Lung cancer screening update Pegna, Andrea Lopes; Picozzi, Giulia
Current opinion in pulmonary medicine,
2009-July, 2009-Jul, 2009-07-00, 20090701, Volume:
15, Issue:
4
Journal Article
PURPOSE OF REVIEWLung cancer is a health problem of global proportions. Despite intensive research over many years, the prognosis is still very poor. For the surgery to be effective, tumours need to ...be recognized early. Computed tomography (CT) is significantly more sensitive than chest radiograph for identifying small, asymptomatic lung cancers. Although low-dose CT screening observational trials have demonstrated that survival for all tumour types and sizes detected were extremely high, there is no clear evidence that low-dose CT screening reduces deaths from lung cancer. Only the results of ongoing randomized controlled trials can reveal a real benefit of screening in terms of mortality reduction.
RECENT FINDINGSWe summarize the protocols and the preliminary results of the lung cancer screening randomized controlled trial and the problems linked to the detection of suspected early cancer.
SUMMARYToday, we cannot already prove the ultimate mortality benefit of lung cancer screening with low-dose CT nor we can confirm that this approach is not harmful. We are waiting the final analysis of randomized controlled trials for lung cancer mortality. Even if is widely accepted that pooling data of randomized controlled trials could be of help to get powerful results in terms of mortality reduction in shorter follow-up time, this opportunity is still under evaluation.
Magnetic resonance imaging (MRI) of the chest coinciding with menses 4 months later showed an oval-shaped lesion with homogeneous high signal intensity in T1- and T2-weighted images in the right ...posterior costodiaphragmatic recess (fig 2A, B).
Prior analyses of X-ray exposures in lung cancer screening with CT considered the basic acquisition technique in single-detector scanners and the effects of a lifetime screening regimen, whereas the ...potential benefit in terms of lives saved was not addressed.
We determined the total-body effective dose of different acquisition techniques for one single-detector and one MDCT scanner and made projections about the cumulative radiation exposure to smokers undergoing four annual CT examinations on the same scanners in the Italung-CT Trial. Combining these data with estimates of radiation-induced fatal cancer and of the benefit of screening, we calculated the risk-benefit ratio for participants in the trial, ex-smokers, and never-smokers.
The cumulative effective doses per 1,000 subjects were 3.3 Sv using an MDCT scanner and 5.8 or 7.1 Sv using a single-detector scanner. Potential fatal cancers associated with radiation exposure were 0.11 per 1,000 subjects for MDCT scanners and 0.20 or 0.24 for single-detector scanners, which is about 10-100 times lower than the number of expected lives saved by screening assuming a 20-30% lung cancer-specific mortality reduction in current smokers. They were, however, of similar magnitude to the lives saved by screening in never-smokers and former smokers assuming a 10% efficacy of screening.
MDCT is associated with lower radiation doses than single-detector CT technology. The risk of radiation dose in the Italung-CT Trial is compensated for by the expected benefit. CT screening for lung cancer should not be offered to never-smokers, whereas its recommendation in former smokers is debatable.
Abstract The aim of this study was to evaluate the diagnostic value of a grid of molecular genetic markers detectable in sputum and plasma samples of individuals enrolled in a lung cancer screening ...program with low-dose CT. Subjects enrolled in the baseline screening round of the ITALUNG (randomised) screening trial were invited to provide biological specimens for molecular analysis (1356 subjects out of 1406). We included 98 subjects in this analysis. There was a highly statistically significant difference between proportion of subjects with a negative baseline CT screening test who were positive to allelic imbalance, and those with a non-calcified nodule (NCN greater than or equal to 5 mm), the reason of recall for all suspects at CT Scan ( χ2 : 22.9; P < 0.0001). Allelic imbalance showed good performance for screening of NCN ≥5 mm. In subjects recalled for NCN ≥5 mm, LOH, K-ras mutations and high levels of free plasma DNA (>5 ng/ml plasma) might be important to support clinical decision making for further follow-up and repeated screening. This study, embedded in an early diagnosis randomised trial, suggests that a multi-screening approach integrating imaging technique and a biomolecular marker panel is worth of further investigation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
OBJECTIVE:We sought to assess the reproducibility of size measurements of small lung nodules examined with low-dose thin-section computed tomography (LDTSCT).
MATERIALS AND METHODS:Three radiologists ...measured volume with a semiautomatic tool and diameters manually of 20 (equivalent diameter range, 5.3–11 mm) phantom nodules and 37 (mean diameter range, 5–8.5 mm) lung nodules in subjects undergoing LDTSCT.
RESULTS:In phantoms, the worst 95% limits of agreement (95% LA) for volume were −3.0% and 3.0% within operator and −3.1% and 2.8% between operators. The coefficient of repeatability (CR) for diameter ranged between 0.51 and 0.67 mm within operator and the 95% LA were from −0.71 to 0.71 mm between operators. In nodules, the worst intraoperator 95% LA for volume were −14.4% and 17.6% within operator and −13.1% and 14.2% between operators. The CR for diameter ranged between 0.48 and 0.73 mm within operator and the 95% LA were from −1.16 to 1.16 mm between operators.
CONCLUSION:Operator-dependent variability of size measurements of small nodules examined with LDTSCT is not negligible and should be considered in lung cancer-screening studies.
Magnetic resonance imaging (MRI) of the chest coinciding with menses 4 months later showed an oval-shaped lesion with homogeneous high signal intensity in T1- and T2-weighted images in the right ...posterior costodiaphragmatic recess ( fig 2A, B ).
A 43-year-old multiparous woman with a history of pelvic endometriosis and myocardial infarction presented with acute onset of right hemithorax pain and dyspnoea coinciding with dysmenorrhoeic ...menstruation. A chest CT confirmed the presence of a right hydropneumothorax which was drained. A video-assisted thoracoscopy was unremarkable but at a subsequent menses, an MRI chest demonstrated a lesion in the right costophrenic angle. The patient underwent a hysterectomy and oophorectomy for treatment of endometriosis. Six months later, she was free of thoracic symptoms and a repeat MRI scan showed resolution of the right pleural abnormality.
Lesion growth is a relevant clue to possible malignancy of solitary pulmonary nodules. A solitary nodule was incidentally detected on chest X-ray film performed before abdominal surgery in a ...57-year-old non-smoker woman with Sjogren’s syndrome. The nodule was non-calcified and showed an increase in size on two CTs performed 15 months apart. The doubling time (195 days) was typical of malignant lesions and the nodule was resected. Histopathology revealed amyloid material and giant cell reaction consistent with solitary amyloidotic nodule.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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