Computed Tomography Screening Research Articles

Early diagnosis of lung cancer: is rapid access CT scanning the answer?

Lung cancer remains the most common cause of cancer mortality in Britain. The 10-year survival rate from the disease is in the order of 5%, because the majority of patients present with advanced disease. Five-year survival rates for lung cancer in the UK from 2000–2014 are only 13%, lagging far behind most other EU nations. These findings, which were published in the Lancet in January 2018, have also been widely reported in many national newspapers.1 Currently, the US, Canada, and a number of European countries have implemented screening programmes for lung cancer with low-dose computed tomography (CT). Early diagnosis by low-dose CT (LDCT) screening has been shown to lead to a reduction in lung cancer mortality by 20% in the National Lung Screening Trial (NLST), a large randomised clinical trial from the US.2 The final results from the Dutch-Belgian NELSON trial, the only other clinical study powered to detect a reduction in mortality, are still awaited.3 The Accelerate, Coordinate, Evaluate (ACE) Programme was funded by Cancer Research UK and Macmillan Cancer Support, and took place between 2014 and 2017. The final ACE report was published in April 2017.4 Although not funding local screening programmes as such, the ACE programme was an important early diagnostic cancer initiative focused on evaluating a wide variety of innovations designed to either streamline diagnostic pathways or identify individuals at an increased risk of cancer.5 One strand of ACE was the lung cancer cluster, which aimed to explore the most …

Definitive Radiation for Stage I Lung Cancer in a Screened Population: Results From the I-ELCAP

The International Early Lung Cancer Action Program is a cohort study to assess the cure rate of participants undergoing annual low-dose computed tomography screening for lung cancer. This study compares the characteristics and outcomes of patients who received a diagnosis of clinical stage I non-small cell lung carcinoma (NSCLC) treated with definitive radiation therapy and surgical resection. Patient information was drawn from the International Early Lung Cancer Action Program database from 1992 to 2017. All instances in which treatment was performed for histologically proven stage I NSCLC using definitive radiation therapy and surgery were identified. The home institution determined radiation plans. Patient characteristics and Kaplan-Meier lung cancer-specific (LCS) long-term survival rates were compared for both types of treatment. Follow-up time was calculated from time of diagnosis until death from lung cancer, loss to follow-up, or December 31, 2017, whichever came earlier. Among 82,628 baseline and 109,250 annual repeat screenings, 853 patients received a diagnosis of clinical stage I NSCLC, of whom 31 (3.6%) were treated by definitive radiation therapy and 702 (82.3%) by surgical resection alone. Radiation therapy prescription information was obtainable for 24 of the 31 patients: The median dose was 54.5Gy, the median number of fractions was 5, and 17 patients were treated using stereotactic body radiation therapy. LCS survival rates were not significantly different for radiation therapy compared with surgery: 90.0% (95% confidence interval, 84.9%-100.0%) versus 94.8% (95% confidence interval, 93.0%-96.6%) (P=.09). Median follow-up time was 9.7years for all, but it was shorter for those treated by radiation therapy than for those who underwent surgery (4.3 vs 10.0years, P<.0001). The majority of patients identified by computed tomography screening were treated with surgical resection. Despite being older and having more comorbidities, LCS long-term survival rates of patients treated with definitive radiation therapy were not significantly different compared with survival rates of patients treated with surgery alone. Radiation therapy appears to be a viable alternative to surgery for screen-diagnosed patients with lung cancer.

18F‐fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of clinically node‐negative non‐small cell lung cancer

One in four non‐small cell lung cancer (NSCLC) patients are diagnosed at an early‐stage. Following the results of the National Lung Screening Trial that demonstrated a survival benefit for low‐dose computed tomography screening in high‐risk patients, the incidence of early‐stage NSCLC is expected to increase. Use of 18F‐fluorodeoxyglucose positron emission tomography/computed tomography during initial diagnosis of these early‐stage lesions has been increasing. Traditionally, positron emission tomography/computed tomography scans have been utilized for mediastinal nodal staging and to rule out distant metastases in suspected early‐stage NSCLC. In clinically node‐negative NSCLC, the use of sublobar resection and selective lymph node dissection has been increasing as a therapeutic option. The higher rate of locoregional recurrences after limited resection and the significant incidence of occult lymph node metastases underscores the need to further stratify clinically node‐negative NSCLC in order to select patients for limited resection versus lobectomy with complete mediastinal lymph node dissection. In this report, we review the published data, and discuss the significance and potential role of 18F‐fluorodeoxyglucose positron emission tomography/computed tomography evaluation for clinically node‐negative NSCLC. Consequently, the literature review demonstrates that maximum standardized uptake value is a predictive factor for occult nodal metastasis with an accuracy of 55–77%. In addition, maximum standardized uptake value is a predictor for worse overall, as well as disease‐free, survival.

Deep Machine Learning Predicts Cancer Risk in Follow-Up Lung Screening

Background: Lung cancer screening protocols for the next scheduled computed tomography (CT) or early recall CT are based on growth or intensity change of lung nodules in the baseline scan or size of new incident nodules. We aimed at developing an accurate deep machine learning (ML) risk prediction tool to estimate the person-level 3-year lung cancer risk after the next scheduled repeat screening CT. Methods: Two ML predictors (ML1 and ML2) were developed from 25,097 participants who had received follow-up CT screenings in the National Lung Screening Trial (NLST). Double-blinded validation was performed using the Pan-Canadian Early Detection of Lung Cancer Study (PanCan). Performance of ML predictors was compared with Lung-RADS and volume doubling time (VDT) using time-dependent ROC analysis. Added values of ML predictors to Lung-RADS in identifying individuals with high cancer incidence risk and aggressive lung cancers were explored. Findings: In the PanCan validation cohort, ML2 consistently gave the highest time dependent AUC values of 0.968±0.013 and 0.946±0.013 respectively for cancer diagnosis within 1 and 2 years compared to 0.944±0.016 and 0.908±0.019 for Lung-RADS (p= 0.202, 0.048); and 0.830±0.300 and 0.777±0.029 for VDT(p<0.001). ML predictors performed better than LungRADS or VDT in stratifying lung cancer incidence and mortality risks. Interpretation: ML tool that recognizes patterns in both temporal and spatial changes as well as synergy among changes in nodule and non-nodule features may be used to accurately guide clinical management in a longitudinal screening program. Funding Statement: This study was funded by Allegheny Health Network Cancer Research, Johns Hopkins University Discovery Award, P30 CA006973, the Terry Fox Research Institute, and the BC Cancer Foundation. Declaration of Interests: There is no competing interest or conflict of interest from all authors. Ethics Approval Statement: We have institutional approved Material Transfer Agreement (MTA) to use data from both the National Lung Screening Trial (NLST) and the Pan-Canadian Early Detection of Lung Cancer (PanCan) among authors from Johns Hopkins University, University of British Columbia-British Columbia Cancer Agency, and National Cancer Institution to conduct work related to our submitted manuscript.

Diffusion weighted magnetic resonance imaging in differentiation of small focal liver lesions ( and #8804; 10 mm) detected in patients with extrahepatic primary malignancy

The purpose of the study is to assess the advantages of diffusion weighted resonance imaging (DWI) prospectively in the metastasis and benign differentiation of small (≤ 10 mm) focal liver lesions (FLL) detected in routine ultrasonography and/or computed tomography screening of patients with extrahepatic primary malignancy. A total of 77 small FLLs (33 metastasis, 27 cyst, 17 hemangioma) of 53 patients who received DWI in addition to conventional magnetic resonance imaging were assessed by 2 independent readers prospectively. Apparent diffusion coefficient (ADC) values were measured for each FLL. T-test was used to assess the statistically significant difference between average ADC values in differentiating between metastasis and benign FLLs. In the metastasis and benign differentiation of small FLLs, optimum cutoff values of ADC values were found by using receiver operating characteristic (ROC) analysis. Average ADC values of small focal liver metastases were statistically significantly lower than those of benign FLL (p < 0.001). Small focal liver metastases were differentiated from benign FLL with 100% sensitivity and 97.1% specificity by using 1.44 x 10-3 s/mm2 cutoff ADC value. This study shows that DWI can be useful in differentiating whether incidentally found small FLL is metastasis in patients who have extrahepatic primary malignancy.

Methods of computed tomography screening and management of lung cancer in Tianjin: design of a population-based cohort study.

ObjectiveEuropean lung cancer screening studies using computed tomography (CT) have shown that a management protocol based on measuring lung nodule volume and volume doubling time (VDT) is more specific for early lung cancer detection than a diameter-based protocol. However, whether this also applies to a Chinese population is unclear. The aim of this study is to compare the diagnostic performance of a volume-based protocol with a diameter-based protocol for lung cancer detection and optimize the nodule management criteria for a Chinese population.MethodsThis study has a population-based, prospective cohort design and includes 4000 participants from the Hexi district of Tianjin, China. Participants will undergo low-dose chest CT at baseline and after 1 year. Initially, detected lung nodules will be evaluated for diameter and managed according to a routine diameter-based protocol (Clinical Practice Guideline in Oncology for Lung Cancer Screening, Version 2.2018). Subsequently, lung nodules will be evaluated for volume and management will be simulated according to a volume-based protocol and VDT (a European lung nodule management protocol). Participants will be followed up for 4 years to evaluate lung cancer incidence and mortality. The primary outcome is the diagnostic performance of the European volume-based protocol compared to diameter-based management regarding lung nodules detected using low-dose CT.ResultsThe diagnostic performance of volume- and diameter-based management for lung nodules in a Chinese population will be estimated and compared.ConclusionsThrough the study, we expect to improve the management of lung nodules and early detection of lung cancer in Chinese populations.

Smoking Cessation and Low-Dose Computed Tomography Screening: A Necessary Pair

Smoking Cessation and Low-Dose Computed Tomography Screening: A Necessary Pair

Benefits, harms and cost-effectiveness of cancer screening in Australia: an overview of modelling estimates

There are three government-funded population-based screening programs in Australia - the national breast cancer screening program (BreastScreen Australia), the National Cervical Screening Program (NCSP), and the National Bowel Cancer Screening Program (NBCSP). Options for early detection of other cancers (e.g. hepatocellular carcinoma and melanoma) are under investigation. This study provides an overview of the health benefits, harms and cost-effectiveness of population-level breast, cervical and colorectal cancer screening, targeted-risk screening for lung cancer and Lynch syndrome, and prostate specific antigen (PSA) testing in Australia. The study reviewed and, where possible, updated the estimated health benefits, harms and cost-effectiveness of screening approaches from modelling studies for four cancer types, PSA testing and Lynch syndrome testing in Australia. Costs are presented in 2018 Australian dollars. The renewed NCSP (for women not HPV-vaccinated) and the NBCSP were estimated to be cost-effective versus no screening; the cost-effectiveness ratio (CER) was $16 632 per life-year saved (LYS) for the NCSP, and $3380/LYS for the NBCSP. BreastScreen Australia was predicted to have a CER of $40 279/LYS-$65 065/LYS. In 2017, the NCSP transitioned to 5-yearly primary HPV testing with partial genotyping for HPV types 16 and 18 for women aged 25-74 years. Alongside vaccination, this change is predicted to prevent a further 587 cervical cancer deaths in 2018-2035, and have a favourable benefit-to-harm balance versus prior practice (biennial cytology testing for women aged 18-69 years). On average, the NBCSP (biennial screening using an immunochemical faecal occult blood test for people aged 50-74 years) is estimated to prevent 2519 colorectal cancer deaths and result in 350 colonoscopy-related adverse events annually. The inaccuracy of PSA testing as a screening tool impedes the capacity to conduct meaningful cost-effectiveness analyses at a population level, based on current evidence. Three annual low-dose computed tomography screens for lung cancer using the US National Lung Screening Trial selection criteria would not be cost-effective in Australia. A comprehensive cost-effectiveness evaluation of systematic proband testing, cascade testing and subsequent surveillance for Lynch syndrome in Australia is currently underway. Current evidence supports a favourable cost-effectiveness and benefit-to-harm balance for the NCSP and NBCSP. An updated cost-effectiveness and benefits-to-harms analysis for BreastScreen Australia is required. Carefully founded quantitative estimates of health benefits, harms and cost-effectiveness provide an important aid to policy decision making, and form the basis for developing decision aids to guide individual screening decisions. Opportunities exist for lung cancer screening, systematic Lynch syndrome testing and informed decision making about PSA testing. However, more evidence is required on risk assessment, targeting of screening tests, optimal referral pathways, managing potential harms and delivering services in a cost-effective framework.

Recent update of image diagnostic and therapeutic modalities in thoracic surgery.

Recently, there have been increasingly more advancements in new image diagnostic and therapeutic modalities for use in the diagnosis and management of thoracic diseases. The use of low-dose computed tomography screening is increasing, thus resulting in an increase in the detection rate of early lung cancers.

Incidence trends and risk prediction nomogram of metachronous second primary lung cancer in lung cancer survivors.

BackgroundThis study was designed to estimate the trends in 5-year incidence of metachronous second primary lung cancer(SPLC) and to establish a risk prediction model to identify candidates who were at high risk of developing metachronous SPLC.MethodsIncidence data between 2004 and 2007 were obtained from SEER database, including 42453 participants who survived ≥ 2 years after the initial diagnosis of lung cancer. Joinpoint regression analysis was used to calculate the 5-year incidence rates of metachronous SPLC per 100 000 population. Related risk factors of the survivors who developed MSPLC during five years were identified through logistic regression analysis, followed by establishment of risk prediction nomogram. Discrimination (C-index), calibration and decision analysis were further performed to assess the validation and clinical net benefit of risk prediction nomogram.ResultsA total of 1412 survivors with lung cancer developed MSPLC during five years, with 3546 per 100 000 population of age-adjusted 5-year incidence. Age, histology, tumor stage, and radiation were recognized as risk factors of metachronous SPLC, as indicated by logistic regression analysis. The risk prediction nomogram of metachronous SPLC harbored moderate discrimination(C-index = 0.67) and good calibration, with the risk of 0.01 to 0.11.The decision curve analysis showed that clinical net benefit of this risk prediction nomogram in a range of risk thresholds (0.01 to 0.06) was higher compared to all-screening or no-screening strategies.ConclusionsCollectively, the cumulative risk of metachronous SPLC of the survivors increased over time. The risk prediction nomogram was available to select high-risk survivors who should regularly undergo computed tomography screening.

Systematic preoperative CT scan is associated with reduced risk of stroke in minimally invasive mitral valve surgery: A meta-analysis

BackgroundMinimally invasive mitral valve surgery (MIMVS) is performed with increasing frequency. However, patients undergoing MIMVS might be at increased risk of perioperative stroke, mainly due to retrograde aortic embolization during femoral cardio-pulmonary bypass. Pre-operative computed tomography (CT) screening allows visualization of the aorta and femoro-iliac vessels and individualization of the surgical approach. In this meta-analysis, we aim to determine if systematic pre-operative CT screening is associated with decreased incidence of post-operative stroke and other complications following MIMVS. MethodsA comprehensive review was performed in PubMed (inception-May 2018). Eligible studies included those which reported on MIMVS (mini-thoracotomy, port access or robotic approach) with retrograde arterial perfusion. Studies were separated into two subgroups: systematic pre-operative CT screening (CT-group) and no CT screening (Non-CT). Pooled event rates (PER) for operative mortality, post-operative stroke, perioperative myocardial infarction (MI), and new onset renal failure requiring dialysis were estimated and inter-group comparisons were performed. ResultsData from 57 studies (13,731 patients) were analyzed (19 CT-group, 38 Non-CT). PER for post-operative stroke was 2.0% with a statistically significant difference between the groups (CT-group: 1.5% versus Non-CT: 2.2%, P = 0.03). PER for new dialysis was 1.9%, significantly lower in the CT-group (0.8% versus 2.3% in the Non-CT group, P = 0.02). PER for operative mortality was 1.4% with a trend towards better outcomes in the CT-group (0.8% versus 1.6% in the Non-CT group, P = 0.05). ConclusionsSystematic pre-operative CT screening is associated with lower risk of post-operative stroke and need for dialysis and a trend toward lower operative mortality after MIMVS.

A population-based cohort study to evaluate the effectiveness of lung cancer screening using low-dose CT in Hitachi city, Japan

To evaluate the effectiveness of lung cancer screening using low-dose computed tomography for the general population, we conducted a retrospective cohort study of screening for participants among Hitachi residents. Citizens aged 50-74 who underwent low-dose computed tomography screening at least once during 1998-2006 were defined as the computed tomography group, and those who underwent X-ray screening at least once during the same period, but did not receive low-dose computed tomography screening throughout the follow-up period, were defined as the XP group. We investigated the lung cancer incidence rate, mortality rate and all-cause mortality rate for both groups from the first lung cancer screening to the end of 2012. In the computed tomography group (17 935 residents; 9790 males and 8145 females), 273 cases of lung cancer (1.5%), 72 cases of lung cancer death (0.4%), and 885 cases of all-cause death (4.9%) were observed. On the other hand, 164 cases (1.1%) of lung cancer, 80 cases (0.5%) of lung cancer death and 1188 cases (7.6%) of all-cause death were observed in the XP group (15 548 residents; 6526 males and 9022 females). The hazard ratios of the computed tomography group to the XP group adjusted for gender, age and smoking history were 1.23 for lung cancer incidence rate, 0.49 for lung cancer mortality rate and 0.57 for all-cause mortality rate. Non-smokers and light smokers (<30 pack-years) had a significantly lower lung cancer mortality (0.41 and 0.21, respectively). low-dose computed tomography screening for a population including non-smokers and light smokers may be effective.

Clinical Use of Opportunistic Computed Tomography Screening for Osteoporosis.

* Opportunistic use of computed tomography (CT) allows assessment of bone status from studies obtained for other purposes.* The linear x-ray attenuation coefficient is known as the Hounsfield unit (HU).* HU values can be determined for any region of interest using standard imaging software.* HU values strongly correlate with bone mineral density.* A threshold of &lt;135 HU for the L1 vertebral body indicates a risk for osteoporosis.* HU values have been used to assess other bone regions, including the wrist, proximal and distal end of the femur, and sacrum, to predict future fracture and the presence of osteoporosis.* Opportunistic use of CT aids in the identification of patients who are not otherwise suspected to be at risk for osteoporosis.

Applying CT texture analysis to determine the prognostic value of subsolid nodules detected during low-dose CT screening

To analyse subsolid nodules (SSNs) detected during low-dose (LD) computed tomography (CT) screening and investigated whether CT texture analysis parameters can predict the malignancy and growth trends of GGNs. In this retrospective study, 89 SSNs were detected in 86 LDCT screening participants, including 42 pure ground-glass nodules (GGNs) and 47 part-solid GGNs. In these participants, 28 SSNs were diagnosed as lung cancer at histopathology, and 61 SSNs from participants who underwent at least two LDCT imaging studies. All nodules were divided into three groups: cancer group, growth group, and non-growth group. The nodule size, volume, attenuation, volume doubling time (VDT), and texture parameters (mean value, uniformity, entropy and energy) were assessed, respectively. The entropy of the cancer group was significantly higher than that of the growth and non-growth groups (pure GGNs: p=0.009, 0.001; part-solid GGNs: p=0.012, 0.004). The energy of the cancer group was significantly lower than that of the other groups (pure GGNs: p=0.043, 0.021; part-solid GGNs: p=0.001, 0.002). A good positive correlation was found between uniformity and VDT (p=0.022). Different CT texture parameters show good predictive value for SSNs detected at LDCT screening: the entropy and energy differences between malignant pulmonary nodules and others could be a helpful quantitative index to predict the malignancy of SSNs. Uniformity could be used to predict the growth probability of pure GGNs at baseline to pay more attention to these nodules. Moreover, the follow-up and treatment plan could be more targeted.

Lung Cancer Screening: Implementation of and Barriers to a Nurse Practitioner-Led Program.

Lung cancer accounts for more American deaths annually than any other cancer, and the survival rate is low among those diagnosed with advanced-stage disease. Screening with low-dose computed tomography (CT) can help to reduce mortality. CT screening for lung cancer should be performed in the context of a comprehensive screening program, rather than as a single isolated test. The addition of the nurse practitioner role is instrumental in creating a lung cancer screening program that may increase patient satisfaction and that meets regulatory criteria.

Comparison of values of CT and MRI imaging in the diagnosis of hepatocellular carcinoma and analysis of prognostic factors.

Value of computed tomography (CT) and magnetic resonance imaging (MRI) in the diagnosis of small hepatocellular carcinoma (HCC), and in analysis of the prognostic factors of primary hepatocellular carcinoma (PHC) were compared. A total of 300 patients with PHC were selected from January 2013 to January 2016. Among them, 170 patients were diagnosed with small HCC. Patients were diagnosed by MRI and CT scans, respectively, and diagnostic efficacy of the methods was compared. A single factor and multivariate analysis of prognostic factors were performed on 300 patients. The sensitivity of MRI screening was 78.82%, specificity was 78.46%, accuracy was 78.67%, positive predictive value was 82.72%, and negative predictive value was 73.91%. CT screening showed a sensitivity of 62.35%, a specificity of 73.85%, an accuracy of 67.33%, a positive predictive value of 75.71%, and a negative predictive value of 60.00%. Differences in sensitivity, accuracy, and negative predictive value between MRI and CT screening were statistically significant (P<0.05). There was no statistically significant difference between two groups in specificity and positive predictive value (P>0.05). Diagnostic efficiency of MRI is better than that of CT diagnosis. Univariate analysis showed that age, hepatitis B cirrhosis background, tumor stage, and portal vein embolization were prognostic factors for PHC. Cox multivariate regression analysis showed that the background of liver cirrhosis, tumor stage, and portal thrombosis were independent risk factors for poor prognosis for PHC patient and the differences were statistically significant (P<0.05). MRI is superior to CT in the sensitivity, specificity and accuracy of the diagnosis of small HCC. Individualized comprehensive treatment plans based on the patient's condition may be effective in prolonging the patient's survival time. Imaging diagnosis can provide survival basis for patients, improve diagnostic accuracy, and help to improve the survival rate.

Impact of low-dose computed tomography screening on lung cancer mortality among asbestos-exposed workers.

We previously showed that low-dose computed tomography (LDCT) screening in asbestos-exposed workers is effective in detecting lung cancer (LC) at an early stage. Here, we evaluate whether LDCT screening could reduce mortality from LC in such a high-risk population. Within a cohort of 2433 asbestos-exposed men enrolled in an Occupational Health surveillance programme, we compared mortality between the participants in the ATOM002 study (LDCT-P, N = 926) and contemporary non-participants (LDCT-NP, N = 1507). We estimated standardized mortality ratios for the LDCT-P and LDCT-NP populations using regional and national rates (SMR_FVG and SMR_ITA, respectively). We compared survival for all causes, all neoplasms, LC and malignant neoplasm of pleura (MNP) between LDCT-P and LDCT-NP using Cox proportional hazard models adjusted for age, smoking history, asbestos exposure level and comorbidities. A reduction in mortality from LC was observed in the LDCT-P group compared with regional and national figures (SMR_FVG = 0.55, 95% confidence interval (CI) 0.24-1.09; SMR_ITA = 0.51, 95% CI 0.22-1.01); this was not the case for the LDCT-NP group (SMR_FVG = 2.07, 95% CI 1.53-2.73; SMR_ITA = 1.98, 95% CI 1.47-2.61). A strong reduction in LC mortality was observed for the LDCT-P compared with the LDCT-NP [hazard ratio (HR) = 0.41, 95% CI 0.17-0.96]. Mortality was also reduced for all causes (HR = 0.61, 95% CI 0.44-0.84), but not for all neoplasms (HR = 0.97, 95% CI 0.62-1.50) and MNP (HR = 0.86, 95% CI 0.31-2.41) within the LDCT-P population. In our cohort, participation in the LDCT screening study was associated with reduced mortality from LC. This finding supports the use of LDCT in surveillance programmes for asbestos-exposed workers.

Routine surveillance scanning in HNSCC: Lung screening CT scans have value but head and neck scans do not

ObjectivesTo examine the utility of computed tomography (CT) imaging during routine surveillance for the detection of recurrent head and neck squamous cell carcinoma (HNSCC). Materials/methodsClinical characteristics of HNSCC patients treated between 2008 and 2017 with radiation therapy or concurrent chemoradiation were abstracted from medical records. In patients who achieved a complete response to treatment by positron emission tomography scan, surveillance CT scans were conducted to the maxillofacial area, neck, and chest every 3 months in year 1, every 6 months in year 2, and every 12 months in years 3 and beyond. ResultsWithin the entire cohort (n = 534), complete response was achieved in 446 patients (83.5%); of these, 84 (15.7%) patients had a recurrence. Among the 84 patients with disease recurrence, 25 (30%) patients remained alive, of which 15 (18%) underwent successful salvage treatment and became free of disease. Lung screening CT scans detected failure in 8 of these successfully salvaged patients. Among the 8 patients successfully salvaged for locoregional recurrence, 3 failures were asymptomatic at onset and detected by laryngoscope or dental exam. The remaining 5 failures were symptomatic and detected upon work up prompted by symptoms. Maxillofacial and neck surveillance CT imaging failed to detect any successfully salvaged patients. ConclusionsRoutine surveillance for HNSCC patients with lung CT imaging had value but routine head and neck CT scans failed to identify any successfully salvaged patients. Given this finding, routine CT imaging surveillance in HNSCC patients should be restricted to annual lung screening with low-dose chest CT.

P3.11-20 Patterns and Predictors of Adherence to Recommended Follow-Up After Low-Dose Computed Tomography Screening for Lung Cancer

P3.11-20 Patterns and Predictors of Adherence to Recommended Follow-Up After Low-Dose Computed Tomography Screening for Lung Cancer

The Occupational Dimension of Lung Cancer Screening

An editorial is presented that explores the occupational dimension of lung cancer screening. Particular focus is given to a study presented in the issue that looks at low-dose computerized tomography screening. Additional topics discussed include improving outcomes for patients, causes of lung cancer including smoking and asbestos exposure, and expanding the use of low-dose CT scanning