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Bintein F, Yannoutsos A, Chatellier G, Fontaine M, Damotte D, Paterlini-Bréchot P, Meyer G, Duchatelle V, Marini V, Schwering KL, Labrousse C, Beaussier H, Zins M, Salmeron S, Lajonchère JP, Priollet P, Emmerich J, Trédaniel J. Patients with atherosclerotic peripheral arterial disease have a high risk of lung cancer: Systematic review and meta-analysis of literature. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:53-65. [PMID: 33752847 DOI: 10.1016/j.jdmv.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Lung cancer and atherosclerosis share common risk factors. Literature data suggest that the prevalence of lung malignancy in patients with peripheral arterial disease (PAD) is higher than in the general population. Our goal was to determine, through a systematic literature review, the prevalence of lung cancer in patients with PAD. METHODS We consulted available publications in the Cochrane library, MEDLINE, PUBMED, EMBASE, and ClinicalTrials.gov. We included all articles, written in English or French, published between 1990 and 2020 reporting the prevalence of lung cancer in patients with PAD (atherosclerotic aortic aneurysm or peripheral occlusive diseases). Patients with coronary artery disease, cardiac valvulopathy or carotid stenosis were not included. We did not include case reports. We performed a critical analysis of each article. Data were collected from two independent readers. A fixed effect model meta-analysis allowed to estimate a summary prevalence rate. RESULTS We identified 303 articles, and selected 19 articles according to selection criteria. A total of 16849 patients were included (mean age 68.3 years, 75.1% of males). Aortic aneurysms were found in 29% of patients and atherosclerotic occlusive disease in 66% of patients. Lung cancer was identified in 538 patients, representing a prevalence of 3%. DISCUSSION Lung cancer is found in 3% of patients with atherosclerotic PAD. This prevalence is higher than that found in lung cancer screening programs performed in the general population of smokers and former smokers. These patients should be screened for lung cancer. Their selection may dramatically increase the benefit of lung cancer screening.
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Affiliation(s)
- F Bintein
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France.
| | - A Yannoutsos
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France; Inserm UMR 1153 Center of Research in Epidemiology and Statistics, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - G Chatellier
- Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - D Damotte
- Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Unité Inserm U1138, centre de recherche des Cordeliers, Paris, France
| | | | - G Meyer
- Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - V Duchatelle
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - V Marini
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | | | - C Labrousse
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - H Beaussier
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - M Zins
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - S Salmeron
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - J-P Lajonchère
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - P Priollet
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - J Emmerich
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France; Inserm UMR 1153 Center of Research in Epidemiology and Statistics, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - J Trédaniel
- Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Unité Inserm UMR-S 1124, toxicologie, pharmacologie et signalisation cellulaire, Paris, France
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Whole-body computed tomography: a new point of view in a hospital check-up unit? Our experience in 6516 patients. Radiol Med 2019; 124:1199-1211. [PMID: 31407223 DOI: 10.1007/s11547-019-01068-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 08/06/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated. AIM To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups. MATERIALS AND METHODS We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used. RESULTS WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%). CONCLUSION The most common WB-CT findings in asymptomatic subjects are benign. However, this examination allows identifying an important number of relevant and precocious findings that significantly increase with age, involving changes in lifestyle and precocious treatment.
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Nourzaie R, Das J, Abbas H, Thulasidasan N, Gkoutzios P, Ilyas S, Monzon L, Sabharwal T, Moser S, Diamantopoulos A. Extravascular findings during upper limb computed tomographic angiography focusing on undiagnosed malignancy. World J Radiol 2019; 11:10-18. [PMID: 30705743 PMCID: PMC6354083 DOI: 10.4329/wjr.v11.i1.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/01/2019] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Computer tomography angiography (CTA) has been an established method for diagnostic vascular disease of lower limbs. Recently, the method is widely used for diagnosis of vascular pathologies in the upper limbs too. It also has increased the possibilities of this scans being reviewed by no specially trained radiologists. This increases the risk of incidental non vascular findings to be missed or misinterpreted. The study is focusing in the frequency of extravascular incidental finding (EVIF) and highlights the importance for both the reporting radiologist and the referring physician recognizing the frequency of EVIFs.
AIM To analyse the frequency of EVIF identified on computed angiography (CT) of the upper limb.
METHODS A total of 1383 CT angiographic studies of the peripheral arterial system were performed between August 2015 and August 2017. All upper limb CTAs (n = 79) were retrospectively reviewed for the presence of non-vascular incidental findings within the chest, abdomen/pelvis, musculoskeletal system or head and neck. These EVIFs were subsequently grouped into 3 categories based on clinical significance. EVIFs of immediate clinical relevance were included in category A, findings considered indeterminate but most likely benign were placed in category B, while incidental findings of no clinical significance were included in category C.
RESULTS Complete imaging datasets were available in 74/79 (93.7%). Patient demographics included 39 (52.7%) females and 35 (47.2%) males with a mean age of 59 ± 19.5 years (range 19-93 years). A total of 153 EVIFs were reported in 52 patients (70.3%). Of these, 44 EVIFs (28.7%) were found in the chest, 83 (54.2%) in the abdomen, 14 (9.2%) in the musculoskeletal system and 9 (5.8%) in the head and neck. Thirteen EVIFs (8.4%) identified in 11 patients were noted to be of immediate clinical significance (Category A), 50 EVIFs (32.3%) were identified in 20 patients and were considered indeterminate but most likely benign, while the remaining 91 EVIFs (59.5%) identified in 21 patients were determined to be of no clinical significance (Category C). One index case of malignancy (1.3%) and four cases of new disseminated metastatic disease (5.4%) were identified.
CONCLUSION Our study of upper limb CTA examinations demonstrated a frequency of 8.4% for extravascular incidental findings of immediate clinical significance. We highlight the importance for both the reporting radiologist and the referring physician of the need to recognize the frequency with which EVIFs are identified in the upper limb peripheral arterial system and of the necessity for further clinical and imaging work-up.
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Affiliation(s)
- Romman Nourzaie
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Jeeban Das
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Hiba Abbas
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Narayanan Thulasidasan
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Panos Gkoutzios
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Shahzad Ilyas
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Leo Monzon
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Tarun Sabharwal
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Steven Moser
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
| | - Athanasios Diamantopoulos
- Department of Interventional Radiology, Guys’ and St. Thomas’ NHS Foundation Trust, London SE17EH, United Kingdom
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