Early Detection of Lung Cancer Using CT Scan and Bronchoscopy in a High Risk Population

Vijayvel Jayaprakash,D Kyle Hogarth,Gregory M Loewen,Mary E Reid,Samjot S Dhillon,Sai Yendamuri,Kirsten B Moysich,Martin C Mahoney

doi:10.4236/jct.2012.324051

Vijayvel Jayaprakash, D Kyle Hogarth + Show 6 more

Open Access

https://doi.org/10.4236/jct.2012.324051

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Abstract

Background: Computed tomography (CT) and bronchoscopy have been shown to improve the detection rates of peripheral and central lung cancers (LC), respectively. However, the performance of the combination of CT and bronchoscopy in detecting LC, in high-risk patients, is not clear. Patients & Methods: This prospective study included 205 high-risk patients with a history of at least 2 of the following risk factors: 1) heavy smoking; 2) aero-digestive cancer; 3) pulmonary asbestosis or; 4) chronic obstructive pulmonary disease. Patients were offered chest X-ray, sputum cytology, conventional white-light followed by autofluorescence bronchoscopy (WL/AFB) and low-dose spiral CT both at baseline and follow-up visits. Results: Seven patients (3.4%) were diagnosed with LC or carcinoma in-situ (CIS) at baseline: CT evaluation detected 5 LC/CIS, while WL/AFB evaluation also identified 5 LC/CIS, 2 of which were not detected on CT. Six (85%) of these baseline lesions were early stage (0/IA). The relative-sensitivity of CT with WL/ AFB was 40% better than CT alone. By four year follow-up, 20 patients (9.8%) were diagnosed with LC/CIS. CT with WL/AFB detected 19 cases (95%), whereas CT alone detected 15 cases (75%). Conclusion: Bimodality surveillance with spiral CT and WL/AFB can improve the detection of early stage LCs among high-risk patients.

Highlights

Lung cancer (LC) is the most commonly diagnosed malignancy and accounts for about 1.4 million deaths worldwide [1]
Patients were offered chest X-ray, sputum cytology, conventional white-light followed by autofluorescence bronchoscopy (WL/auto-fluorescence bronchoscopy (AFB)) and low-dose spiral computerized tomography (CT) both at baseline and follow-up visits
The optimal lung cancer early detection strategy would be a cost-effective diagnostic test that can be performed on asymptomatic high-risk patients to identify a disease at an earlier stage, when intervention has a good chance of reducing the mortality from the disease

Summary

Introduction

Lung cancer (LC) is the most commonly diagnosed malignancy and accounts for about 1.4 million deaths worldwide [1]. Improved 5 year survival is limited only to early stage LC patients [2]. Several large studies examined the effectiveness of chest X-ray and sputum cytology as screening tools to detect LCs [5,6,7,8]. Due to the lack of success using X-ray and sputum cytology, researchers have used spiral computerized tomography (CT) of the chest [9,10,11]. Computed tomography (CT) and bronchoscopy have been shown to improve the detection rates of peripheral and central lung cancers (LC), respectively. Patients were offered chest X-ray, sputum cytology, conventional white-light followed by autofluorescence bronchoscopy (WL/AFB) and low-dose spiral CT both at baseline and follow-up visits. Conclusion: Bimodality surveillance with spiral CT and WL/AFB can improve the detection of early stage LCs among high-risk patients

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