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Lee J, Ahn HK, Kim S, Han J, Lee SS, Park HS, Lee HW, Kim J, Cho E, Huggenberger R, Cho BC. Real-world treatment patterns and clinical outcomes in patients with stage III NSCLC in Korea: The KINDLE study. Cancer Med 2024; 13:e7174. [PMID: 38622869 PMCID: PMC11019151 DOI: 10.1002/cam4.7174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/31/2024] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE KINDLE-Korea is part of a real-world KINDLE study that aimed to characterize the treatment patterns and clinical outcomes of patients with stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS The KINDLE was an international real-world study that explores patient and disease characteristics, treatment patterns, and survival outcomes. The KINDLE-Korea included stage III NSCLC patients diagnosed between January 2013 and December 2017. RESULTS A total of 461 patients were enrolled. The median age was 66 years (range: 24-87). Most patients were men (75.7%) with a history of smoking (74.0%), stage IIIA NSCLC (69.2%), and unresectable disease (52.9%). A total of 24.3% had activating EGFR mutation and 62.2% were positive for PDL1 expression. Broadly categorized, 44.6% of the patients received chemoradiation (CRT)-based therapy, 35.1% underwent surgery, and 20.3% received palliative therapies as initial treatment. The most commonly adopted approaches for patients with stage IIIA and IIIB disease were surgery and CRT, respectively. The median PFS was 15.2 months and OS was 66.7 months. Age >65 years, adenocarcinoma histology, and surgery as the initial treatment were significantly associated with longer OS. CONCLUSION This study revealed the heterogeneity of treatment patterns and survival outcomes in patients with stage III NSCLC before durvalumab consolidation came into clinical practice. There is an unmet need for patients who are not eligible for surgery as an initial therapy. Novel therapeutic approaches are highly warranted to improve clinical outcomes.
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Affiliation(s)
- Jiyun Lee
- Lung Cancer Center, Yonsei Cancer CenterYonsei University College of MedicineSeoulKorea
| | - Hee Kyung Ahn
- Department of Medical OncologyGachon University Gil Medical CenterIncheonKorea
| | - Sang‐We Kim
- Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Ji‐Youn Han
- Center for Lung Cancer, National Cancer CenterResearch Institute and HospitalGoyangKorea
| | - Sung Sook Lee
- Department of Hematology‐OncologyInje University Haeundae Paik HospitalBusanKorea
| | - Hyung Soon Park
- Division of Medical Oncology, Department of Internal Medicine, St. Vincent's HospitalThe Catholic University of KoreaSuwonKorea
| | - Hyun Woo Lee
- Department of Hematology‐OncologyAjou University School of MedicineSuwonKorea
| | - Joo‐Hang Kim
- CHA Bundang Medical CenterCHA UniversitySeongnamKorea
| | | | | | - Byoung Chul Cho
- Lung Cancer Center, Yonsei Cancer CenterYonsei University College of MedicineSeoulKorea
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Vicini S. Perspectives and limitations of Lung-RADS in different target populations: the power of systematic review and meta-analysis. Eur Radiol 2024; 34:1875-1876. [PMID: 37646817 DOI: 10.1007/s00330-023-10156-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/16/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Simone Vicini
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome - Academic Diagnostic Imaging Division, I.C.O.T. Hospital, Via Franco Faggiana 1668, 04100, Latina, LT, Italy.
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Mao Y, Cai J, Heuvelmans MA, Vliegenthart R, Groen HJM, Oudkerk M, Vonder M, Dorrius MD, de Bock GH. Performance of Lung-RADS in different target populations: a systematic review and meta-analysis. Eur Radiol 2024; 34:1877-1892. [PMID: 37646809 PMCID: PMC10873443 DOI: 10.1007/s00330-023-10049-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Multiple lung cancer screening studies reported the performance of Lung CT Screening Reporting and Data System (Lung-RADS), but none systematically evaluated its performance across different populations. This systematic review and meta-analysis aimed to evaluate the performance of Lung-RADS (versions 1.0 and 1.1) for detecting lung cancer in different populations. METHODS We performed literature searches in PubMed, Web of Science, Cochrane Library, and Embase databases on October 21, 2022, for studies that evaluated the accuracy of Lung-RADS in lung cancer screening. A bivariate random-effects model was used to estimate pooled sensitivity and specificity, and heterogeneity was explored in stratified and meta-regression analyses. RESULTS A total of 31 studies with 104,224 participants were included. For version 1.0 (27 studies, 95,413 individuals), pooled sensitivity was 0.96 (95% confidence interval [CI]: 0.90-0.99) and pooled specificity was 0.90 (95% CI: 0.87-0.92). Studies in high-risk populations showed higher sensitivity (0.98 [95% CI: 0.92-0.99] vs. 0.84 [95% CI: 0.50-0.96]) and lower specificity (0.87 [95% CI: 0.85-0.88] vs. 0.95 (95% CI: 0.92-0.97]) than studies in general populations. Non-Asian studies tended toward higher sensitivity (0.97 [95% CI: 0.91-0.99] vs. 0.91 [95% CI: 0.67-0.98]) and lower specificity (0.88 [95% CI: 0.85-0.90] vs. 0.93 [95% CI: 0.88-0.96]) than Asian studies. For version 1.1 (4 studies, 8811 individuals), pooled sensitivity was 0.91 (95% CI: 0.83-0.96) and specificity was 0.81 (95% CI: 0.67-0.90). CONCLUSION Among studies using Lung-RADS version 1.0, considerable heterogeneity in sensitivity and specificity was noted, explained by population type (high risk vs. general), population area (Asia vs. non-Asia), and cancer prevalence. CLINICAL RELEVANCE STATEMENT Meta-regression of lung cancer screening studies using Lung-RADS version 1.0 showed considerable heterogeneity in sensitivity and specificity, explained by the different target populations, including high-risk versus general populations, Asian versus non-Asian populations, and populations with different lung cancer prevalence. KEY POINTS • High-risk population studies showed higher sensitivity and lower specificity compared with studies performed in general populations by using Lung-RADS version 1.0. • In non-Asian studies, the diagnostic performance of Lung-RADS version 1.0 tended to be better than in Asian studies. • There are limited studies on the performance of Lung-RADS version 1.1, and evidence is lacking for Asian populations.
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Affiliation(s)
- Yifei Mao
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands
| | - Jiali Cai
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands
| | - Marjolein A Heuvelmans
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands
| | - Matthijs Oudkerk
- Institute for Diagnostic Accuracy, Prof. Wiersmastraat 5, 9713 GH, Groningen, the Netherlands
| | - Marleen Vonder
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands
| | - Monique D Dorrius
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands
- Department of Radiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9700 RB, Groningen, the Netherlands.
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Kim Y, Lee J, Lee E, Lim J, Kim Y, Lee CT, Jang SH, Paek YJ, Lee WC, Lee CW, Kim HY, Goo JM, Choi KS, Park B, Lee DH, Seo HG. Strategies to Improve Smoking Cessation for Participants in Lung Cancer Screening Program: Analysis of Factors Associated with Smoking Cessation in Korean Lung Cancer Screening Project (K-LUCAS). Cancer Res Treat 2024; 56:92-103. [PMID: 37562437 PMCID: PMC10789955 DOI: 10.4143/crt.2022.1598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/05/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Smoking cessation intervention is one of the key components of successful lung cancer screening program. We investigated the effectiveness and related factors of smoking cessation services provided to the participants in a population-based lung cancer screening trial. MATERIALS AND METHODS The Korean Lung Cancer Screening Project (K-LUCAS) is a nationwide, multi-center lung cancer screening trial that evaluates the feasibility of implementing population-based lung cancer screening. All 5,144 current smokers who participated in the K-LUCAS received a mandatory smoking cessation counseling. Changes in smoking status were followed up using a telephone survey in 6 months after lung cancer screening participation. The lung cancer screening's impact on smoking cessation is analyzed by variations in the smoking cessation interventions provided in screening units. RESULTS Among 4,136 survey responders, participant's motivation to quit smoking increased by 9.4% on average after lung cancer screening. After 6 months from the initial screening, 24.3% of participants stopped smoking, and 10.6% of participants had not smoked continuously for at least 6 months after screening. Over 80% of quitters stated that participation in lung cancer screening motivated them to quit smoking. Low-cost public smoking cessation program combined with lung cancer screening increased the abstinence rates. The smokers were three times more likely to quit smoking when the smoking cessation counseling was provided simultaneously with low-dose computed tomography screening results than when provided separately. CONCLUSION A mandatory smoking cessation intervention integrated with screening result counselling by a physician after participation in lung cancer screening could be effective for increasing smoking cessation attempts.
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Affiliation(s)
- Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jaeho Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eunju Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Juntae Lim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yonghyun Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Choon-Taek Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hun Jang
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yu-Jin Paek
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Won-Chul Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Wha Lee
- Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea
| | - Hyae Young Kim
- Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Duk Hyoung Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hong Gwan Seo
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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Cho MK, Cho YH. Factors influencing the intention for lung cancer screening in high-risk populations for lung cancer. Asia Pac J Oncol Nurs 2024; 11:100332. [PMID: 38192279 PMCID: PMC10772583 DOI: 10.1016/j.apjon.2023.100332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/29/2023] [Indexed: 01/10/2024] Open
Abstract
Objective Utilizing low-dose computed tomography for lung cancer screening has proven effective in reducing lung cancer mortality among high-risk individuals. This study aimed to investigate the health beliefs, knowledge of lung cancer, and cancer prevention behaviors in adults at high risk for lung cancer, with the goal of identifying predictors influencing their intention to undergo lung cancer screening. Methods The study utilized a descriptive cross-sectional design. Online questionnaires, including assessments of lung cancer screening health beliefs, knowledge of lung cancer, cancer prevention behaviors, intention to undergo lung cancer screening, and participant characteristics, were distributed to 186 individuals at high risk of lung cancer through a survey link. The data collection period spanned from April 26 to May 3, 2023. Analytical procedures encompassed descriptive statistics, independent t-test, one-way ANOVA, Pearson's correlations, and hierarchical multiple regression. Results The mean score for the intention to undergo lung cancer screening in our study was 3.66 out of 5. The regression model explaining the intention to undergo lung cancer screening accounted for 34.7% of the variance. Significant factors identified included stress level (β = 0.20, P = 0.002), perceived risk (β = 0.13, P = 0.040), self-efficacy (β = 0.35, P < 0.001), and engagement in cancer prevention behavior (β = 0.26, P < 0.001). Conclusions Healthcare providers should implement psychological interventions and provide education about cancer screening for high-risk individuals, aiming to enhance their perceived risk and self-efficacy, thus promoting a higher likelihood of undergoing screening.
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Affiliation(s)
- Mi-Kyoung Cho
- Department of Nursing Science, Chungbuk National University, Cheongju, Republic of Korea
| | - Yoon Hee Cho
- Department of Nursing, College of Nursing, Dankook University, Cheonan, Republic of Korea
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Kim W, Lee SC, Lee WR, Chun S. The effect of the introduction of the national lung cancer screening program on short-term mortality in Korea. Lung Cancer 2023; 186:107412. [PMID: 37856923 DOI: 10.1016/j.lungcan.2023.107412] [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: 08/28/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND South Korea introduced the National Lung Cancer Screening Program (NLCSP) in 2019. This study investigated the effect of the NLCSP on one-year mortality in individuals with a history of lung cancer. METHODS This study used the 2018-2020 National Health Insurance Service claims data. The difference-in-differences approach was used to investigate the effect of participating in the NLCSP between the case and control groups before and after the intervention period. The case group included individuals aged between 54 and 74 years with a smoking history of ≥ 30 pack-years and the control group those aged between 54 and 74 years with a history of smoking of <30 pack-years and non-smokers. The pre-intervention period was from January 2018 to June 2019 and the post-intervention period from July 2019 to December 2020. RESULTS The introduction of the NLCSP was related to an overall decrease in one-year mortality (-3.21 % points, 95 % Confidence Interval (CI) -4.84 to -1.58). Specifically, this reduction was significant for lung cancer related mortality (lung cancer: -2.69 % points, 95 % CI -4.24 to -1.13). Furthermore, stronger associations were found in individuals of older age, residing in non-metropolitan areas, and who visited healthcare institutions in non-metropolitan areas. CONCLUSION The findings confirm a relationship between implementation of the NLCSP and one-year mortality in eligible individuals with a history of lung cancer, which is noteworthy considering that Korea is one of the first countries to include lung cancer into the national cancer screening program.
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Affiliation(s)
- Woorim Kim
- National Hospice Center, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea; Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, Goyang-si, Republic of Korea
| | - Sang Chul Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Woo-Ri Lee
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Sungyoun Chun
- Department of Research and Analysis, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea.
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Maharjan A, Gautam R, Acharya M, Jo J, Lee D, K C PB, Lee YA, Kwon JT, Kim H, Kim K, Kim C, Kim H, Heo Y. Association of immunotoxicological indices with lung cancer biomarkers in poultry, grape, and rose farming workers. Toxicol Res 2023; 39:739-747. [PMID: 37779584 PMCID: PMC10541357 DOI: 10.1007/s43188-023-00199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/08/2023] [Accepted: 06/18/2023] [Indexed: 10/03/2023] Open
Abstract
Exposure to occupational hazards like dust, pesticides, diesel emission particles, or physical hazards in the agricultural sector is known to cause adverse health effects on farm workers. Our study aimed at addressing the association of immunomodulatory status with plasma levels of lung cancer biomarkers in farming population, attempting to recognition of vulnerable farming group. Blood samples from apparently healthy 51 chicken husbandry, 19 grape orchard, and 21 rose greenhouse workers were subjected to evaluate plasma levels of two representative lung cancer biomarkers, pro-gastrin releasing peptide (Pro-GRP) and cytokeratin fragment 19 (CYFRA 21-1). Peripheral blood mononuclear cells obtained from farmers were used for natural killer (NK) cell phenotyping and cytokines (interferon-gamma, IFN-γ and interleukin-13, IL-13) profiling in the culture supernatant. Compared to the rose greenhouse farmers, the grape orchard and chicken husbandry workers revealed a significantly upregulated plasma Pro-GRP and CYFRA 21-1 level. A low proportion of NK cells was observed among the female grape orchard workers and a lowered IFN- γ:IL-13 ratio was seen in the grape and chicken husbandry workers than the rose workers. Our findings imply that grape orchard and chicken husbandry workers have more disturbed immune homeostasis implicated with augmentation in the levels of lung cancer biomarkers than the rose greenhouse workers.
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Affiliation(s)
- Anju Maharjan
- Department of Occupational Health, College of Bio and Medical Sciences, Daegu Catholic University, 13-13, Hayang-Ro, Gyeongsan-Si, Gyeongsan, 38430 Republic of Korea
| | - Ravi Gautam
- Department of Occupational Health, College of Bio and Medical Sciences, Daegu Catholic University, 13-13, Hayang-Ro, Gyeongsan-Si, Gyeongsan, 38430 Republic of Korea
| | - Manju Acharya
- Department of Occupational Health, College of Bio and Medical Sciences, Daegu Catholic University, 13-13, Hayang-Ro, Gyeongsan-Si, Gyeongsan, 38430 Republic of Korea
| | - JiHun Jo
- Department of Occupational Health, College of Bio and Medical Sciences, Daegu Catholic University, 13-13, Hayang-Ro, Gyeongsan-Si, Gyeongsan, 38430 Republic of Korea
| | - DaEun Lee
- Department of Occupational Health, College of Bio and Medical Sciences, Daegu Catholic University, 13-13, Hayang-Ro, Gyeongsan-Si, Gyeongsan, 38430 Republic of Korea
| | - Pramod Bahadur K C
- Graduate School Department of Toxicology, Daegu Catholic University, Gyeongsan, 38430 Republic of Korea
| | - Young-A Lee
- Department of Food Science and Nutrition, College of Bio and Medical Sciences, Daegu Catholic University, 38430 Gyeongsan, Republic of Korea
| | - Jung-Taek Kwon
- Environmental Health Research Department, National Institute of Environmental Research, Incheon, 22689 Republic of Korea
| | - HyoCher Kim
- Rural Development Administration, National Institute of Agricultural Sciences, Jeonju, 54875 Republic of Korea
| | - KyungRan Kim
- Rural Development Administration, National Institute of Agricultural Sciences, Jeonju, 54875 Republic of Korea
| | - ChangYul Kim
- Graduate School Department of Toxicology, Daegu Catholic University, Gyeongsan, 38430 Republic of Korea
| | - HyoungAh Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, 06591 Republic of Korea
| | - Yong Heo
- Department of Occupational Health, College of Bio and Medical Sciences, Daegu Catholic University, 13-13, Hayang-Ro, Gyeongsan-Si, Gyeongsan, 38430 Republic of Korea
- Graduate School Department of Toxicology, Daegu Catholic University, Gyeongsan, 38430 Republic of Korea
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Chae KJ, Lim S, Seo JB, Hwang HJ, Choi H, Lynch D, Jin GY. Interstitial Lung Abnormalities at CT in the Korean National Lung Cancer Screening Program: Prevalence and Deep Learning-based Texture Analysis. Radiology 2023; 307:e222828. [PMID: 37097142 DOI: 10.1148/radiol.222828] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Background Interstitial lung abnormalities (ILAs) are associated with worse clinical outcomes, but ILA with lung cancer screening CT has not been quantitatively assessed. Purpose To determine the prevalence of ILA at CT examinations from the Korean National Lung Cancer Screening Program and define an optimal lung area threshold for ILA detection with CT with use of deep learning-based texture analysis. Materials and Methods This retrospective study included participants who underwent chest CT between April 2017 and December 2020 at two medical centers participating in the Korean National Lung Cancer Screening Program. CT findings were classified by three radiologists into three groups: no ILA, equivocal ILA, and ILA (fibrotic and nonfibrotic). Progression was evaluated between baseline and last follow-up CT scan. The extent of ILA was assessed visually and quantitatively with use of deep learning-based texture analysis. The Youden index was used to determine an optimal cutoff value for detecting ILA with use of texture analysis. Demographics and ILA subcategories were compared between participants with progressive and nonprogressive ILA. Results A total of 3118 participants were included in this study, and ILAs were observed with the CT scans of 120 individuals (4%). The median extent of ILA calculated by the quantitative system was 5.8% for the ILA group, 0.7% for the equivocal ILA group, and 0.1% for the no ILA group (P < .001). A 1.8% area threshold in a lung zone for quantitative detection of ILA showed 100% sensitivity and 99% specificity. Progression was observed in 48% of visually assessed fibrotic ILAs (15 of 31), and quantitative extent of ILA increased by 3.1% in subjects with progression. Conclusion ILAs were detected in 4% of the Korean lung cancer screening population. Deep learning-based texture analysis showed high sensitivity and specificity for detecting ILA with use of a 1.8% lung area cutoff value. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Egashira and Nishino in this issue.
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Affiliation(s)
- Kum Ju Chae
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro Deokjin-gu, Jeonju-si, Jeollabuk-do, Korea 54907 (K.J.C., G.Y.J.); Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C., H.J.H., D.L.); Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea (S.L.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.B.S., H.J.H.); and Department of Statistics and Institute of Applied Statistics, Jeonbuk National University, Jeonju, Republic of Korea (H.C.)
| | - Soyeoun Lim
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro Deokjin-gu, Jeonju-si, Jeollabuk-do, Korea 54907 (K.J.C., G.Y.J.); Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C., H.J.H., D.L.); Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea (S.L.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.B.S., H.J.H.); and Department of Statistics and Institute of Applied Statistics, Jeonbuk National University, Jeonju, Republic of Korea (H.C.)
| | - Joon Beom Seo
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro Deokjin-gu, Jeonju-si, Jeollabuk-do, Korea 54907 (K.J.C., G.Y.J.); Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C., H.J.H., D.L.); Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea (S.L.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.B.S., H.J.H.); and Department of Statistics and Institute of Applied Statistics, Jeonbuk National University, Jeonju, Republic of Korea (H.C.)
| | - Hye Jeon Hwang
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro Deokjin-gu, Jeonju-si, Jeollabuk-do, Korea 54907 (K.J.C., G.Y.J.); Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C., H.J.H., D.L.); Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea (S.L.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.B.S., H.J.H.); and Department of Statistics and Institute of Applied Statistics, Jeonbuk National University, Jeonju, Republic of Korea (H.C.)
| | - Hyemi Choi
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro Deokjin-gu, Jeonju-si, Jeollabuk-do, Korea 54907 (K.J.C., G.Y.J.); Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C., H.J.H., D.L.); Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea (S.L.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.B.S., H.J.H.); and Department of Statistics and Institute of Applied Statistics, Jeonbuk National University, Jeonju, Republic of Korea (H.C.)
| | - David Lynch
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro Deokjin-gu, Jeonju-si, Jeollabuk-do, Korea 54907 (K.J.C., G.Y.J.); Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C., H.J.H., D.L.); Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea (S.L.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.B.S., H.J.H.); and Department of Statistics and Institute of Applied Statistics, Jeonbuk National University, Jeonju, Republic of Korea (H.C.)
| | - Gong Yong Jin
- From the Department of Radiology, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonjiro Deokjin-gu, Jeonju-si, Jeollabuk-do, Korea 54907 (K.J.C., G.Y.J.); Department of Radiology, Jeonbuk National University Medical School, Jeonju, Korea (K.J.C., G.Y.J.); Department of Radiology, National Jewish Health, Denver, Colo (K.J.C., H.J.H., D.L.); Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea (S.L.); Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (J.B.S., H.J.H.); and Department of Statistics and Institute of Applied Statistics, Jeonbuk National University, Jeonju, Republic of Korea (H.C.)
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9
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Chi SA, Yu H, Choi YL, Park S, Sun JM, Lee SH, Ahn JS, Ahn MJ, Choi DH, Kim K, Jung HA, Park K. Trends in Survival Rates of Non-Small Cell Lung Cancer With Use of Molecular Testing and Targeted Therapy in Korea, 2010-2020. JAMA Netw Open 2023; 6:e232002. [PMID: 36929402 PMCID: PMC10020884 DOI: 10.1001/jamanetworkopen.2023.2002] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
IMPORTANCE Over the past 10 years, treatment of non-small cell lung cancer (NSCLC) has been continually revolutionized. However, standard clinical trials may not reflect current multiple lines of treatment and corresponding outcomes in a timely manner. OBJECTIVE To investigate outcomes associated with new treatment of NSCLC in a clinical setting. DESIGN, SETTING, AND PARTICIPANTS This cohort study included patients with NSCLC between January 1, 2010, and November 30, 2020, who received any anticancer treatment at Samsung Medical Center in Korea. Data were analyzed from November 2021 through February 2022. EXPOSURES Clinical and pathological stage, histology, and major druggable sequence variation, including epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), ROS1, RET, MET exon 14 skipping, BRAF V600E, KRAS G12C, and NTRK between 2 periods (period I: 2010-2015 vs period II: 2016-2020). MAIN OUTCOMES AND MEASURES The primary outcome was the 3-year survival rate of NSCLC. Secondary outcomes included median overall survival, progression-free survival, and recurrence-free survival. RESULTS Among 21 978 patients with NSCLC (median [range] age at diagnosis, 64.1 [57.0-71.0] years; 13 624 males [62.0%]), there were 10 110 patients in period I and 11 868 patients in period II; adenocarcinoma (AD) was the predominant histology (7112 patients [70.3%] in period I and 8813 patients [74.3%] in period II). There were 4224 never smokers [41.8%] in period I and 5292 never smokers [44.6%] in period II. Compared with patients in period I, patients during period II were more likely to undergo molecular tests in the AD (5678 patients [79.8%] vs 8631 patients [97.9%]) and non-AD (1612 of 2998 patients [53.8%] and 2719 of 3055 patients [89.0%]) groups. In patients with AD in period I, 3-year survival rates were 92.8% (95% CI, 91.8%-93.7%), 72.4% (95% CI, 68.3%-76.8%), 56.7% (95% CI, 53.4%-60.2%), and 28.7% (95% CI, 27.0%-30.4%) for stage I, II, III, and IV, respectively. In period II, 3-year survival rates of patients with AD were 95.1% (95% CI, 94.4%-95.9%), 82.5% (95% CI, 79.1%-86.1%), 65.1% (95% CI, 61.8%-68.6%), and 42.4% (95% CI, 40.3%-44.7%) for each stage, respectively. In patients without AD, 3-year survival rates were 72.0% (95% CI, 68.8%-75.3%), 60.0% (95% CI, 56.2%-64.1%), 38.9% (95% CI, 35.6%-42.5%), and 9.7% (95% CI, 7.9%-12.1%) for each stage in period I. In period II, the 3-year survival rates of patients without AD were 79.3% (95% CI, 76.3%-82.4%), 67.3% (95% CI, 62.8%-72.1%), 48.2% (95% CI, 44.5%-52.3%), and 18.1% (95% CI, 15.1%-21.6%) for each stage. CONCLUSIONS AND RELEVANCE In this cohort study of 10 years of clinical data, survival outcomes were improved across all stages, with larger increases in patients with stage III to IV disease. The incidence of never-smokers and the use of molecular testing increased.
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Affiliation(s)
- Sang Ah Chi
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hyeyeon Yu
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon-La Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sehhoon Park
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Mu Sun
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Se-Hoon Lee
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Ahn
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae-Ho Choi
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Department of Data Convergence and Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hyun Ae Jung
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keunchil Park
- Division of Hematology Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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10
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Jin GY. [Lung Imaging Reporting and Data System (Lung-RADS) in Radiology: Strengths, Weaknesses and Improvement]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:34-50. [PMID: 36818696 PMCID: PMC9935959 DOI: 10.3348/jksr.2022.0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/05/2022] [Accepted: 12/27/2022] [Indexed: 06/18/2023]
Abstract
In 2019, the American College of Radiology announced Lung CT Screening Reporting & Data System (Lung-RADS) 1.1 to reduce lung cancer false positivity compared to that of Lung-RADS 1.0 for effective national lung cancer screening, and in December 2022, announced the new Lung-RADS 1.1, Lung-RADS® 2022 improvement. The Lung-RADS® 2022 measures the nodule size to the first decimal place compared to that of the Lung-RADS 1.0, to category 2 until the juxtapleural nodule size is < 10 mm, increases the size criterion of the ground glass nodule to 30 mm in category 2, and changes categories 4B and 4X to extremely suspicious. The category was divided according to the airway nodules location and shape or wall thickness of atypical pulmonary cysts. Herein, to help radiologists understand the Lung-RADS® 2022, this review will describe its advantages, disadvantages, and future improvements.
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11
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Nightingale C, Bavor C, Stone E, Rankin NM. Lung Cancer Screening: Implementation Challenges and Health Equity Considerations For the Western Pacific Region. JCO Glob Oncol 2023; 9:e2200329. [PMID: 36749907 PMCID: PMC10166439 DOI: 10.1200/go.22.00329] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Claire Nightingale
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Claire Bavor
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Emily Stone
- Department of Lung Transplantation and Thoracic Medicine, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Nicole M Rankin
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Sydney School of Public Health, The University of Sydney, Camperdown, Australia
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12
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Lee JH, Hwang EJ, Lim WH, Goo JM. Determination of the optimum definition of growth evaluation for indeterminate pulmonary nodules detected in lung cancer screening. PLoS One 2022; 17:e0274583. [PMID: 36108077 PMCID: PMC9477274 DOI: 10.1371/journal.pone.0274583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
To determine the optimum definition of growth for indeterminate pulmonary nodules detected in lung cancer screening.
Materials and methods
Individuals with indeterminate nodules as defined by volume of 50–500 mm3 (solid nodules) and solid component volume of 50–500 mm3 or average diameter of non-solid component ≥8 mm (part-solid nodules) on baseline lung cancer screening low-dose chest CT (LDCT) were included. The average diameters and volumes of the nodules were measured on baseline and follow-up LDCTs with semi-automated segmentation. Sensitivities and specificities for lung cancer diagnosis of nodule growth defined by a) percentage volume growth ≥25% (defined in the NELSON study); b) absolute diameter growth >1.5 mm (defined in the Lung-RADS version 1.1); and c) subjective decision by a radiologist were evaluated. Sensitivities and specificities of diagnostic referral based on various thresholds of volume doubling time (VDT) were also evaluated.
Results
Altogether, 115 nodules (one nodule per individual; 93 solid and 22 part-solid nodules; 105 men; median age, 68 years) were evaluated (median follow-up interval: 201 days; interquartile range: 127–371 days). Percentage volume growth ≥25% exhibited higher sensitivity but lower specificity than those of diametrical measurement compared to absolute diameter growth >1.5 mm (sensitivity, 69.2% vs. 42.3%, p = 0.023; specificity, 82.0% vs. 96.6%, p = 0.002). The radiologist had an equivalent sensitivity (53.9%; p = 0.289) but higher specificity (98.9%; p = 0.002) compared to those of volume growth, but did not differ from those of diameter growth (p>0.05 both in sensitivity and specificity). Compared to the VDT threshold of 600 days (sensitivity, 61.5%; specificity, 87.6%), VDT thresholds ≤200 and ≤300 days exhibited significantly lower sensitivity (30.8%, p = 0.013) and higher specificity (94.4%, p = 0.041), respectively.
Conclusion
Growth evaluation of screening-detected indeterminate nodules with volumetric measurement exhibited higher sensitivity but lower specificity compared to diametric measurements.
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Affiliation(s)
- Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- * E-mail:
| | - Woo Hyeon Lim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
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13
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Luu T. Reduced Cancer Screening Due to Lockdowns of the COVID-19 Pandemic: Reviewing Impacts and Ways to Counteract the Impacts. Front Oncol 2022; 12:955377. [PMID: 35965514 PMCID: PMC9372444 DOI: 10.3389/fonc.2022.955377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has created disruptions in health services in general and cancer screening and diagnostic services in particular, leading to diminished cancer screening participation rates. This paper aims to seek insights into impacts that the pandemic has had on cancer screening, impacts that reduced cancer screening may have in the long run, and how to address such impacts. The paper demonstrates that reduced cancer screening in the pandemic is likely to result in enhanced demands for cancer screening in the new normal, enhanced demands for resources to address such demands, and poor prognosis due to stage migration of cancer diseases. Some measures are recommended for counteracting these impacts.
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14
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Lee K, Kang S, Hwang J. Lung Cancer Patients' Characteristics and Comorbidities Using the Korean National Hospital Discharge In-depth Injury Survey Data. J Epidemiol Glob Health 2022; 12:258-266. [PMID: 35648377 PMCID: PMC9470800 DOI: 10.1007/s44197-022-00044-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 05/09/2022] [Indexed: 12/01/2022] Open
Abstract
Background The aim of this study was to assess the incidence of lung cancer and comorbidities in Korea and analyze the lung cancer patient’s characteristics and their comorbidities over the past 12 years. This study also aimed to investigate factors related to death as treatment outcome in discharged lung cancer patients. Methods This study analyzed the data obtained from the Korean National Hospital Discharge In-depth Injury Survey from 2006 to 2017. The quantity of discharged lung cancer patients was assessed by year. Comorbidities were limited to those included in the Elixhauser Comorbidity Index (ECI). A Chi-square test was performed to determine statistically significant differences in the distributions of the ECI and ECI scores according to the presence or absence of metastatic cancer. Logistic regression analysis was used to analyze factors related to death as treatment outcome. Results From 2006 to 2017, the number of discharged male and female patients with lung cancer increased from 31,720 to 42,016 and 10,897 to 18,197, respectively. The increase in the number of lung cancer patients was greater in women than in men (67.0% vs. 32.5%, respectively). The most common associated comorbidities were hypertension, diabetes, and chronic pulmonary disease. The factors related to death as treatment outcome were found to include sex, admission route, number of hospital beds, length of stay, presence or absence of metastatic cancer, and ECI score. Conclusion The number of lung cancer patients in Korea has increased, and a high proportion of these patients have chronic diseases, which negatively would impact the treatment and outcome of lung cancer patients as well as their quality of life. Thus, the management of chronic diseases needs to be prioritized in patients with lung cancer.
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Affiliation(s)
- Kyunghee Lee
- Department of Healthcare Management, Eulji University, 553 Sanseongdae-ro, Sujeong-gu, Seongnam, Kyeonggi-do, 13135, South Korea
| | - Sunghong Kang
- Department of Health Policy and Management, Inje University, 197 Inje-ro, Kimhae, Kyungsangnam-do, 50834, South Korea
| | - Jieun Hwang
- College of Health Science, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungcheongnam-do, 31116, South Korea.
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15
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Goo JM, Jung KW, Kim HY, Kim Y. Potential Overdiagnosis with CT Lung Cancer Screening in Taiwanese Female: Status in South Korea. Korean J Radiol 2022; 23:571-573. [PMID: 35617992 PMCID: PMC9174499 DOI: 10.3348/kjr.2022.0190] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology and Institution of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea.
| | - Kyu-Won Jung
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyae Young Kim
- Department of Radiology, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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16
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Li C, Wang H, Jiang Y, Fu W, Liu X, Zhong R, Cheng B, Zhu F, Xiang Y, He J, Liang W. Advances in lung cancer screening and early detection. Cancer Biol Med 2022; 19:j.issn.2095-3941.2021.0690. [PMID: 35535966 PMCID: PMC9196057 DOI: 10.20892/j.issn.2095-3941.2021.0690] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
Lung cancer is associated with a heavy cancer-related burden in terms of patients' physical and mental health worldwide. Two randomized controlled trials, the US-National Lung Screening Trial (NLST) and Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON), indicated that low-dose CT (LDCT) screening results in a statistically significant decrease in mortality in patients with lung cancer, LDCT has become the standard approach for lung cancer screening. However, many issues in lung cancer screening remain unresolved, such as the screening criteria, high false-positive rate, and radiation exposure. This review first summarizes recent studies on lung cancer screening from the US, Europe, and Asia, and discusses risk-based selection for screening and the related issues. Second, an overview of novel techniques for the differential diagnosis of pulmonary nodules, including artificial intelligence and molecular biomarker-based screening, is presented. Third, current explorations of strategies for suspected malignancy are summarized. Overall, this review aims to help clinicians understand recent progress in lung cancer screening and alleviate the burden of lung cancer.
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Affiliation(s)
- Caichen Li
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Huiting Wang
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Yu Jiang
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Wenhai Fu
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Xiwen Liu
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Ran Zhong
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Bo Cheng
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
| | - Feng Zhu
- Department of Internal Medicine, Detroit Medical Center Sinai-Grace Hospital, Detroit, Michigan 48235, USA
| | - Yang Xiang
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Jianxing He
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
- Department of Thoracic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China
| | - Wenhua Liang
- Department of Thoracic Oncology and Surgery, the First Affiliated Hospital of Guangzhou Medical University, China National Center for Respiratory Medicine, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
- Dongguan Affiliated Hospital of Southern Medical University, Dongguan People Hospital, Dongguan 523059, China
- Department of Oncology, the First People’s Hospital of Zhaoqing, Zhaoqing 526020, China
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17
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Goncalves S, Fong PC, Blokhina M. Artificial intelligence for early diagnosis of lung cancer through incidental nodule detection in low- and middle-income countries-acceleration during the COVID-19 pandemic but here to stay. Am J Cancer Res 2022; 12:1-16. [PMID: 35141002 PMCID: PMC8822269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/27/2021] [Indexed: 06/14/2023] Open
Abstract
Although the coronavirus disease of 2019 (COVID-19) pandemic had profound pernicious effects, it revealed deficiencies in health systems, particularly among low- and middle-income countries (LMICs). With increasing uncertainty in healthcare, existing unmet needs such as poor outcomes of lung cancer (LC) patients in LMICs, mainly due to late stages at diagnosis, have been challenging-necessitating a shift in focus for judicious health resource utilization. Leveraging artificial intelligence (AI) for screening large volumes of pulmonary images performed for noncancerous reasons, such as health checks, immigration, tuberculosis screening, or other lung conditions, including but not limited to COVID-19, can facilitate easy and early identification of incidental pulmonary nodules (IPNs), which otherwise could have been missed. AI can review every chest X-ray or computed tomography scan through a trained pair of eyes, thus strengthening the infrastructure and enhancing capabilities of manpower for interpreting images in LMICs for streamlining accurate and early identification of IPNs. AI can be a catalyst for driving LC screening with enhanced efficiency, particularly in primary care settings, for timely referral and adequate management of coincidental IPN. AI can facilitate shift in the stage of LC diagnosis for improving survival, thus fostering optimal health-resource utilization and sustainable healthcare systems resilient to crisis. This article highlights the challenges for organized LC screening in LMICs and describes unique opportunities for leveraging AI. We present pilot initiatives from Asia, Latin America, and Russia illustrating AI-supported IPN identification from routine imaging to facilitate early diagnosis of LC at a potentially curable stage.
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Affiliation(s)
- Susana Goncalves
- Medical Director, AstraZeneca LatAm AreaNicolás de Vedia 3616, 8° Piso (C1430DAH) CABA, República Argentina
| | - Pei-Chieh Fong
- Head of Oncology, International MedicalAstraZeneca 21st Fl., 207, Tun Hwa South Road, Sec. 2, Taipei 10602, Taiwan
| | - Mariya Blokhina
- Therapeutic Area Lead, AstraZeneca1st Krasnogvardeyskiy Proezd 21, Building 1, Moscow 123100, Russian Federation
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18
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Field JK, Vulkan D, Davies MP, Baldwin DR, Brain KE, Devaraj A, Eisen T, Gosney J, Green BA, Holemans JA, Kavanagh T, Kerr KM, Ledson M, Lifford KJ, McRonald FE, Nair A, Page RD, Parmar MK, Rassl DM, Rintoul RC, Screaton NJ, Wald NJ, Weller D, Whynes DK, Williamson PR, Yadegarfar G, Gabe R, Duffy SW. Lung cancer mortality reduction by LDCT screening: UKLS randomised trial results and international meta-analysis. THE LANCET REGIONAL HEALTH. EUROPE 2021; 10:100179. [PMID: 34806061 PMCID: PMC8589726 DOI: 10.1016/j.lanepe.2021.100179] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial. METHODS From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation to screening with LDCT or to no screening (usual care). Eligible participants (aged 50-75) had a risk score (LLPv2) ≥ 4.5% of developing lung cancer over five years. Data were collected on lung cancer cases to 31 December 2019 and deaths to 29 February 2020 through linkage to national registries. The primary outcome was mortality due to lung cancer. We included our results in a random-effects meta-analysis to provide a synthesis of the latest randomised trial evidence. FINDINGS 1 987 participants in the intervention and 1 981 in the usual care arms were followed for a median of 7.3 years (IQR 7.1-7.6), 86 cancers were diagnosed in the LDCT arm and 75 in the control arm. 30 lung cancer deaths were reported in the screening arm, 46 in the control arm, (relative rate 0.65 [95% CI 0.41-1.02]; p=0.062). The meta-analysis indicated a significant reduction in lung cancer mortality with a pooled overall relative rate of 0.84 (95% CI 0.76-0.92) from nine eligible trials. INTERPRETATION The UKLS trial of single LDCT indicates a reduction of lung cancer death of similar magnitude to the NELSON and NLST trials and was included in a meta-analysis of nine randomised trials which provides unequivocal support for lung cancer screening in identified risk groups. FUNDING NIHR Health Technology Assessment programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation.
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Affiliation(s)
- John K. Field
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Daniel Vulkan
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Michael P.A. Davies
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Kate E. Brain
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, and National Heart and Lung Institute, Imperial College, London, UK
| | - Tim Eisen
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - John Gosney
- Department of Pathology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Beverley A. Green
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - John A. Holemans
- Department of Radiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Keith M. Kerr
- Department of Pathology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Martin Ledson
- Department of Respiratory Medicine, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Kate J. Lifford
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Fiona E. McRonald
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Arjun Nair
- Department of Radiology, University College, London Hospital, London, UK
| | - Richard D. Page
- Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Doris M. Rassl
- Department of Pathology, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Robert C. Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas J. Screaton
- Department of Thoracic Oncology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicholas J. Wald
- Faculty of Population Health Sciences, University College London, London, UK
| | - David Weller
- School of Clinical Sciences and Community Health, University of Edinburgh, Edinburgh, UK
| | - David K. Whynes
- School of Economics, University of Nottingham, Nottingham, UK
| | | | - Gasham Yadegarfar
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Rhian Gabe
- Center for Evaluation and Methods, Wolfson Institute of Population Health. Queen Mary University of London, London, UK
| | - Stephen W. Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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19
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Jacobs C, Schreuder A, van Riel SJ, Scholten ET, Wittenberg R, Wille MMW, de Hoop B, Sprengers R, Mets OM, Geurts B, Prokop M, Schaefer-Prokop C, van Ginneken B. Assisted versus Manual Interpretation of Low-Dose CT Scans for Lung Cancer Screening: Impact on Lung-RADS Agreement. Radiol Imaging Cancer 2021; 3:e200160. [PMID: 34559005 DOI: 10.1148/rycan.2021200160] [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] [Indexed: 12/17/2022]
Abstract
Purpose To compare the inter- and intraobserver agreement and reading times achieved when assigning Lung Imaging Reporting and Data System (Lung-RADS) categories to baseline and follow-up lung cancer screening studies by using a dedicated CT lung screening viewer with integrated nodule detection and volumetric support with those achieved by using a standard picture archiving and communication system (PACS)-like viewer. Materials and Methods Data were obtained from the National Lung Screening Trial (NLST). By using data recorded by NLST radiologists, scans were assigned to Lung-RADS categories. For each Lung-RADS category (1 or 2, 3, 4A, and 4B), 40 CT scans (20 baseline scans and 20 follow-up scans) were randomly selected for 160 participants (median age, 61 years; interquartile range, 58-66 years; 61 women) in total. Seven blinded observers independently read all CT scans twice in a randomized order with a 2-week washout period: once by using the standard PACS-like viewer and once by using the dedicated viewer. Observers were asked to assign a Lung-RADS category to each scan and indicate the risk-dominant nodule. Inter- and intraobserver agreement was analyzed by using Fleiss κ values and Cohen weighted κ values, respectively. Reading times were compared by using a Wilcoxon signed rank test. Results The interobserver agreement was moderate for the standard viewer and substantial for the dedicated viewer, with Fleiss κ values of 0.58 (95% CI: 0.55, 0.60) and 0.66 (95% CI: 0.64, 0.68), respectively. The intraobserver agreement was substantial, with a mean Cohen weighted κ value of 0.67. The median reading time was significantly reduced from 160 seconds with the standard viewer to 86 seconds with the dedicated viewer (P < .001). Conclusion Lung-RADS interobserver agreement increased from moderate to substantial when using the dedicated CT lung screening viewer. The median reading time was substantially reduced when scans were read by using the dedicated CT lung screening viewer. Keywords: CT, Thorax, Lung, Computer Applications-Detection/Diagnosis, Observer Performance, Technology Assessment Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Colin Jacobs
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Anton Schreuder
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Sarah J van Riel
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Ernst Th Scholten
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Rianne Wittenberg
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Mathilde M Winkler Wille
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Bartjan de Hoop
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Ralf Sprengers
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Onno M Mets
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Bram Geurts
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Mathias Prokop
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Cornelia Schaefer-Prokop
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
| | - Bram van Ginneken
- From the Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, Geert Grooteplein 10, 6525 GA, Nijmegen, the Netherlands (C.J., A.S., S.J.v.R., E.T.S., B.G., M.P., C.S.P., B.v.G.); Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands (R.W.); Department of Diagnostic Imaging, Section of Radiology, Nordsjællands Hospital, Hillerød, Denmark (M.M.W.W.); Department of Radiology, Streekziekenhuis Koningin Beatrix, Winterswijk, the Netherlands (B.d.H.); Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands (C.S.P.); Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands (O.M.M.); Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands (O.M.M., R.S.); and Fraunhofer MEVIS, Bremen, Germany (B.v.G.)
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20
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Kim J, Cho B, Kim SH, Choi CM, Kim Y, Jo MW. Cost Utility Analysis of a Pilot Study for the Korean Lung Cancer Screening Project. Cancer Res Treat 2021; 54:728-736. [PMID: 34583458 PMCID: PMC9296945 DOI: 10.4143/crt.2021.480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to evaluate the cost utility of a pilot study of Korean Lung Cancer Screening Project. Materials and Methods We constructed a Markov model consisting of 26 states based on the natural history of lung cancer according to the Surveillance, Epidemiology, and End Results summary stage (localized, regional, distant). In the base case, people aged 55–74 years were under consideration for annual screening. Costs and quality-adjusted life years were simulated to calculate the incremental cost utility ratio. Sensitivity analyses were performed on the uncertainty associated with screening target ages, stage distribution, cost, utility, mortality, screening duration, and discount rate. Results The base case (US$25,383 per quality-adjusted life year gained) was cost-effective compared to the scenario of no screening and acceptable considering a willingness-to-pay threshold of US$27,000 per quality-adjusted life years gained. In terms of the target age of screening, the age between 60 and 74 years was the most cost-effective. Lung cancer screening was still cost-effective in the sensitivity analyses on the cost for treatment, utility, mortality, screening duration, and less than 5% discount rates, although the result was sensitive to a rise in positive rates or variation of stage distribution. Conclusion Our results showed the cost-effectiveness of annual low-dose computed tomography screening for lung cancer in high-risk populations.
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Affiliation(s)
- Juyoung Kim
- Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Bogeum Cho
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Seon-Ha Kim
- Department of Nursing, College of Nursing, Dankook University, Cheonan, Korea
| | - Chang-Min Choi
- Department of Pulmonology and Critical Care Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Min-Woo Jo
- Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
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21
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Lam S, Tammemagi M. Contemporary issues in the implementation of lung cancer screening. Eur Respir Rev 2021; 30:30/161/200288. [PMID: 34289983 DOI: 10.1183/16000617.0288-2020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
Lung cancer screening with low-dose computed tomography can reduce death from lung cancer by 20-24% in high-risk smokers. National lung cancer screening programmes have been implemented in the USA and Korea and are being implemented in Europe, Canada and other countries. Lung cancer screening is a process, not a test. It requires an organised programmatic approach to replicate the lung cancer mortality reduction and safety of pivotal clinical trials. Cost-effectiveness of a screening programme is strongly influenced by screening sensitivity and specificity, age to stop screening, integration of smoking cessation intervention for current smokers, screening uptake, nodule management and treatment costs. Appropriate management of screen-detected lung nodules has significant implications for healthcare resource utilisation and minimising harm from radiation exposure related to imaging studies, invasive procedures and clinically significant distress. This review focuses on selected contemporary issues in the path to implement a cost-effective lung cancer screening at the population level. The future impact of emerging technologies such as deep learning and biomarkers are also discussed.
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Affiliation(s)
- Stephen Lam
- British Columbia Cancer Agency, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Martin Tammemagi
- Dept of Health Sciences, Brock University, St Catharines, ON, Canada
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22
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Kim H, Goo JM, Kim TJ, Kim HY, Gu G, Gil B, Kim W, Park SY, Park J, Park J, Park H, Song W, Shin KE, Oh J, Yoon SH, Lee S, Lee Y, Lim WH, Jeong WG, Jung JI, Cha MJ, Choi S, In Choi H, Ham SY, Kim Y. Effectiveness of radiologist training in improving reader agreement for Lung-RADS 4X categorization. Eur Radiol 2021; 31:8147-8159. [PMID: 33884472 DOI: 10.1007/s00330-021-07990-y] [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] [Received: 10/30/2020] [Revised: 03/11/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To identify the agreement on Lung CT Screening Reporting and Data System 4X categorization between radiologists and an expert-adjudicated reference standard and to investigate whether training led to improvement of the agreement measures and diagnostic potential for lung cancer. METHODS Category 4 nodules in the Korean Lung Cancer Screening Project were identified retrospectively, and each 4X nodule was matched with one 4A or 4B nodule. An expert panel re-evaluated the categories and determined the reference standard. Nineteen radiologists were asked to determine the presence of CT features of malignancy and 4X categorization for each nodule. A review was performed in two sessions, and training material was given after session 1. Agreement on 4X categorization between radiologists and the expert-adjudicated reference standard and agreement between radiologist-assessed 4X categorization and lung cancer diagnosis were evaluated. RESULTS The 48 expert-adjudicated 4X nodules and 64 non-4X nodules were evenly distributed in each session. The proportion of category 4X decreased after training (56.4% ± 16.9% vs. 33.4% ± 8.0%; p < 0.001). Cohen's κ indicated poor agreement (0.39 ± 0.16) in session 1, but agreement improved in session 2 (0.47 ± 0.09; p = 0.03). The increase in agreement in session 2 was observed among inexperienced radiologists (p < 0.05), and experienced and inexperienced reviewers exhibited comparable agreement performance in session 2 (p > 0.05). All agreement measures between radiologist-assessed 4X categorization and lung cancer diagnosis increased in session 2 (p < 0.05). CONCLUSION Radiologist training can improve reader agreement on 4X categorization, leading to enhanced diagnostic performance for lung cancer. KEY POINTS • Agreement on 4X categorization between radiologists and an expert-adjudicated reference standard was initially poor, but improved significantly after training. • The mean proportion of 4X categorization by 19 radiologists decreased from 56.4% ± 16.9% in session 1 to 33.4% ± 8.0% in session 2. • All agreement measures between the 4X categorization and lung cancer diagnosis increased significantly in session 2, implying that appropriate training and guidance increased the diagnostic potential of category 4X.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea. .,Cancer Research Institute, Seoul National University, Seoul, South Korea.
| | - Tae Jung Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Guanmin Gu
- Pohang St. Mary's Hospital, Pohang, South Korea
| | - Bomi Gil
- Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Wooil Kim
- Asan Medical Center, Seoul, South Korea
| | | | - Junghoan Park
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Juil Park
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | | | | | - Kyung Eun Shin
- SoonChunHyang University Bucheon Hospital, Bucheon, South Korea
| | - Jiseon Oh
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Sung Hyun Yoon
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | - Youkyung Lee
- Hanyang University Guri Hospital, Guri, South Korea
| | - Woo Hyeon Lim
- Department of Radiology, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Won Gi Jeong
- Chonnam National University Hwasun Hospital, Hwasun-gun, South Korea
| | - Jung Im Jung
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Min Jae Cha
- Chung-Ang University Hospital, Seoul, South Korea
| | - Sinae Choi
- Wesarang Internal Medicine Clinic, Jeonju, South Korea
| | - Hyoung In Choi
- Korean Armed Forces Capital Hospital, Seongnam, South Korea
| | - Soo-Youn Ham
- Sungkyunkwan University Kangbuk Samsung Hospital, Seoul, South Korea
| | - Yeol Kim
- National Cancer Center, Goyang, South Korea
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23
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Hwang EJ, Goo JM, Kim HY, Yi J, Kim Y. Optimum diameter threshold for lung nodules at baseline lung cancer screening with low-dose chest CT: exploration of results from the Korean Lung Cancer Screening Project. Eur Radiol 2021; 31:7202-7212. [PMID: 33738597 DOI: 10.1007/s00330-021-07827-8] [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] [Received: 09/05/2020] [Revised: 01/01/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To explore the optimum diameter threshold for solid nodules to define positive results at baseline screening low-dose CT (LDCT) and to compare two-dimensional and volumetric measurement of lung nodules for the diagnosis of lung cancers. METHODS We included consecutive participants from the Korean Lung Cancer Screening project between 2017 and 2018. The average transverse diameter and effective diameter (diameter of a sphere with the same volume) of lung nodules were measured by semi-automated segmentation. Diagnostic performances for lung cancers diagnosed within 1 year after LDCT were evaluated using area under receiver-operating characteristic curves (AUCs), sensitivities, and specificities, with diameter thresholds for solid nodules ranging from 6 to 10 mm. The reduction of unnecessary follow-up LDCTs and the diagnostic delay of lung cancers were estimated for each threshold. RESULTS Fifty-two lung cancers were diagnosed among 10,424 (10,141 men; median age 62 years) participants within 1 year after LDCT. Average transverse (0.980) and effective diameters (0.981) showed similar AUCs (p = .739). Elevating the average transverse diameter threshold from 6 to 9 mm resulted in a significantly increased specificity (91.7 to 96.7%, p < .001), a modest reduction in sensitivity (96.2 to 94.2%, p = .317), a 60.2% estimated reduction of unnecessary follow-up LDCTs, and a diagnostic delay in 1.9% of lung cancers. Elevating the threshold to 10 mm led to a significant reduction in sensitivity (86.5%, p = .025). CONCLUSIONS Elevating the diameter threshold for solid nodules from 6 to 9 mm may lead to a substantial reduction in unnecessary follow-up LDCTs with a small proportion of diagnostic delay of lung cancers. KEY POINTS • Elevation of the diameter threshold for solid nodules from 6 to 9 mm can substantially reduce unnecessary follow-up LDCTs with a small proportion of diagnostic delay of lung cancers. • The average transverse and effective diameters of lung nodules showed similar performances for the prediction of a lung cancer diagnosis.
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Affiliation(s)
- Eui Jin Hwang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Jin Mo Goo
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Cancer Research Institute, Seoul National University, Seoul, South Korea.
| | - Hyae Young Kim
- Department of Radiology, National Cancer Center, Goyang, South Korea
| | | | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
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Park J, Lee J, Kim Y. Public opinion on implementing the National Lung Cancer Screening Program in Korea. Transl Lung Cancer Res 2021; 10:1355-1367. [PMID: 33889515 PMCID: PMC8044494 DOI: 10.21037/tlcr-20-865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Lung cancer screening for high-risk population using low-dose computed tomography is a valid strategy to reduce lung cancer mortality. This study investigated public opinions toward the initiation and participation in the National Lung Cancer Screening Program (NLCSP) launched in Korea. Methods In this cross-sectional analysis of the 2018 Korean National Cancer Screening Survey, we analyzed the responses related to lung cancer screening. Eligible participants for NLCSP are aged 55‒74 years with at least 30 pack-years of smoking history. We compared public opinions on implementing lung cancer screening according to smoking status and eligibility for NLCSP. Results Among 3,495 respondents, 205 (5.9%) were eligible for screening. Most of the respondents (71.2%) agreed with implementing NLCSP. Agreement rates were relatively lower in never smokers (66.2%) and higher in former (80.8%) and current smokers (82.3%). Factors associated with agreement included the presence of private health insurance [odds ratio (OR) 1.36, 95% confidence interval (CI), 1.04–1.78], regular health checkup (OR 2.10, 95% CI, 1.72–2.57), and smoking history (former, OR 1.66, 95% CI, 1.09–2.55; current, OR 1.97, 95% CI, 1.45–2.67). Preference of the screening facilities showed that quality was considered more important than accessibility (46.9% vs. 31.9%). Furthermore, people were more affirmative (75.5%) towards receiving mandatory smoking cessation counseling included in NLCSP. Conclusions Public agreement and active participation of the eligible population are key factors in the successful implementation of NLCSP. Our data would be a valuable resource in building appropriate strategies to maximize the benefits of nationwide lung cancer screening.
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Affiliation(s)
- Junli Park
- Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Korea
| | - Jaeho Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
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Lee J, Kim Y, Kim HY, Goo JM, Lim J, Lee CT, Jang SH, Lee WC, Lee CW, Choi KS, Park B, Lee DH. Feasibility of implementing a national lung cancer screening program: Interim results from the Korean Lung Cancer Screening Project (K-LUCAS). Transl Lung Cancer Res 2021; 10:723-736. [PMID: 33718017 PMCID: PMC7947393 DOI: 10.21037/tlcr-20-700] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Lung cancer screening conducted in high-risk group using low-dose computer tomography (LDCT) has been reported as an effective method to reduce lung cancer mortality in two large randomized-control trials. However, the effectiveness is uncertain when lung cancer screening is expanded to a nationwide population-based program. Methods The Korean Lung Cancer Screening Project (K-LUCAS) is a single-arm cohort study that was conducted from February 2017 to evaluate the feasibility of implementing an organized national lung cancer screening program in Korea. High-risk population aged 55–74 years with more than a 30-pack-year smoking history was recruited. Smoking history was obtained from administering questionnaires at national health screening programs or public smoking cessation programs which are already established programs in Korea. The screening results were reported using the Lung Imaging Reporting and Data System (Lung-RADS), suggested by the American College of Radiology. K-LUCAS was performed by a network-based diagnosis supporting system using a computer-aided detection (CAD) program to maintain screening quality. Current smokers were provided with mandatory smoking counseling. Results Among 71,829 participants aged 50 years or older in the national health screening program, 5,975 (8.3%) were eligible for lung cancer screening. Among them, 1,062 (17.8%) refused to participate in K-LUCAS. Additionally, 779 participants were recruited in the smoking cessation program. Thus, a total of 5,692 eligible high-risk participants were recruited in this study. Among them, 865 (15.2%) had positive screening results, which requires a further examination; 529 (9.3%) had Lung-RADS category 3 (indeterminate), and 336 (5.9%) had category 4 (suspicious of lung cancer); 42 (0.7%) had confirmed lung cancer. Approximately 66.7% had early-stage lung cancer: 24 (57.1%), stage I and 4 (9.5%), stage II. Six (1.1%) patients developed complications at the time of diagnosis, including one death. The anxiety level related to cancer screening was low. Participation in screening encouraged motivation to quit smoking. Conclusions K-LUCAS provided promising evidence supporting the implementation of a national lung cancer screening program to detect early stage lung cancer and promote smoking cessation for participants in Asian population.
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Affiliation(s)
- Jaeho Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Hyae Young Kim
- Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Juntae Lim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Choon-Taek Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hun Jang
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Won-Chul Lee
- Department of Preventive Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Chan Wha Lee
- Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Duk Hyoung Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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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: 44] [Impact Index Per Article: 14.7] [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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External validation and comparison of the Brock model and Lung-RADS for the baseline lung cancer CT screening using data from the Korean Lung Cancer Screening Project. Eur Radiol 2020; 31:4004-4015. [PMID: 33241512 DOI: 10.1007/s00330-020-07513-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/08/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To validate and compare the performance of the Brock model and Lung CT Screening Reporting and Data System (Lung-RADS) on nodules detected by baseline CT screening. METHODS We performed a secondary analysis of the Korean Lung Cancer Screening Project (K-LUCAS; ClinicalTrials.gov , NCT03394703), a nationwide, multicenter, prospective cohort study. From April 2017 to December 2018, low-dose CT screening was performed on high-risk subjects. Discrimination and calibration of Brock models 2a and 2b (i.e., full model without and with spiculation, respectively) were assessed, and discrimination was compared with that of Lung-RADS, which utilized subjective assessment categories 2b (b stands for benign) and 4X. RESULTS Of the 13,150 subjects, 4578 were eligible (median age 62 years; 4458 men; 9929 nodules including 40 lung cancers). Areas under the receiver operating characteristic curve were 0.96 (IQR 0.92-0.99) for Brock model 2a, 0.96 (IQR 0.92-0.99) for Brock model 2b, and 0.95 (IQR 0.91-0.99) for Lung-RADS (p = 0.32 and p = 0.34, respectively). At an equivalent cutoff of 5%, Brock model 2b (sensitivity 87.5% [35/40]; specificity 93.6% [9259/9889]; positive predictive value [PPV] 5.3% [35/665]; negative predictive value [NPV] 99.9% [9259/9264]) and Lung-RADS (sensitivity 87.5% [35/40]; specificity 93.3% [9222/9889]; PPV 5.0% [35/702]; NPV 99.9% [9222/9227]) performed similarly well (all p > 0.05). The calibration performance of both Brock models 2a and 2b was poor (both p < 0.001). CONCLUSIONS Lung-RADS, when reinforced with visual assessment-based categories, has a similar diagnostic performance to the Brock model for baseline CT scans. KEY POINTS • Brock model 2b and Lung CT Screening Reporting and Data System (Lung-RADS) demonstrated a similar discrimination performance for lung cancer in the baseline CT screening (areas under the receiver operating characteristic curve 0.96 vs. 0.95; p = 0.34). • When visual assessment-based categories were removed from Lung-RADS, specificity and positive predictive value were lower than those of Brock model 2b (p = 0.001 and p = 0.02, respectively). • The Brock model showed poor calibration (p < 0.001).
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Hwang EJ, Goo JM, Kim HY, Yoon SH, Jin GY, Yi J, Kim Y. Variability in interpretation of low-dose chest CT using computerized assessment in a nationwide lung cancer screening program: comparison of prospective reading at individual institutions and retrospective central reading. Eur Radiol 2020; 31:2845-2855. [PMID: 33123794 DOI: 10.1007/s00330-020-07424-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/29/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the degree of variability in computer-assisted interpretation of low-dose chest CTs (LDCTs) among radiologists in a nationwide lung cancer screening (LCS) program, through comparison with a retrospective interpretation from a central laboratory. MATERIALS AND METHODS Consecutive baseline LDCTs (n = 3353) from a nationwide LCS program were investigated. In the institutional reading, 20 radiologists in 14 institutions interpreted LDCTs using computer-aided detection and semi-automated segmentation systems for lung nodules. In the retrospective central review, a single radiologist re-interpreted all LDCTs using the same system, recording any non-calcified nodules ≥ 3 mm without arbitrary rejection of semi-automated segmentation to minimize the intervention of radiologist's discretion. Positive results (requiring additional follow-up LDCTs or diagnostic procedures) were initially classified by the lung CT screening reporting and data system (Lung-RADS) during the interpretation, while the classifications based on the volumetric criteria from the Dutch-Belgian lung cancer screening trial (NELSON) were retrospectively applied. Variabilities in positive rates were assessed with coefficients of variation (CVs). RESULTS In the institutional reading, positive rates by the Lung-RADS ranged from 7.5 to 43.3%, and those by the NELSON ranged from 11.4 to 45.0% across radiologists. The central review exhibited higher positive rates by Lung-RADS (20.0% vs. 27.3%; p < .001) and the NELSON (23.1% vs. 37.0%; p < .001), and lower inter-institution variability (CV, 0.30 vs. 0.12, p = .003 by Lung-RADS; CV, 0.25 vs. 0.12, p = .014 by the NELSON) compared to the institutional reading. CONCLUSION Considerable inter-institution variability in the interpretation of LCS results is caused by different usage of the computer-assisted system. KEY POINTS • Considerable variability existed in the interpretation of screening LDCT among radiologists partly from the different usage of the computerized system. • A retrospective reading of low-dose chest CTs in the central laboratory resulted in reduced variability but an increased positive rate.
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Affiliation(s)
- Eui Jin Hwang
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Jin Mo Goo
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Cancer Research Institute, Seoul National University, Seoul, South Korea.
| | - Hyae Young Kim
- Department of Radiology, National Cancer Center, Goyang, South Korea
| | - Soon Ho Yoon
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Gong Yong Jin
- Department of Radiology, Jeonbuk National University Hospital, Jeonju, South Korea
| | | | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, South Korea
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Lung cancer LDCT screening and mortality reduction - evidence, pitfalls and future perspectives. Nat Rev Clin Oncol 2020; 18:135-151. [PMID: 33046839 DOI: 10.1038/s41571-020-00432-6] [Citation(s) in RCA: 204] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/17/2022]
Abstract
In the past decade, the introduction of molecularly targeted agents and immune-checkpoint inhibitors has led to improved survival outcomes for patients with advanced-stage lung cancer; however, this disease remains the leading cause of cancer-related mortality worldwide. Two large randomized controlled trials of low-dose CT (LDCT)-based lung cancer screening in high-risk populations - the US National Lung Screening Trial (NLST) and NELSON - have provided evidence of a statistically significant mortality reduction in patients. LDCT-based screening programmes for individuals at a high risk of lung cancer have already been implemented in the USA. Furthermore, implementation programmes are currently underway in the UK following the success of the UK Lung Cancer Screening (UKLS) trial, which included the Liverpool Health Lung Project, Manchester Lung Health Check, the Lung Screen Uptake Trial, the West London Lung Cancer Screening pilot and the Yorkshire Lung Screening trial. In this Review, we focus on the current evidence on LDCT-based lung cancer screening and discuss the clinical developments in high-risk populations worldwide; additionally, we address aspects such as cost-effectiveness. We present a framework to define the scope of future implementation research on lung cancer screening programmes referred to as Screening Planning and Implementation RAtionale for Lung cancer (SPIRAL).
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Silva M, Milanese G, Kauczor HU, Revel MP, Sverzellati N. Milestones towards lung cancer screening implementation. Clin Radiol 2020; 75:881-885. [PMID: 32863024 DOI: 10.1016/j.crad.2020.07.028] [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: 04/30/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023]
Abstract
The European Society of Radiology (ESR) and European Respiratory Society (ERS) published their joint statement paper on lung cancer screening (LCS), on 12 February 2020. This document joins and completes previous recommendations on LCS with specific emphasis on the analysis of issues encountered in the practical implementation of LCS in the community. Major milestones to enable the most efficient and equal dissemination of LCS are recognised as engagement of all stakeholders (e.g. candidate/participant, general practitioners, up to the specialised LCS facility), quality assurance, and primary prevention in the form of provision of counselling for smoking cessation.
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Affiliation(s)
- M Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Italy.
| | - G Milanese
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Italy
| | - H-U Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - M-P Revel
- Radiology Department, Cochin Hospital, APHP, Paris, France
| | - N Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Italy
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Implementation of the cloud-based computerized interpretation system in a nationwide lung cancer screening with low-dose CT: comparison with the conventional reading system. Eur Radiol 2020; 31:475-485. [PMID: 32797309 DOI: 10.1007/s00330-020-07151-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/10/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We aimed to compare the CT interpretation before and after the implementation of a computerized system for lung nodule detection and measurements in a nationwide lung cancer screening program. METHODS Our screening program started in April 2017, with 14 participating institutions. Initially, all CTs were interpreted using interpretation systems in each institution and manual nodule measurement (conventional system). A cloud-based CT interpretation system, equipped with semi-automated measurement and CAD (computer-aided detection) for lung nodules (cloud-based system), was implemented during the project. Positive rates and performances for lung cancer diagnosis based on the Lung-RADS version 1.0 were compared between the conventional and cloud-based systems. RESULTS A total of 1821 (M:F = 1782:39, mean age 62.7 years, 16 confirmed lung cancers) and 4666 participants (M:F = 4560:106, mean age 62.8 years, 31 confirmed lung cancers) were included in the conventional and cloud-based systems, respectively. Significantly more nodules were detected in the cloud-based system (0.76 vs. 1.07 nodule/participant, p < .001). Positive rate did not differ significantly between the two systems (9.9% vs. 11.0%, p = .211), while their variability across institutions was significantly lower in the cloud-based system (coefficients of variability, 0.519 vs. 0.311, p = .018). The Lung-RADS-based sensitivity (93.8% vs. 93.5%, p = .979) and specificity (90.9% vs. 89.6%, p = .132) did not differ significantly between the two systems. CONCLUSION Implementation of CAD and semi-automated measurement for lung nodules in a nationwide lung cancer screening program resulted in increased number of detected nodules and reduced variability in positive rates across institutions. KEY POINTS • Computer-aided CT reading detected more lung nodules than radiologists alone in lung cancer screening. • Positive rate in lung cancer screening did not change with computer-aided reading. • Computer-aided CT reading reduced inter-institutional variability in lung cancer screening.
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Hatabu H, Hunninghake GM, Richeldi L, Brown KK, Wells AU, Remy-Jardin M, Verschakelen J, Nicholson AG, Beasley MB, Christiani DC, San José Estépar R, Seo JB, Johkoh T, Sverzellati N, Ryerson CJ, Graham Barr R, Goo JM, Austin JHM, Powell CA, Lee KS, Inoue Y, Lynch DA. Interstitial lung abnormalities detected incidentally on CT: a Position Paper from the Fleischner Society. THE LANCET RESPIRATORY MEDICINE 2020; 8:726-737. [PMID: 32649920 DOI: 10.1016/s2213-2600(20)30168-5] [Citation(s) in RCA: 265] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/20/2020] [Accepted: 03/31/2020] [Indexed: 12/12/2022]
Abstract
The term interstitial lung abnormalities refers to specific CT findings that are potentially compatible with interstitial lung disease in patients without clinical suspicion of the disease. Interstitial lung abnormalities are increasingly recognised as a common feature on CT of the lung in older individuals, occurring in 4-9% of smokers and 2-7% of non-smokers. Identification of interstitial lung abnormalities will increase with implementation of lung cancer screening, along with increased use of CT for other diagnostic purposes. These abnormalities are associated with radiological progression, increased mortality, and the risk of complications from medical interventions, such as chemotherapy and surgery. Management requires distinguishing interstitial lung abnormalities that represent clinically significant interstitial lung disease from those that are subclinical. In particular, it is important to identify the subpleural fibrotic subtype, which is more likely to progress and to be associated with mortality. This multidisciplinary Position Paper by the Fleischner Society addresses important issues regarding interstitial lung abnormalities, including standardisation of the definition and terminology; predisposing risk factors; clinical outcomes; options for initial evaluation, monitoring, and management; the role of quantitative evaluation; and future research needs.
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Affiliation(s)
- Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Gary M Hunninghake
- Department of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Luca Richeldi
- Unitá Operativa Complessa di Pneumologia, Universitá Cattolica del Sacro Cuore, Fondazione Policlinico A Gemelli IRCCS, Rome, Italy
| | - Kevin K Brown
- Department of Medicine, Denver, CO, USA; National Jewish Health, Denver, CO, USA
| | - Athol U Wells
- Department of Respiratory Medicine, Royal Brompton and Hospital NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Martine Remy-Jardin
- Department of Thoracic Imaging, Hospital Calmette, University Centre of Lille, Lille, France
| | | | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Hospital NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Mary B Beasley
- Department of Pathology, Icahn School of Medicine at Mount, New York, NY, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raúl San José Estépar
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joon Beom Seo
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Takeshi Johkoh
- Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan
| | | | - Christopher J Ryerson
- Department of Medicine, University of British Columbia and Centre for Heart Lung Innovations, St Paul's Hospital, Vancouver, BC, Canada
| | - R Graham Barr
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - John H M Austin
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Charles A Powell
- Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount, New York, NY, USA
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
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Kim H, Kim HY, Goo JM, Kim Y. Lung Cancer CT Screening and Lung-RADS in a Tuberculosis-endemic Country: The Korean Lung Cancer Screening Project (K-LUCAS). Radiology 2020; 296:181-188. [PMID: 32286195 DOI: 10.1148/radiol.2020192283] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Low-dose CT screening for lung cancer in a tuberculosis-endemic country may be less effective because of false-positive results caused by tuberculosis sequelae. Purpose To evaluate the impact of tuberculosis sequelae at CT screening according to the American College of Radiology Lung CT Screening Reporting and Data System (Lung-RADS) using data from the Korean Lung Cancer Screening Project (K-LUCAS). Materials and Methods This is a secondary analysis of K-LUCAS (ClinicalTrials.gov identifier NCT03394703), a nationwide Asian population-based, multicenter, prospective cohort study. Participants at high risk for lung cancer were enrolled between April 2017 and December 2018. Associations of tuberculosis sequelae with a positive screening result for lung cancer (defined as Lung-RADS categories 3 or 4) and diagnosis of lung cancer were analyzed with multivariable logistic regression. The diagnostic performance of Lung-RADS in predicting lung cancer was compared between participants with and participants without tuberculosis sequelae by using the χ2 test. Results A total of 11 394 participants (median age, 62 years; interquartile range, 58-67 years; 11 098 men) were evaluated. Positive screening results were found in 1868 of the 11 394 participants (16%); lung cancer was diagnosed in 65 of the 11 394 participants (0.6%). Tuberculosis sequelae were identified in 1509 of the 11 394 participants (13%) on the basis of CT scans. Tuberculosis sequelae were associated with positive CT screening results (odds ratio [OR] with one nodule, 1.22; 95% confidence interval [CI]: 1.02, 1.45; P = .03), but no evidence was found of an association with lung cancer (OR, 0.9; 95% CI: 0.4, 1.6; P = .64). Specificity of Lung-RADS was higher for participants without tuberculosis sequelae (85% [8327 of 9829 participants]; 95% CI: 84.0%, 85.4%) than for those with tuberculosis sequelae (80% [1198 of 1500 participants]; 95% CI: 77.7%, 82%; P < .001). Sensitivity was not different between participants with tuberculosis sequelae (100% [nine of nine participants]; 95% CI: 62.9%, 100%) and those without tuberculosis sequelae (98% [55 of 56 participants]; 95% CI: 89.2%, 99.9%; P > .99). Conclusion In an at-risk population, tuberculosis sequelae resulted in a reduced specificity of CT screening for lung cancer using the Lung CT Screening Reporting and Data System. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Ketai in this issue.
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Affiliation(s)
- Hyungjin Kim
- From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (H.K., J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (H.K., J.M.G.); Department of Diagnostic Radiology (H.Y.K.) and Cancer Early Detection Branch, National Cancer Control Institute (Y.K.), National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea; and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
| | - Hyae Young Kim
- From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (H.K., J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (H.K., J.M.G.); Department of Diagnostic Radiology (H.Y.K.) and Cancer Early Detection Branch, National Cancer Control Institute (Y.K.), National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea; and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
| | - Jin Mo Goo
- From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (H.K., J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (H.K., J.M.G.); Department of Diagnostic Radiology (H.Y.K.) and Cancer Early Detection Branch, National Cancer Control Institute (Y.K.), National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea; and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
| | - Yeol Kim
- From the Department of Radiology, Seoul National University Hospital, Seoul, Korea (H.K., J.M.G.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (H.K., J.M.G.); Department of Diagnostic Radiology (H.Y.K.) and Cancer Early Detection Branch, National Cancer Control Institute (Y.K.), National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea; and Cancer Research Institute, Seoul National University, Seoul, Korea (J.M.G.)
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Suh YJ, Lee JW, Shin SY, Goo JM, Kim Y, Yong HS. Coronary artery calcium severity grading on non-ECG-gated low-dose chest computed tomography: a multiple-observer study in a nationwide lung cancer screening registry. Eur Radiol 2020; 30:3684-3691. [DOI: 10.1007/s00330-020-06707-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/26/2019] [Accepted: 02/04/2020] [Indexed: 12/15/2022]
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Triphuridet N, Henschke C. Landscape on CT screening for lung cancer in Asia. LUNG CANCER (AUCKLAND, N.Z.) 2019; 10:107-124. [PMID: 31686936 PMCID: PMC6777900 DOI: 10.2147/lctt.s192643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 08/28/2019] [Indexed: 12/24/2022]
Abstract
Lung cancer remains the leading cause of cancer incidence and mortality worldwide. Approximately 60% of the world's new cases of lung cancer and deaths from it are expected in Asia in 2018. Currently, lung cancer screening using low-dose computed tomography (LDCT) is recommended for heavy smokers in North America, Europe and some countries in Asia. Tobacco smoking being the major risk factor for lung cancer, but in Asia, lung cancer in never-smokers (LCINS) is also a concern. This paper reviews on lung cancer incidence, mortality, etiology, smoking in Asia, and systematic reviews on LDCT lung cancer screening studies, including ongoing projects and recommendation on lung cancer screening in Asia. Some of the earliest studies of LDCT lung cancer screening worldwide were in Asia. Many countries in Asia have developed LDCT screening studies in various high-risk participants. Currently, there are several ongoing large-scale lung cancer screening trials to evaluate the efficacy of LDCT screening for never-smokers and light smokers, as well as heavy smokers, and to evaluate the feasibility of population-based LDCT lung cancer screening.
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Affiliation(s)
- Natthaya Triphuridet
- Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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