Computed Tomography Screening For Lung Cancer Research Articles

Abstract 16664: Aortic Valve Calcification is Prognostic for Mild Cognitive Impairment

Introduction: While an association between vascular disease and dementia has been identified, few studies have assessed the longitudinal relationship between aortic valve calcification (AVC) and mild cognitive impairment (MCI). We recently found AVC to be associated with increased atherosclerotic events, and we sought to determine the prognostic value of AVC derived from low dose, lung cancer screening computed tomography (LCSCT) for MCI in a moderate-to-high atherosclerotic risk cohort. Methods: This was a single site, retrospective analysis of 1401 U.S. veterans (65 years [IQI: 61, 68] years; 97% male), who underwent quantification of AVC from LCSCT indicated for smoking history. Exclusion criteria included lung cancer, prior aortic valve replacement and prior MCI diagnosis. The primary outcome was new diagnosis of MCI identified by objective testing (Mini-Mental Status Exam or Montreal Cognitive Assessment) or by ICD coding. Secondary outcome was nonfatal cerebrovascular accident (CVA). Time-to-event analysis was carried out using AVC as a continuous and a categorical variable, and multivariate adjustment included age, diabetes mellitus, glomerular filtration rate <60 mL/min, coronary artery disease, and prior CVA. Results: Over a 5-year follow up, 110 patients (8%) were newly diagnosed with MCI and 45 patients (3%) had CVA. By Cox regression, AVC was predictive of MCI (HR: 1.15 [1.07 -1.24], p<0.001) and the association remained significant after multivariate adjustment (HR: 1.09 [1.01-1.18], p=0.026). Non-zero AVC tertiles were: 0.1-115; 116-427; and ≥428 Agatston Units. AVC was associated with MCI at increasing tertiles, and after multivariate analysis, the association remained significant (HR: 1.89 [1.09-3.28], p=0.024 and HR: 1.80 [1.01-3.20], p=0.047; tertiles 2 and 3, respectively). AVC was also associated with CVA (HR: 1.17 [1.05-1.32], p=0.006); however, the association lost significance after multivariate adjustment (HR: 1.12 [0.99-1.26], p=0.080). Conclusions: To our knowledge, this is the first study demonstrating that quantification of AVC from LCSCT is predictive of MCI. The association may be in part due to atherosclerotic thromboembolic events as there was a trend toward increasing nonfatal CVA in this population.

Lung Screening Benefits and Challenges: A Review of The Data and Outline for Implementation.

Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for almost a fifth of all cancer-related deaths. Annual computed tomographic lung cancer screening (CTLS) detects lung cancer at earlier stages and reduces lung cancer-related mortality among high-risk individuals. Many medical organizations, including the U.S. Preventive Services Task Force, recommend annual CTLS in high-risk populations. However, fewer than 5% of individuals worldwide at high risk for lung cancer have undergone screening. In large part, this is owing to delayed implementation of CTLS in many countries throughout the world. Factors contributing to low uptake in countries with longstanding CTLS endorsement, such as the United States, include lack of patient and clinician awareness of current recommendations in favor of CTLS and clinician concerns about CTLS-related radiation exposure, false-positive results, overdiagnosis, and cost. This review of the literature serves to address these concerns by evaluating the potential risks and benefits of CTLS. Review of key components of a lung screening program, along with an updated shared decision aid, provides guidance for program development and optimization. Review of studies evaluating the population considered "high-risk" is included as this may affect future guidelines within the United States and other countries considering lung screening implementation.

Urban-Rural Disparities in Access to Low-Dose Computed Tomography Lung Cancer Screening in Missouri and Illinois.

IntroductionLow-dose computed tomography (LDCT) lung cancer screening is recommended for current and former smokers who meet eligibility criteria. Few studies have quantitatively examined disparities in access to LDCT screening. The objective of this study was to examine relationships between 1) rurality, sociodemographic characteristics, and access to LDCT lung cancer screening and 2) screening access and lung cancer mortality.MethodsWe used census block group and county-level data from Missouri and Illinois. We defined access to screening as presence of an accredited screening center within 30 miles of residence as of May 2019. We used mixed-effects logistic models for screening access and county-level multiple linear regression models for lung cancer mortality.ResultsApproximately 97.6% of metropolitan residents had access to screening, compared with 41.0% of nonmetropolitan residents. After controlling for sociodemographic characteristics, the odds of having access to screening in rural areas were 17% of the odds in metropolitan areas (95% CI, 12%–26%). We observed no association between screening access and lung cancer mortality. Southeastern Missouri, a rural and impoverished area, had low levels of screening access, high smoking prevalence, and high lung cancer mortality.ConclusionAlthough access to LDCT is lower in rural areas than in urban areas, lung cancer mortality in rural residents is multifactorial and cannot be explained by access alone. Targeted efforts to implement rural LDCT screening could reduce geographic disparities in access, although further research is needed to understand how increased access to screening could affect uptake and rural disparities in lung cancer mortality.

Evaluation of a Low-Dose Computed Tomography Lung Cancer Screening Program in Henan, China

Lung cancer screening has been widely implemented in Europe and the US. However, there is little evidence on participation and diagnostic yields in population-based lung cancer screening in China. To assess the participation rate and detection rate of lung cancer in a population-based screening program and the factors associated with participation. This cross-sectional study used data from the Cancer Screening Program in Urban China from October 2013 to October 2019, with follow-up until March 10, 2020. The program is conducted at centers in 8 cities in Henan Province, China. Eligible participants were aged 40 to 74 and were evaluated for a high risk for lung cancer using an established risk score system. Overall and group-specific participation rates by common factors, such as age, sex, and educational level, were calculated. Differences in participation rates between those groups were compared. The diagnostic yield of both screening and nonscreening groups was calculated. The study recruited 282 377 eligible participants and included 55 428 with high risk for lung cancer; the mean (SD) age was 55.3 (8.1) years, and 34 966 participants (63.1%) were men. A total of 22 260 participants underwent LDCT (participation rate, 40.16%; 95% CI, 39.82%-40.50%). The multivariable logistic regression model showed that female sex (odds ratio [OR], 1.64; 95% CI, 1.52-1.78), former smoking (OR, 1.26; 95% CI, 1.13-1.41), lack of physical activity (OR, 1.19; 95% CI, 1.14-1.24), family history of lung cancer (OR, 1.73; 95% CI, 1.66-1.79), and 7 other factors were associated with increased participation of LDCT screening. Overall, at 6-year follow-up, 78 participants in the screening group (0.35%; 95% CI, 0.29%-0.42%) and 125 in the nonscreening group (0.38%; 95% CI, 0.33%-0.44%) had lung cancer detected, which resulted in an odds ratio of 0.93 (95% CI, 0.70-1.23; P = .61). The low participations rate in the program studied suggests that an improved strategy is needed. These findings may provide useful information for designing effective population-based lung cancer screening strategies in the future.

Study shows lung cancer screening feasible in primary care.

Findings showed low adverse event rates and 70% of diagnosed lung cancers being detected in early stages. The authors say that the results provide further data for some leaders in the primary care community who have questioned whether evidence from the National Lung Screening Trial was sufficient to support routine screening in the community setting. Results from that trial, published in 2011, led the US Preventive Services Task Force to recommend systematic, lowdose computed tomography lung cancer screening for highrisk individuals. However, the American Academy of Family Physicians said at the time that the evidence was insufficient to make a recommendation for or against the screening and that primary care providers should engage in shared decision making with their patients about whether or not they should be screened. In this study led by John Handy, Jr, MD, of the Providence Cancer Institute in Portland, Oregon, researchers analyzed more than 6000 lung cancer screenings within the community health system. Primary care providers referred the patients, and data were collected prospectively from November 2013 to December 2018 and retrospectively analyzed. Findings showed that lung cancer diagnosis, stage shift, intervention frequency, and adverse event rates were similar to those in the National Lung Screening Trial, and they indicated that lung cancer screenings can be safely and effectively performed in the community setting, the authors say. An ongoing concern is that screenings carry the risk of net harm, including false-positives. In an accompanying editorial response to the study, Chyke Doubeni, MD, MPH, a Mayo Clinic epidemiologist and health services researcher, cautions that the “window of net benefit” relies on a variety of factors involved with both screening and treatment. They include the quality of computed tomography images and interpretation; the prevalence of disease in the population; the health status of patients; and the timeliness, safety, and effectiveness of treatment after abnormal screening results.

Surgery and invasive diagnostic procedures for benign disease are rare in a large low-dose computed tomography lung cancer screening program

ObjectiveLung cancer screening with low-dose chest computed tomography improves survival. However, concerns about overdiagnosis and unnecessary interventions persist. We reviewed our lung cancer screening program to determine the rate of surgery and invasive procedures for nonmalignant disease. MethodsWe reviewed all patients undergoing lung cancer screening from January 2012 to June 2017 with follow-up through January 2019. Patients with suspicious findings (Lung CT Screening Reporting and Data System 4) were referred for further evaluation. ResultsOf 3280 patients screened, 345 (10.5%) had Lung CT Screening Reporting and Data System 4 findings. A total of 311 patients had complete follow-up, of whom 93 (29.9%) were diagnosed with lung cancer. Eighty-three patients underwent lung surgery (2.5% of screened patients). Forty patients underwent lobectomy (48.2%), 3 patients (3.6%) underwent bilobectomy, and 40 patients (48.2%) underwent sublobar resection. Fourteen patients underwent surgery for benign disease (0.43% of screened patients). Fifty-four patients, 5 with benign disease, had at least 1 invasive diagnostic procedure but never underwent surgery. The incidence of any invasive intervention for nonmalignant disease was 0.95% (31/3280 patients). There were no postprocedural deaths within 60 days. Twenty-five patients (0.76%) underwent stereotactic body radiation therapy; 19 patients (76%) had presumed lung cancer without pretreatment pathologic confirmation. ConclusionsSurgical resection for benign disease occurred in 0.43% of patients undergoing lung cancer screening. The combined incidence of any invasive diagnostic or therapeutic intervention, including surgical resection, for benign disease was only 0.95%. Periprocedural complications were rare. These results indicate that concern over unnecessary interventions is overstated and should not hinder adoption of lung cancer screening. A multidisciplinary team approach, including thoracic surgeons, is critical to maintain an appropriate rate of interventions in lung cancer screening.

Factors Influencing the False Positive Rate in CT Lung Cancer Screening

To identify factors influencing the likelihood of a false positive lung cancer screening (LCS) computed tomography (CT), which may lead to increased costs and patient anxiety. In this retrospective study, we examined all LCS CTs performed across our healthcare network from 2014 to 2018, recording Lung-RADS category and diagnosis of lung cancer. A false positive was defined by Lung-RADS 3-4X and no diagnosis of lung cancer within 1 year. Patient demographics and smoking history, presence of emphysema, diagnosis of chronic obstructive pulmonary disease, radiologist years of experience and annual volume, income level by patient zip code, and screening institution were evaluated in a multivariate logistic regression model for false positive exams. A total of 5835 LCS CTs were included from 3735 patients. Lung cancer was diagnosed in 142 cases (2%). Of the LCS CTs, 905 (16%) were positive by Lung-RADS, and 766 (13%) represented false positives. Logistic regression analysis showed that screening institution (odds ratios [OR] 0.91 - 2.43), baseline scan (OR 1.43), radiologist experience (OR 0.59), patient age (OR 2.08), diagnosis of chronic obstructive pulmonary disease (OR 1.34), presence of emphysema (OR 1.32), and income level (OR 0.43) were significant predictors of false positives. A number of patient-specific and site/radiologist-specific factors influence the false positive rate in CT LCS. In particular, radiologists with less experience had a higher false positive rate. Screening programs may wish to develop quality assurance programs to compare the false positive rates of their radiologists to national benchmarks.

Technical Note: Synthesizing of lung tumors in computed tomography images

When investigating new radiation therapy techniques in the treatment planning stage, it can be extremely time consuming to locate multiple patient scans that match the desired characteristics for the treatment. With the help of machine learning, we propose to bypass the difficulty in finding patient computed tomography (CT) scans that match the treatment requirements. Furthermore, we aim to provide the developed method as a tool that is easily accessible to interested researchers. We propose a generative adversarial network (GAN) to edit individual volumes of interest (VOIs) in pre-existing CT scans, translating features of the healthy VOIs into features of cancerous volumes. Training and testing was done using VOIs from a dataset of 460 diagnostic and lung cancer screening CT scans. Agreement between real tumors and those produced by the editor was tested by comparing the distributions of several histogram parameters and second-order statistics as well as using qualitative analysis. After training, the network was successfully able to map healthy CT segments to realistic looking cancerous volumes. Based on visual inspection, tumors produced by the editor were found to be both realistic and visually consistent with the surrounding anatomy when placed back into the original CT scan. Furthermore, the network was found to be able to extrapolate well beyond the upper size limit of the training set. Lastly, a graphical user interface (GUI) was developed to easily interact with the resulting network. The trained network and associated GUI can serve as a tool to develop an abundance of lung cancer patient data to be used in treatment planning. In addition, this method can be extended to a variety of cancer types if given an appropriate baseline dataset. The GUI and instructions on how to utilize the tool have been made publicly available at https://github.com/teaghan/CT_Editor.

Aortic valve calcification predicts all-cause mortality independent of coronary calcification and severe stenosis

Background and aimsCalcific aortic valve disease is highly prevalent in patients with significant smoking history and is a marker of atherosclerosis. The aim of this study was to define the prognostic value of aortic valve calcification (AVC) derived from low dose, lung cancer screening computed tomography (LCSCT) for all-cause mortality in this higher risk population. MethodsThis is a single site, retrospective analysis of 1529 moderate-to-high atherosclerotic cardiovascular risk U.S. veterans (65 years [IQI: 61, 68] years; 96% male), who underwent clinically indicated LCSCT. CTs were scored for aortic valve calcification (AVC) and coronary artery calcification (CAC). The primary endpoint was all-cause mortality and secondary endpoints were nonfatal myocardial infarction (MI) and nonfatal cerebrovascular accident (CVA). ResultsOver 4-year follow-up, 227 patients (15%) died, 112 patients (7%) had nonfatal MI, and 52 patients (3%) had nonfatal CVA. AVC was predictive of all-cause mortality (HR per 100: 1.041 [1.030–1.052], p < 0.001), and this association remained significant after multivariate adjustment for traditional atherosclerotic risk factors, including CAC (1.021 [1.007–1.036], p = 0.003). After excluding patients with severe aortic stenosis (AS) or severe AVC (≥1274 AU in women and ≥2065 AU in men), in a subset of 765 patients who had echocardiograms, this association remained significant after multivariate analysis (HR per 100: 1.052 [1.010–1.095], p = 0.014). Despite controlling for CAC in the models, AVC was still associated with MI (HR per 100: 1.021 [1.004–1.039], p = 0.017) and with CVA (HR per 100: 1.027 [1.002–1.051], p = 0.032). ConclusionsScoring AVC derived from LCSCT is predictive of mortality, nonfatal MI, and nonfatal CVA in patients at known risk for cardiovascular disease, independent of coronary calcification or severe aortic valve stenosis.

Clinical impact and cost-effectiveness of integrating smoking cessation into lung cancer screening: a microsimulation model.

Low-dose computed tomography (CT) screening can reduce lung cancer mortality in people at high risk; adding a smoking cessation intervention to screening could further improve screening program outcomes. This study aimed to assess the impact of adding a smoking cessation intervention to lung cancer screening on clinical outcomes, costs and cost-effectiveness. Using the OncoSim-Lung mathematical microsimulation model, we compared the projected lifetime impact of a smoking cessation intervention (nicotine replacement therapy, varenicline and 12 wk of counselling) in the context of annual low-dose CT screening for lung cancer in people at high risk to lung cancer screening without a cessation intervention in Canada. The simulated population consisted of Canadians born in 1940-1974; lung cancer screening was offered to eligible people in 2020. In the base-case scenario, we assumed that the intervention would be offered to smokers up to 10 times; each intervention would achieve a 2.5% permanent quit rate. Sensitivity analyses varied key model inputs. We calculated incremental cost-effectiveness ratios with a lifetime horizon from the health system's perspective, discounted at 1.5% per year. Costs are in 2019 Canadian dollars. Offering a smoking cessation intervention in the context of lung cancer screening could lead to an additional 13% of smokers quitting smoking. It could potentially prevent 12 more lung cancers and save 200 more life-years for every 1000 smokers screened, at a cost of $22 000 per quality-adjusted life-year (QALY) gained. The results were most sensitive to quit rate. The intervention would cost over $50 000 per QALY gained with a permanent quit rate of less than 1.25% per attempt. Adding a smoking cessation intervention to lung cancer screening is likely cost-effective. To optimize the benefits of lung cancer screening, health care providers should encourage participants who still smoke to quit smoking.

Clinical utility of circulating genetically abnormal cells within low-dose computed tomography lung cancer screening: A correlative MCPND trial study.

e15536 Background: Recent screening trial results using low-dose computed tomography (LDCT) have been shown to reduce lung cancer mortality in high-risk patients. However, high false-positive rates, inter-grader variability, and radiation injuries are challenging, and therefor highlight the necessity for complementary biomarkers. The diagnostic performance of circulating genetically abnormal cells (CACs) was respectively evaluated in samples collected from patients with pulmonary nodules before and after lung lobectomy within the Multicenter Chinese Pulmonary Nodule Detection (MCPND) trial. We also propose a deep learning that detects related genetically abnormal cells in excisions of symptomatic lesions to identify the source of CACs. Methods: 269 plasma samples (n = 179, before surgery; n = 90, after surgery) from 179 participants, including 125 patients with lung cancer and 54 donors with benign nodular lesions, were analyzed by using a FISH–based assay for 3p22.1, 3q29, 10q22_3 and CEP10. Diagnostic performance of CAC was evaluated in a blinded validation group. 109 paraffin-embedded specimens (45 benign nodular lesions, 64 malignancies) obtained from participants were tested in the same way to identify the genetically abnormal cells. Results: The diagnostic performance of CACs for lung cancer detection was 91% for sensitivity and 81% for specificity. For all participants, CACs had a positive predictive value of 92% and 80% for negative predictive value, respectively. Area under the ROC curve was 0.89 (P &lt; 0.01; 95%CI (0.82, 0.96)). 90 plasma samples were drawn from patients within 10 days after surgery. Of these samples, 58 participants’ CACs level reduced and 25 of them remained stable. Moreover, of 64 malignant specimens, genetically abnormal cells were detected in 60 specimens. However, only 4 specimens were detected having genetically abnormal cells in 45 benign nodular lesions. Conclusions: This validation study indicated that the number of genetically abnormal cells in circulation decreased after surgical resection, which suggested CACs could be released from lung cancer. CACs have diagnostic and prognostic value and could assist to improve the diagnostic accuracy in early stage lung cancer after low-dose computed tomography. Clinical trial information: ChiCTR1900026233.

Prognostic effect of implementation of the mass low-dose computed tomography lung cancer screening program: a hospital-based cohort study.

Low-dose computed tomography lung cancer screening aims to detect early-stage lung cancers in order to decrease the incidence of advanced-stage lung cancers and to reduce lung cancer mortality. We analyzed the time trends of lung cancer stage distribution and mortality rates after the gradual implementation of the low-dose computed tomography lung cancer screening in a hospital-based cohort. Using the hospital-based cancer registry data on lung cancer number and death from 2007 to 2014, we aim to evaluate the trends in stage distribution and mortality rate after the gradual implementation of low-dose computed tomography lung cancer screening program over recent years. From 2007 to 2014, overall 2542 cases of lung cancers were diagnosed according to hospital-based cancer registry. For the 1-year mortality rate, the mortality rate decreased gradually from 48.16 to 37.04% between 2007 and 2014. For the 5-year mortality rate, the mortality rate decreased gradually from 88.49 to 69.44% between 2007 and 2014. There was a gradual decrease in stage IV lung cancer with the corresponding sharp increase in stage I early lung cancer after following the implementation of the large volume of the low-dose computed tomography examination between the years 2011 and 2014. In conclusion, these results suggest that the gradual implementation of low-dose computed tomography lung screening program could lead to a remarkable decrease in lung cancer mortality and a remarkable stage shift in the trend over time in this hospital-based cohort.

CT Screening for Lung Cancer — Another Trial

In the U.S. National Lung Screening Trial (NLST), screening with low-dose computed tomography (CT) lowered lung-cancer mortality compared with a

Lung Cancer Screening at a Military Treatment Facility: A Retrospective Review.

Lung cancer is the leading cause of cancer death among men and women, accounting for more fatalities than colon, breast, and prostate cancers combined. Smoking causes about 85% of all lung cancers in the United States and is the single greatest risk factor. In 2013, the US Preventive Services Task Force (USPSTF) published initial guidelines for low-dose computed tomography lung cancer screening (LCS) among patients 55-80years old, with a 30-pack-year history, who are current smokers or who quit within the previous 15years. Smoking prevalence is higher among military personnel compared to the civilian population, demonstrating a need for vigilant screening. A retrospective review of Naval Medical Center San Diego's (NMCSD) LCS data was conducted to examine screening numbers, lung cancer rates, and initial analysis of screening results. Patients were referred for screening if they met the USPSTF criteria. Between September 2013 and September 2018, 962 patients underwent LCS. A total of 1758 examinations were performed, including follow-up and annual surveillance examinations. The American College of Radiology's Lung CT Screening Reporting and Data System (Lung-RADS) was used to classify lung nodules' risk for malignancy. On this initial analysis, 42 enrolled patients received the diagnosis of lung cancer detected by screening. The initial calculated lung cancer rate is 4.4% (42/962) over the 5-year reporting period. The lung cancer rate among those patients with a Lung-RADS score of 3 or 4 was 31% (42/135). Thirty-seven patients were classified as having non-small cell lung cancer (NSCLC), while five were classified as having small cell lung cancer. Of the 37 NSCLC patients, 76% (28/37) were diagnosed at stage I and II, 11% (4/37) were diagnosed at stage III, and 13% (5/37) were diagnosed at stage IV. The total number of years a person smoked was a significant risk factor (P=0.004), but not pack-years a person smoked (P=0.052). These preliminary results demonstrate the success of a Military Treatment Facility (MTF)-based LCS Program in the detection of early stage lung cancer. Earlier stage detection may result in better health outcomes for affected patients. In the population studied, duration of smoking proved to be more significant than pack-years in predicting lung cancer risk. These results validate the newly dedicated resources and continued efforts to strengthen the LCS program at NMCSD and across MTFs.

Patient-centered Radiology Reporting for Lung Cancer Screening.

Medicine is slowly transitioning toward a more patient-centered approach, with patients taking a more central role in their own care. A key part of this movement has involved giving patients increased access to their medical record and imaging results via electronic health portals. However, most patients lack the knowledge to fully understand medical documents, which are generally written above their comprehension level. Radiology reports, in particular, utilize complex terminology due to radiologists' historic function as consultants to other physicians, with little direct communication to patients. As a result, typical radiology reports lack standardized formatting, and they are often inscrutable to patients. Numerous studies examining patient preference also point to a trend for more accessible radiology reports geared toward patients. Reports designed with an infographic format, combining simple pictures and standardized text, may be an ideal format that radiologists can pursue to provide patient-centered care. Our team, through feedback from patient advisory groups, developed a patient-friendly low-dose computed tomography lung cancer screening report with an infographic format that is both visually attractive and comprehensible to the average patient. The report is designed with sections including a description of low-dose computed tomography, a section on individualized patient results, the meaning of the results, and a list of the next steps in their care. We believe that this form of the report has the potential to serve as a bridge between radiologists and patients, allowing for a better patient understanding of their health and empowering patients to participate in their health and health care.

Common mental disorders in Taiwanese consumers of commercial low-dose computed tomography lung cancer screening: Comparison with a nationally representative sample

We examined the prevalence of probable common mental disorders (CMDs) in commercial low-dose computed tomography (LDCT) lung cancer screening consumers relative to the general population and to determine the correlates of probable CMDs among screening participants. Commercial LDCT lung cancer screening consumers (N=1323) were compared with a nationally representative sample from the Taiwan Social Change Survey (TSCS) (N=2034). Respondents scoring ≥3 on the Chinese Health Questionnaire were classified as having a probable CMD. Logistic regression was used to investigate differences between the two groups and correlates of probable CMDs among LDCT lung cancer screening participants. The prevalence of probable CMDs was higher among LDCT lung cancer screening participants (25.47%) than among TSCS adults (21.56%). Compared with the TSCS sample, the screening participants had a higher probability of CMDs (OR=1.40, 95% CI=1.13-1.73), higher education levels (OR=7.95, 95% CI=6.00-10.53), and a history of drinking (OR=11.85, 95% CI=9.45-14.85) or betel-quid use (OR=5.43, 95% CI=3.98-7.42) but were less likely to smoke (OR=0.52, 95% CI=0.40-0.68). Among the screening participants, being female (OR=1.37, 95% CI=1.02-1.84) and a current smoker (OR=1.74, 1.19-2.54) and living near ≥2 smoking family members (OR=2.30, 95% CI 1.57-3.38) were associated with an increased likelihood of having CMDs. Commercial LDCT lung cancer screening users may have a positive association with probable CMDs compared to the general population. Screening programs should consider including criteria and providing psychoeducation to improve the physical and mental outcomes of participants. Purely observational studies (those in which the assignment of the medical intervention is not at the discretion of the investigator) do not require registration.

The 100 most cited articles on thoracic surgery management of lung cancer.

Lung cancer is the leading cause of cancer-related deaths worldwide. In 2019, 228,150 new lung cancer cases and 142,670 cancer deaths are projected to occur in the United States (1), and non-small cell lung cancer (NSCLC) accounts for nearly 85% of all diagnosed cases (1,2). As the US Preventative Services Task Force has released recommendations of computed tomography lung cancer screening for long-term smokers, the incidence of newly diagnosed lung cancer will have a marked increase (3). Over the past two decades, the therapies for lung cancer have evolved into a mature subspecialty, also being the culmination of a progressive research initiative and the continued innovation of interventional techniques. For operable NSCLC, the current guideline states that VATS lobectomy is the standard operation (4,5). In recent years, a great progress in the clinical treatment and basic research of adjuvant therapy for lung cancer has been obtained, such as chemotherapy, radiotherapy, target therapy, and immunotherapy (6-8). A large amount of literature is available to thoracic medicine specialists who perform thoracic surgery management of lung cancer. It is difficult to recognize articles of significance since the quality of the literature varies substantially and includes low impact studies and open access journals. An understanding of the available literature and the most heavily cited works will allow for a better understanding of the evidence base when discussing and providing these treatments. A bibliometric analysis is a quantitative method used to examine the knowledge structure and development of a research field and its publications. Among all the bibliometric methods, the citation analysis is the most common which focuses on citation number and number of citations per year (9,10). It evaluates the impact an article has had on a specific field of medicine by measuring the number of citations an article has received. Since 1971, the global output of academic research into the management of lung cancer has increased. There has been no specific quantitative analysis on the articles which have had the most significant impact on the treatment of lung cancer been performed. The aim of this study was to perform a citation analysis on the most cited articles in the thoracic surgery management for lung cancer and analyze each article individually, collecting the article type, year of publication, topic of interest, citation index, authorship, country of origin, institution, and level of evidence.

Impact of Significant Coronary Artery Calcification Reported on Low-Dose Computed Tomography Lung Cancer Screening.

Coronary artery calcification (CAC) is a common and important incidental finding in low-dose computed tomography (LDCT) performed for lung cancer screening (LCS). The impact of these incidental findings on patient management is unclear. The goals of our study were to determine the impact of reporting CAC on patient management and to determine whether standardized reporting of CAC affects the likelihood of future interventions. In this IRB-approved retrospective study, we queried our LCS database for reports of LDCT performed between January 2016 and September 2018. All reports with significant findings of CAC designated with the letter "S" for any Lung-RADS category were selected. The grading of CAC was extracted from the reports. Medical records were reviewed for each patient to determine demographics, clinical history, medications, and cardiac-related diagnostic and interventional procedures. The changes in management after the report of significant CAC on LDCT were documented. Statistical analysis with Student t test and Pearson χ test was performed. A total of 756/3110 patients (mean age: 67±6.4 y; M=466, 61.6%: F=290, 38.4%) were reported to have significant CAC on LDCT for LCS. Of them, 236/756 patients (31.2%) had established coronary artery disease (CAD) at baseline, before the initial LDCT. A change in management was observed in 155/756 patients (20.5%). The most common changes in management included the following: alteration in medication regimen (n=114/155, 73.5%), stress testing (n=65/155, 41.9%), and referral to a cardiologist (36/155, 23.2%). Percutaneous coronary intervention (4, 2.6%) and surgery (3, 1.9%) were uncommon. Changes in management were more common in those without established CAD and in those whose CAC was semiquantitatively graded (35% vs. 25%, P=0.02). CAC is a common significant finding in LDCT for LCS. Reporting of CAC in patients with nonestablished CAD and semiquantitative assessment resulted in changes in management.

MS18.06 Captive Audience, Teachable Moment — Integrating Tobacco Cessation in Lung Cancer Screening

MS18.06 Captive Audience, Teachable Moment — Integrating Tobacco Cessation in Lung Cancer Screening

Multidisciplinary selection of pulmonary nodules for surgical resection: Diagnostic results and long-term outcomes

ObjectivePulmonary nodules found incidentally or by lung cancer screening differ in prevalence, risk profile, and diagnostic intervention. The results of surgical intervention for incidental versus screening lung nodules during multidisciplinary Pulmonary Nodule and Lung Cancer Screening Clinic (PNLCSC) follow-up have not been reported. MethodsAll patients evaluated at a PNLCSC from 2012 to 2018 following referral by primary care physicians, specialist physicians, or self-referral after computed tomography (CT) identified nodules on routine diagnostic CT (incidental group) or lung cancer screening CT (screening group) were included. Follow-up interval, invasive intervention, histology, postoperative events, survival, and recurrence were compared. ResultsOf 747 patients evaluated in the PNLCSC, 129 (17.2%) underwent surgical intervention. The surgical cohort consisted of 104 (80.6%) incidental and 25 (19.3%) screening patients followed over a mean of 122 and 70 days, respectively. More benign lesions were excised in the incidental group (20.2%, 21/104)—representing 3.3% (21/632) of all incidental nodules evaluated—than in the screening group (4%, 1/25) (P = .038). Operative mortality was zero. Among 99 patients with primary lung cancer, 87% (screening) and 86.8% (incidental) were pathologic stage Ia. Complete follow-up was available in 725 of 747 (97%), and no patient developed progressive disease. Disease-free survival at 5 years was 74.9% (incidental) and 89.3% (screening) (P = .48). ConclusionsA unique multidisciplinary PNLCSC for incidental and lung cancer screening–detected nodules with individualized risk assessment reliably identifies primary and metastatic tumors while exposing few patients to diagnostic excision for benign disease. Longer-term outcomes, strategies to limit radiation exposure, and cost control need further study.