Lung cancer screening with low-dose computed tomography: A non-invasive diagnostic protocol for baseline lung nodules
Articolo
Data di Pubblicazione:
2008
Abstract:
BACKGROUND:
Indeterminate non-calcified lung nodules are frequent when low-dose spiral computed tomography (LD-CT) is used for lung cancer screening. We assessed the diagnostic utility of a non-invasive work-up protocol for nodules detected at baseline in volunteers enrolled in our single-centre screening trial, and followed for at least 1 year.
METHODS:
5201 high-risk volunteers, recruited over 1 year from October 2004, underwent baseline LD-CT; 4821 (93%) returned for the first repeat LD-CT. Nodules8mm received combined CT-positron emission tomography (CT-PET). A subset of nodules >8mm was studied by CT with contrast. Protocol failures were delayed diagnosis with disease progression beyond stage I, and negative surgical biopsy.
RESULTS:
2754 (53%) volunteers presented one or more non-calcified nodules. Ninety-two lung cancers were diagnosed: 55 at baseline and 37 at annual screening (66% stage I). Among the 37 incident cancers, 17 had a baseline nodule that remained stage I, 7 had a baseline nodule that progressed beyond stage I, and 13 presented a new malignant nodule. Baseline and annual cancers were 79 (1.5%) and 13 (0.2%), respectively. In 15 of 104 (14%) invasive diagnostic procedures, the lesion was benign. Sensitivity, and specificity were 91 and 99.7%, respectively, for the entire protocol; 88 and 93% for CT-PET; and 100 and 59% for CT with contrast.
CONCLUSIONS:
The protocol limits invasive diagnostic procedures while few patients have diagnosis delay, supporting the feasibility of lung cancer screening in high-risk subjects by LD-CT. Nevertheless further optimization of the clinical management of screening-detected nodules is necessary.
Indeterminate non-calcified lung nodules are frequent when low-dose spiral computed tomography (LD-CT) is used for lung cancer screening. We assessed the diagnostic utility of a non-invasive work-up protocol for nodules detected at baseline in volunteers enrolled in our single-centre screening trial, and followed for at least 1 year.
METHODS:
5201 high-risk volunteers, recruited over 1 year from October 2004, underwent baseline LD-CT; 4821 (93%) returned for the first repeat LD-CT. Nodules
RESULTS:
2754 (53%) volunteers presented one or more non-calcified nodules. Ninety-two lung cancers were diagnosed: 55 at baseline and 37 at annual screening (66% stage I). Among the 37 incident cancers, 17 had a baseline nodule that remained stage I, 7 had a baseline nodule that progressed beyond stage I, and 13 presented a new malignant nodule. Baseline and annual cancers were 79 (1.5%) and 13 (0.2%), respectively. In 15 of 104 (14%) invasive diagnostic procedures, the lesion was benign. Sensitivity, and specificity were 91 and 99.7%, respectively, for the entire protocol; 88 and 93% for CT-PET; and 100 and 59% for CT with contrast.
CONCLUSIONS:
The protocol limits invasive diagnostic procedures while few patients have diagnosis delay, supporting the feasibility of lung cancer screening in high-risk subjects by LD-CT. Nevertheless further optimization of the clinical management of screening-detected nodules is necessary.
Tipologia CRIS:
1.1 Articolo in rivista
Keywords:
Computed tomography; Diagnosis; Lung cancer; Positron emission tomography; Screening; Smokers; Surgery; Aged; Chi-Square Distribution; Contrast Media; Disease Progression; Female; Fluorodeoxyglucose F18; Humans; Incidence; Lung Neoplasms; Male; Mass Screening; Middle Aged; Neoplasm Staging; Positron-Emission Tomography; Prospective Studies; Radiation Dosage; Radiographic Image Interpretation, Computer-Assisted; Radiopharmaceuticals; Sensitivity and Specificity; Statistics, Nonparametric; Tomography, X-Ray Computed; Oncology
Elenco autori:
Veronesi, Giulia; Bellomi, Massimo; Mulshine, James L.; Pelosi, Giuseppe; Scanagatta, Paolo; Paganelli, Giovanni; Maisonneuve, Patrick; Preda, Lorenzo; Leo, Francesco; Bertolotti, Raffaella; Solli, Piergiorgio; Spaggiari, Lorenzo
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