Abstract
Lung cancer has the highest mortality rate of all cancers. This paper seeks to address the question: Can the mortality of lung cancer be decreased by screening with low-dose computerized tomography (LDCT) in higher risk patients compared to chest X-rays (CXR) or regular patient care? Currently, CXR screening is recommended for certain high-risk patients. Several recent trials have examined the effectiveness of LDCT versus chest radiography or usual care as a control. These trials include National Lung Screening Trial (NLST), Detection And screening of early lung cancer with Novel imaging TEchnology (DANTE), Lung Screening Study (LSS), Depiscan, Italian Lung (ITALUNG), and Dutch-Belgian Randomized Lung Cancer Screening Trial (Dutch acronym: NELSON study). NLST, the largest trial (n=53, 454), demonstrated a decrease in mortality from lung cancer in the LDCT group (RRR=20%, P=0.004). LSS demonstrated a greater sensitivity in detecting both early stage and any stage of lung cancer in comparison to traditional CXR. Although the DANTE trial yielded data consistent with findings in LSS, it also showed that via LDCT screening a greater proportion of patients were placed under unnecessary surgical procedures. The Depiscan trial yielded a high nodule detection rate at the cost of a high false-positive rate compared to CXR screening. The ITALUNG and NELSON trials demonstrated the early detection capabilities of LDCT for lung cancers compared to usual care without surveillance imaging. False-positive findings with unnecessary workup, intervention, and radiation exposure remain significant concerns for routine LDCT screening. However, current data suggests LDCT may provide a highly sensitive and specific means for detecting lung cancers and reducing mortality.
Highlights
BackgroundCurrently, lung cancer has the highest mortality rates of all cancers in both men and women [1]
Though the percentage of positive low-dose computerized tomography (LDCT) screening ranged between 5% and 35% in the studies, most studies demonstrated that LDCT had strong sensitivity and specificity in detecting lung cancer [5,6,7,8,9,10,11,12]
When compared to chest X-rays (CXR) surveillance, LDCT had a greater rate of lung cancer detection in the National Lung Screening Trial (NLST), Lung Screening Study (LSS), and Depiscan studies [5,7,8]
Summary
Lung cancer has the highest mortality rates of all cancers in both men and women [1]. In the last few years, trials have studied the effectiveness of yearly LDCT scans in patients with more risks for lung cancer as a screening tool by comparing it to chest X-rays or regular patient care. LSS is a pilot study initiated in 2000 with the objective of assessing the feasibility of conducting a large scale randomized control trial (RCT) in comparing LDCT to traditional chest X-rays (CXR) for lung cancer screening. The Italian Lung (ITALUNG) study was a small scale RCT component of the EU-US Collaborative Spiral CT working group aimed to determine differences in lung cancer mortality between high-risk patients receiving annual LDCT screening and those undergoing usual care. The comparable sensitivity, specificity, positive predictive value, and early detection for LDCT in the NELSON study to larger scale RCTs provides significant data for a future standardized lung cancer screening protocol. Each study had a slightly different protocol for the work-up of the nodules and the follow-up CT scans [12]
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