Abstract

BackgroundLow-dose spiral computed tomography (LDSCT) in comparison to conventional chest X-ray proved to be a highly sensitive method of diagnosing early stage lung cancer. However, centrally located early stage lung tumours remain a diagnostic challenge. We determined the practicability and efficacy of early detection of lung cancer when combining LDSCT and sputum cytology.MethodsOf a cohort of 4446 formerly asbestos exposed power industry workers, we examined a subgroup of 187 (4.2%) high risk participants for lung cancer at least once with both LDSCT and sputum cytology. After the examination period the participants were followed-up for more than three years.ResultsThe examinations resulted in the diagnosis of lung cancer in 12 participants (6.4%). Six were in clinical stage I. We found 10 non-small cell lung carcinomas and one small cell lung carcinoma. Sputum specimens showed suspicious pathological findings in seven cases and in 11 cases the results of LDSCT indicated malignancies. The overall sensitivity and specificity of sputum cytology was 58.0% and 98% with positive (PPV) and negative (NPV) predictive values of 70% and 97%. For LDSCT we calculated the sensitivity and specificity of 92% and 97%. The PPV and NPV were 65% and 99% respectively.ConclusionsOur results confirmed that in surveillance programmes a combination of sputum cytology and LDSCT is well feasible and accepted by the participants. Sputum examination alone is not effective enough for the detection of lung cancer, especially at early stage. Even in well- defined risk groups highly exposed to asbestos, we cannot recommend the use of combined LDSCT and sputum cytology examinations as long as no survival benefit has been proved for the combination of both methods. For ensuring low rates of false-positive and false-negative results, programme planners must closely cooperate with experienced medical practitioners and pathologists in a well-functioning interdisciplinary network.

Highlights

  • Low-dose spiral computed tomography (LDSCT) in comparison to conventional chest X-ray proved to be a highly sensitive method of diagnosing early stage lung cancer

  • We examined the practicability and efficacy of lung cancer screening in a group of power industry workers, who were heavily exposed to asbestos dust in the past

  • New cases of lung cancer during the examination period In the active study period 12 participants were newly diagnosed with lung cancer (6.4%), 11 of them confirmed with lung tissue biopsy (Table 2)

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Summary

Introduction

Low-dose spiral computed tomography (LDSCT) in comparison to conventional chest X-ray proved to be a highly sensitive method of diagnosing early stage lung cancer. We determined the practicability and efficacy of early detection of lung cancer when combining LDSCT and sputum cytology. As a result of these and other studies, mass screening for lung cancer was not recommended [7]. In recent studies, where the highly sensitive method of low-dose spiral computed tomography (LDSCT) was used instead of conventional chest X-rays, a higher detection rate of early-stage lung cancers could be demonstrated. Recent results from the National Lung Screening Trial confirmed a decreasing effect of LDSCT screening on mortality, in those with a high risk of lung cancer [11]

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