to VATS is a feasible, safe, and effective procedure for the localization of subcentimeter pulmonary GGOs.
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Affiliation(s)
- Zi-Xuan Wang
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao 266000, China
| | - Lin Li
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao 266000, China
| | - Zhe Zhang
- Department of Thoracic Surgery, Qingdao Municipal Hospital, Qingdao 266000, China
| | - Guo-Hua Wang
- Department of Radiology, Qingdao Municipal Hospital, Qingdao 266000, China
| | - De-Mao Kong
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao 266000, China
| | - Xu-Dong Wang
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao 266000, China
| | - Fa Wang
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao 266000, China
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Necessity of organized low-dose computed tomography screening for lung cancer: From epidemiologic comparisons between China and the Western nations. Oncotarget 2018; 8:1788-1795. [PMID: 27705946 PMCID: PMC5352097 DOI: 10.18632/oncotarget.12400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 09/13/2016] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare the proportion of stage I lung cancer and population mortality in China to those in U.S. and Europe where lung cancer screening by low-dose computed tomography (LDCT) has been already well practiced. METHODS The proportions of stage I lung cancer in LDCT screening population in U.S. and Europe were retrieved from NLST and NELSON trials. The general proportion of stage I lung cancer in China was retrieved from a rapid meta-analysis, based on a literature search in the China National Knowledge Infrastructure database. The lung cancer mortality and prevalence of China, U.S. and Europe was retrieved from Globocan 2012 fact sheet. Mortality-to-prevalence ratio (MPR) was applied to compare the population survival outcome of lung cancer. RESULTS The estimated proportion of stage I lung cancer in China is merely 20.8% among hospital-based cross-sectional population, with relative ratios (RRs) being 2.40 (95% CI 2.18-2.65) and 2.98 (95% CI 2.62-3.38) compared by LDCT-screening population in U.S. and Europe trials, respectively. MPR of lung cancer is as high as 58.9% in China, with RRs being 0.46 (95% CI 0.31-0.67) and 0.58 (95% CI 0.39-0.85) compared by U.S. and Europe, respectively. CONCLUSIONS By the epidemiological inference, the LDCT mass screening might be associated with increasing stage I lung cancer and therefore improving population survival outcome. How to translate the experiences of lung cancer screening by LDCT from developed counties to China in a cost-effective manner needs to be further investigated.
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Pedersen JH, Rzyman W, Veronesi G, D’Amico TA, Van Schil P, Molins L, Massard G, Rocco G. Recommendations from the European Society of Thoracic Surgeons (ESTS) regarding computed tomography screening for lung cancer in Europe. Eur J Cardiothorac Surg 2017; 51:411-420. [PMID: 28137752 PMCID: PMC6279064 DOI: 10.1093/ejcts/ezw418] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/03/2016] [Accepted: 11/30/2016] [Indexed: 12/17/2022] Open
Abstract
In order to provide recommendations regarding implementation of computed tomography (CT) screening in Europe the ESTS established a working group with eight experts in the field. On a background of the current situation regarding CT screening in Europe and the available evidence, ten recommendations have been prepared that cover the essential aspects to be taken into account when considering implementation of CT screening in Europe. These issues are: (i) Implementation of CT screening in Europe, (ii) Participation of thoracic surgeons in CT screening programs, (iii) Training and clinical profile for surgeons participating in screening programs, (iv) the use of minimally invasive thoracic surgery and other relevant surgical issues and (v) Associated elements of CT screening programs (i.e. smoking cessation programs, radiological interpretation, nodule evaluation algorithms and pathology reports). Thoracic Surgeons will play a key role in this process and therefore the ESTS is committed to providing guidance and facilitating this process for the benefit of patients and surgeons.
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Affiliation(s)
- Jesper Holst Pedersen
- Department of Thoracic Surgery RT 2152, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | | | - Thomas A D’Amico
- Thoracic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Laureano Molins
- Thoracic Surgery Respiratory Institute, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Gilbert Massard
- Service de Chirurgie Thoracique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Gaetano Rocco
- Division of Thoracic Surgery, Department of Thoracic Surgical and Medical Oncology, National Cancer Institute, Naples, Italy
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Hackner K, Errhalt P, Mueller MR, Speiser M, Marzluf BA, Schulheim A, Schenk P, Bilek J, Doll T. Canine scent detection for the diagnosis of lung cancer in a screening-like situation. J Breath Res 2016; 10:046003. [PMID: 27677188 DOI: 10.1088/1752-7155/10/4/046003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The prognosis in lung cancer depends largely on early stage detection, and thus new screening methods are attracting increasing attention. Canine scent detection has shown promising results in lung cancer detection, but there has only been one previous study that reproduces a screening-like situation. Here breath samples were collected from 122 patients at risk for lung cancer (smokers and ex-smokers); 29 of the subjects had confirmed diagnosis of lung cancer but had not yet been treated and 93 subjects had no signs or symptoms of lung cancer at the time of inclusion. The breath samples were presented to a trained sniffer dog squadron in a double-blind manner. A rigid scientific protocol was used with respect to earlier canine scent detection studies, with one difference: instead of offering one in five positive samples to the dogs, we offered a random number of positive samples (zero to five). The final positive and negative predictive values of 30.9% and 84.0%, respectively, were rather low compared to other studies. The results differed from those of previous studies, indicating that canine scent detection might not be as powerful as is looked for in real screening situations. One main reason for the rather poor performance in our setting might be the higher stress from the lack of positive responses for dogs and handlers.
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Affiliation(s)
- Klaus Hackner
- Department of Pneumonology, Krems University Hospital, Krems, Austria. Karl Landsteiner University of Health Sciences, Krems, Austria. Author to whom any correspondence should be addressed
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Pedersen JH, Ashraf H. Implementation and organization of lung cancer screening. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:152. [PMID: 27195270 DOI: 10.21037/atm.2016.03.59] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CT screening for lung cancer is now being implemented in the US and China on a widespread national scale but not in Europe so far. The review gives a status for the implementation process and the hurdles to overcome in the future. It also describes the guidelines and requirements for the structure and components of high quality CT screening programs. These are essential in order to achieve a successful program with the fewest possible harms and a possible mortality benefit like that documented in the American National Lung Screening Trial (NLST). In addition the importance of continued research in CT screening methods is described and discussed with focus on the great potential to further improve this method in the future for the benefit of patients and society.
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Affiliation(s)
- Jesper Holst Pedersen
- 1 Rigshospitalet, Department of Cardiothoracic Surgery, University of Copenhagen, Copenhagen, Denmark ; 2 Department of Pulmonary Medicine, Gentofte University Hospital and University of Copenhagen, Denmark ; 3 Department of Radiology, Akershus University Hospital, Lørenskog, Norway
| | - Haseem Ashraf
- 1 Rigshospitalet, Department of Cardiothoracic Surgery, University of Copenhagen, Copenhagen, Denmark ; 2 Department of Pulmonary Medicine, Gentofte University Hospital and University of Copenhagen, Denmark ; 3 Department of Radiology, Akershus University Hospital, Lørenskog, Norway
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Thoracic Malignancies and Pulmonary Nodules in Patients under Evaluation for Transcatheter Aortic Valve Implantation (TAVI): Incidence, Follow Up and Possible Impact on Treatment Decision. PLoS One 2016; 11:e0155398. [PMID: 27171441 PMCID: PMC4865104 DOI: 10.1371/journal.pone.0155398] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/28/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe aortic valve stenosis who are not eligible for operative replacement and an alternative for those with high surgical risk. Due to high age and smoking history in a high proportion of TAVI patients, suspicious findings are frequently observed in pre-procedural chest computer tomography (CCT). METHODS CCT scans of 484 consecutive patients undergoing TAVI were evaluated for incidentally discovered solitary pulmonary nodules (SPN). RESULTS In the entire study population, SPN ≥ 5 mm were found in 87 patients (18%). These patients were compared to 150 patients who were incidentally collected from the 397 patients without SPN or with SPN < 5 mm (control group). After a median follow-up of 455 days, lung cancer was diagnosed in only two patients. Neither SPN ≥ 5 mm (p = 0.579) nor SPN > 8 mm (p = 0.328) were significant predictors of overall survival. CONCLUSIONS Despite the high prevalence of SPNs in this single center TAVI cohort lung cancer incidence at midterm follow-up seems to be low. Thus, aggressive diagnostic approaches for incidentally discovered SPN during TAVI evaluation should not delay the treatment of aortic stenosis. Unless advanced thoracic malignancy is obvious, the well documented reduction of morbidity and mortality by TAVI outweighs potentially harmful delays regarding further diagnostics. Standard guideline-approved procedure for SPN can be safely performed after TAVI.
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Stang A, Kowall B, Schuler M, Darwiche K, Kühl H, Jöckel KH. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:297-298. [PMID: 27173409 PMCID: PMC4873674 DOI: 10.3238/arztebl.2016.0297b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Brenner H, Hoffmeister M, Stock C. Substantiated Modelling Instead of Flying Blind. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:297. [PMID: 27173408 PMCID: PMC4873673 DOI: 10.3238/arztebl.2016.0297a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Hermann Brenner
- *Abteilung Klinische Epidemiologie und Alternsforschung, Abteilung Präventive Onkologie and Deutsches Konsortium für Translationale Krebsforschung (DKTK), Deutsches Krebsforschungszentrum (DKFZ), Heidelberg,
| | | | - Christian Stock
- ***Institut für Medizinische Biometrie und Informatik, Universität Heidelberg
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Hense HW. Screening for Lung Cancer: Balancing Hope With Doubt About Applicability. DEUTSCHES ARZTEBLATT INTERNATIONAL 2015; 112:635-6. [PMID: 26429635 DOI: 10.3238/arztebl.2015.0635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Hans-Werner Hense
- Institute of Epidemi - ology and Social Medicine, University of Münster
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