Detection Rate Of Lung Cancer Research Articles

An Audit of Opportunistic Lung Cancer Screening in a Canadian Province.

Objectives:Lung cancer is a leading cause of cancer-related death in Canada. Early detection can improve outcomes and despite recommendations from the Canadian Task Force on Preventive Health Care to screen patients who are 55 to 74 years old and have a 30+ pack-year history, formal screening programs are rare in Canada. Our goal was to determine if screening is being performed in a representative Canadian population, if recommendations are being followed, and how screening impacts lung cancer stage at diagnosis and prognosis.Methods:A retrospective chart review was performed to identify patients either screened for lung cancer or imaged due to lung cancer symptoms in Eastern Newfoundland between 2015 and 2018. Age, smoking history, screening modality, diagnosis, cancer stage, and mortality were recorded.Results:Under 6.0% of the eligible population were screened for lung cancer with only 28.13% meeting age and smoking criteria and being screened appropriately with low-dose CT. However, 70% of patients that had lung cancers found by screening met age and smoking screening criteria. While lung cancer detection rates were similar, screening detected cancer in patients at an earlier stage (50% Stage 1) compared to patients who were not screened (20% Stage 1). Patients who were screened had an improved prognosis.Conclusions:Physicians are opportunistically screening for lung cancer, but not consistently following screening guidelines. As screening is sensitive, leads to earlier stage diagnosis, and has a mortality benefit, implementation of an organized screening program could increase quality assurance and prevent many lung-cancer related deaths.

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.

9G TestTM Cancer/Lung: A Desirable Companion to LDCT for Lung Cancer Screening.

Simple SummaryLung cancer is the most common cause of cancer-related deaths globally. Patients diagnosed at early-stage (0–I) have a higher survival rate than the metastasized stages (III–IV). Thus, there is great potential to reduce mortality by diagnosing lung cancer at stage 0~I through community screening. LDCT is a promising method, but it has a high false-positive rate. Therefore, a biomarker test that can be used in combination with LDCT for lung cancer screening to reduce false-positive rates is highly awaited. The present study evaluated the applicability of 9G testTM Cancer/Lung test to detect stage 0~IV lung cancer. 9G testTM Cancer/Lung test detects stage I, stage II, stage III, and stage IV cancers with the sensitivities of 77.5%, 78.1%, 67.4%, and 33.3%, respectively, at the specificity of 97.3%. These results indicate that the 9G testTM Cancer/Lung can be used in conjunction with LDCT to screen lung cancer.A complimentary biomarker test that can be used in combination with LDCT for lung cancer screening is highly desirable to improve the diagnostic capacity of LDCT and reduce the false-positive rates. Most importantly, the stage I lung cancer detection rate can be dramatically increased by the simultaneous use of a biomarker test with LDCT. The present study was conducted to evaluate 9G testTM Cancer/Lung’s sensitivity and specificity in detecting Stage 0~IV lung cancer. The obtained results indicate that the 9G testTM Cancer/Lung can detect lung cancer with overall sensitivity and specificity of 75.0% (69.1~80.3) and 97.3% (95.0~98.8), respectively. The detection of stage I, stage II, stage III, and stage IV cancers with sensitivities of 77.5%, 78.1%, 67.4%, and 33.3%, respectively, at the specificity of 97.3% have never been reported before. The receiver operating characteristic curve analysis allowed us to determine the population-weighted AUC of 0.93 (95% CI, 0.91–0.95). These results indicate that the 9G testTM Cancer/Lung can be used in conjunction with LDCT to screen lung cancer. Furthermore, obtained results indicate that the use of 9G testTM Cancer/Lung with LDCT for lung cancer screening can increase stage I cancer detection, which is crucial to improve the currently low 5-year survival rates.

Baseline Results of the West London lung cancer screening pilot study – Impact of mobile scanners and dual risk model utilisation

ObjectivesThe West London lung screening pilot aimed to identify early-stage lung cancer by targeting low-dose CT (LDCT) to high risk participants. Successful implementation of screening requires maximising participant uptake and identifying those at highest risk. As well as reporting pre-specified baseline screening metrics, additional objectives were to 1) compare participant uptake between a mobile and hospital-based CT scanner and 2) evaluate the impact on cancer detection using two lung cancer risk models. MethodsFrom primary care records, ever-smokers aged 60–75 were invited to a lung health check at a hospital or mobile site. Participants with PLCOM2012 6-yr risk ≥1.51 % and/or LLPv2 5-yr risk ≥2.0 % were offered a LDCT. Lung cancer detection rate, stage, and recall rates are reported. Participant uptake was compared at both sites (chi-squared test). LDCT eligibility and cancer detection rate were compared between those recruited under each risk model. ResultsOf 8366 potential participants invited, 1047/5135 (20.4 %) invitees responded to an invitation to the hospital site, and 702/3231 (21.7 %) to the mobile site (p = 0.14). The median distance travelled to the hospital site was less than to the mobile site (3.3 km vs 6.4 km, p < 0.01). Of 1159 participants eligible for a scan, 451/1159 (38.9 %) had a LLPv2 ≥2.0 % only, 71/1159 (6.1 %) had a PLCOM2012 ≥1.5 % only; 637/1159 (55.0 %) met both risk thresholds. Recall rate was 15.9 %. Lung cancer was detected in 29/1145 (2.5 %) participants scanned (stage 1, 58.6 %); 5/29 participants with lung cancer did not meet a PLCOM2012 threshold of ≥1.51 %; all had a LLPv2 ≥2.0 %. ConclusionTargeted screening is effective in detecting early-stage lung cancer. Similar levels of participant uptake at a mobile and fixed site scanner were demonstrated, indicating that uptake was driven by factors in addition to scanner location. The LLPv2 model was more permissive; recruitment with PLCOM2012 alone would have missed several cancers.

Performance of Lung Cancer Screening With Low-Dose Computed Tomography in Gejiu, Yunnan: A Prospective, Population-Based, Screening Cohort Study

PURPOSE Low-dose computed tomography (LDCT) screening has been recommended for individuals with high lung cancer risk, but the performance of lung cancer screening with LDCT in China is uncertain. This study aims to evaluate the performance of LDCT lung cancer screening in the Chinese setting. METHODS From June 2014 through December 2014, a prospective cohort of patients to undergo lung cancer screening with LDCT was established in Gejiu, Yunnan Province, using one screening center of the Lung Cancer Screening Program in Rural China. Participants received baseline screening and 4 rounds of annual screening with LDCT until June 2019. The participation rate, detection rate, early detection rate, and clinical characteristics of lung cancer were reported. RESULTS Of participants, 2,006 had complete baseline screening results with a compliance rate of 98.4%. Of these, 1,411 were high-risk and 558 were non–high-risk individuals. During this period, 40 lung cancer cases were confirmed, and of them, 35 were screen detected, 4 were postscreening, and 1 was an interval case. The positive rate of baseline and annual screening was 9.7% and 9.0%, respectively, whereas the lung cancer detection rate was 0.4% and 0.6%, respectively. The proportion of early lung cancer increased from 37.5% in T0 to 75.0% in T4. Adenocarcinoma was the most common histologic subtype. Lung cancer incidence according to the criteria of the Lung Cancer Screening Program in Rural China and the National Lung Cancer Screening Trial was 513.31 per 100,000 person-years and 877.41 per 100,000 person-years, respectively CONCLUSION The lung cancer screening program with LDCT was a successful performance in Gejiu, Yunnan; however, additional studies are warranted to refine the high-risk population who will benefit most from LDCT screening and reduce the high false-positive results.

Impact of reduced smoking rates on lung cancer screening programs in Japan.

In Japan, lung cancer screening by annual chest radiography has been performed for the past 30years. However, changes in risk factor status may have influenced the efficiency of current organized lung cancer screening program. The purpose of this study was to clarify whether the reduced smoking rate in younger Japanese affects the efficiency and effectiveness of lung cancer screening. We investigated chronological changes in epidemiological indicators, which support lung cancer screening programs offered by the Japan Cancer Society, such as gender- and age-specific numbers of participants and lung cancers detected by the screening by clinical stage, in relation to smoking rates from 1991 to 2016. Participant age at the time of screening and age at the time of cancer detection have both increased over time. The lung cancer detection rate (LCDR) in younger age cohorts tended to decrease from 1991 to 2016 in both genders, particularly men aged <55years. Age-adjusted LCDR significantly decreased from 1991 to 2016 in both genders. After 2001, ~45% of overall detected cases in men and 70% in women were found in stage I. Although trends differed between men and women, smoking rate decreased from 1991 to 2016 in most age cohorts in both genders. These results suggest that organized lung cancer screening in Japan should be limited to higher-risk populations.

Low-dose chest computed tomographic screening and invasive diagnosis of pulmonary nodules for lung cancer in never-smokers.

Although lung cancer screening using low-dose computed tomography (LDCT) is now widely used in clinical practice, the characteristics and outcomes of diagnostic procedures related to screen-detected nodules in never-smokers remain unclear. We aimed to determine the incidence of nodules considered for invasive biopsy and evaluate the final diagnoses and procedure-related complications in never-smokers in comparison to ever-smokers who underwent LDCT screening. We evaluated 37 436 asymptomatic adults (17 968 never-smokers and 19 468 ever-smokers) who underwent LDCT screening for lung cancer between January 2009 and December 2018 at a tertiary centre in South Korea. The rates of invasive diagnostic procedures for detected nodules and related complications, and the diagnostic outcomes were determined in the never-smoker and ever-smoker groups. Among the never-smokers, 2908 (16.2%) out of 17 968 had positive nodules. Overall, 139 (0.77%) out of 17 968 never-smokers and 194 (1.00%) out of 19 468 ever-smokers underwent invasive biopsy (p=0.022). Lung cancer was diagnosed in 84 (0.47%) out of 17 968 never-smokers and 123 (0.63%) out of 19 468 ever-smokers (p=0.032). The proportions of participants diagnosed with benign disease after invasive biopsy (false-positive) were 50 (0.28%) out of 17 968 and 69 (0.35%) out of 19 468 in the never-smoker and ever-smoker groups, respectively (p=0.191). Multivariate analyses revealed no significant associations of smoking with the risk of a false-positive diagnosis (OR 0.98, 95% CI 0.62-1.57) and complications (OR 1.33, 95% CI 0.65-3.73) after biopsy. Of the 84 never-smokers with lung cancer, 82 (97.6%) had adenocarcinoma, and 75 (89.3%) were in stage I with a favourable prognosis. LDCT screening in never-smokers resulted in a notable detection rate of lung nodules, which warranted invasive biopsy. The lung cancer detection rate was lower in never-smokers than in ever-smokers. However, no significant differences in the false-positive and complication rates were observed between the two groups. Accordingly, a more specifically tailored management strategy is needed for screen-detected nodules in Asian never-smokers.

Genetic profiling and TCR repertoire feature of synchronous multiple primary lung carcinomas.

e21031 Background: The incidence and detection rates of multiple primary lung cancer are increasing, as a result of the advances in lung cancer screening techniques. However, the molecular and immune mechanisms of their carcinogenesis were little known, which may have important diagnostic, prognostic and therapeutic implications. Methods: We retrospective analyzed 10 patients (pts) with clinically designated synchronous multiple primary lung cancers (sMPLC). 28 different tumor lesions were included and mutation profiles were analyzed using 1021 genes panel based next-generation sequencing (NGS). Meanwhile, the T-cell receptor (TCR) β repertoire of 28 tumor lesions and peripheral blood were analyzed by amplifying and sequencing the CDR3 region. T-cell clonality was defined as 1-normalized Shannon entropy, which was normalized by dividing Shannon entropy by the natural logarithm of the number of unique productive TCR sequences. Results: 8 of 10 pts were female and only one pts was smoker. The genetic profiles of 28 tissues were analyzed and almost no common mutations were detected between different tumors of one patient. The most common mutation was EGFR and it was detected in 11 tissues belonging to 7 pts. KRAS mutations were detected in 6 tissues belonging to 4 pts and only one patient detected both EGFR and KRAS mutation in different lesions. TP53 mutations were found in 6 tissues, which 5 co-existed with EGFR. Unlike the mutually exclusive between KRAS and EGFR, 4 pts were detected BRAF mutation whose other tissue aslo carried EGFR mutation. Next, we studied T-cell clonality, which ranges from 0 to 1 and describes the shape of T-cell frequency distribution. Analysis of TCR clonality revealed that this metric ranged from 0.092 in Pts T8 to 0.192 in Pts T5. Furthermore, heterogeneity of different lesions of pts was observed, with differences as large as 78% in T-cell clonality across different tumor lesions in Pts T2, which is bigger than difference of between patients. Beside, EGFR mutation lesions showed lower clonality but no significant differences (0.105 vs 0.130,p = 0.245). There no difference of number of non-synonymous mutation (NNSM) between EGFR-mutant and EGFR-wt group (3 vs 2, p = 0.748), and same in KRAS (3.5 vs 2, p = 0.410). However, frequency of share TCR of tissue and blood was positive correlated with NNSM (spearman r = 0.384,p = 0.048), which might means local immune microenvironment was related with regions mutation. Conclusions: Our results reveals independent molecular and immune feature of sMPLC pts, which may have contradictory therapeutic implications.

Outcomes of a lung cancer screening program in a Hispanic urban population: The University of Miami experience.

e19011 Background: The National Lung Screening Trial (NLST) revealed a 20% reduction in lung cancer (LC) mortality when low-dose computed tomography (LDCT) was utilized for LC screening vs chest radiography. NLST participants were predominantly Non-Hispanic Whites, with only 1.8% Hispanics. The goal of our study was to investigate the attributes of a LC screening program in a largely Hispanic urban population and compare with NLST. Methods: We performed a retrospective analysis of 421 consecutive cases who underwent LDCT screening from 2016-2019 at University of Miami (UM), with similar inclusion criteria as the NLST. Demographic characteristics, smoking status, lung RADS, LC detection and compliance were examined &amp; compared with NLST cohort using summary statistics and χ2 tests for categorical variables. Results: Demographic and smoking characteristics of the UM cohort didn’t resemble those of NLST LDCT cohort. UM cohort had a different racial and ethnic profile, with a higher percentage of Hispanics (47.3% vs 1.8%) and African Americans (15% vs 4.5%) in the UM cohort vs NLST cohort respectively (p &lt; 0.001). UM cohort generally had lesser smoking intensity, and significantly fewer active smokers when compared to the NSLT cohort; 38.5% vs 48.1% respectively. The proportion of positive LDCT screens (Lung-RADS Class 3 or 4) in the UM cohort (14.1%) was almost similar to the NLST cohort (13.7%) (p = 0.81). The UM cohort had a higher LC detection rate (3.3%) than the NLST cohort (1.1%) (p &lt; 0.001). In keeping with goals of screening, both cohorts had 50% or more LC cases detected at an early curable stage. Overall patient adherence to screening guidelines was more than 90% in NLST cohort; whereas almost a quarter of referred patients in UM cohort didn’t show for their initial decision-making visit and only 45% completed two or more scans. Conclusions: Our LDCT screening program was based in a Hispanic urban location (UM) with 47.3% Hispanics. Compared to NLST LDCT arm, the UM cohort had fewer active smokers, lighter smoking history, a more diverse population, somewhat higher LC detection rate, weaker adherence to screening related visits. More data is needed to understand obstacles to compliance with screening in minority populations.

Clinicopathological and genetic characteristics of lung cancer in the lungs of explanted from lung transplant recipients

Objective: To describe the clinicopathological features of the lung cancers in the lungs explanted from lung transplant recipients, and to understand the molecular alterations of these cancers. Methods: The patients who underwent lung transplantation in China-Japan Friendship Hospital from March 2017 to December 2018 were reviewed. Clinical data of the patients with lung cancer associated with end-stage interstitial lung diseases (ILD) were collected. Hematoxylin-eosin staining and immunohistochemistry were performed to evaluate the pathological feature. Real-time quantitative PCR was performed to analyze the hotspots and targeted regions of 9 cancer-associated genes. Results: Among the 154 identified patients, 10 met the inclusion criteria and were included. The detection rate of lung cancer in the lung transplantation patients was 6.5%(10/154). All of the included 10 patients were male, with an average age of 59 years. They all had a history of heavy smoking. Three cases had a lung cancer diagnosed before operation, while the other 7 cases were concealed in the specimen of end-stage ILD. All of lung cancers were non-small-cell carcinoma, including 8 cases of adenocarcinoma and 2 cases of squamous cell carcinoma. The proportion of mucinous adenocarcinoma components was 3/10. The mutations in KRAS gene exon 2 were detected in two patients with mucous adenocarcinoma, while no alterations in NRAS, EGFR, ALK, ROS1, BRAF, HER2, PI3KCA and RET were detected in the remaining patients. Conclusions: Lung cancers are difficult to detect in patients with end-stage ILD. They are mainly adenocarcinomas and associated with a higher frequency of mutations in KRAS gene. These cancers have limited treatment options and a poor prognosis.

Predictive model for the diagnosis of benign/malignant small pulmonary nodules.

There is some doubt that all nodules <8 mm are really mainly benign and that simple follow-up is adequate in all cases. The purpose of this study is to create a predictive model for the diagnosis of benign and malignant small pulmonary nodules.This was a retrospective case–control study of patients who had undergone pulmonary nodule resection at the Zhejiang University Jinhua Hospital. Patients with pulmonary nodules of ≤10 mm in size on chest high-resolution computed tomography were included. Patients’ demographic characteristics, clinical features, and high-resolution computed tomography findings were collected. Logistic regression and receiver-operating characteristic analysis were used to create a predictive model for malignancy.A total of 216 patients were included: 160 with malignant and 56 with benign nodules. Nodule density (odds ratio [OR] = 0.996, 95% confidence interval [CI]: 0.993–0.998, P = .001), vascular penetration sign (OR = 3.49, 95% CI: 1.39–8.76, P = .008), nodule type (OR = 4.27, 95% CI: 1.48–12.29, P = .007), and incisure surrounding nodules (OR = 0.18, 95% CI: 0.04–0.84, P = .03) were independently associated with malignant nodules. These factors were used to create a mathematical model that had an area under the receiver-operating characteristic curve of 0.744. Using a cut-off of 0.762 resulted in 63.1% sensitivity and 75.0% specificity.This study proposes a pulmonary nodule prediction model that can estimate benign/malignant lung nodules with good sensitivity and specificity. Mixed ground-glass nodules, vascular penetration sign, density of lung nodules, and the absence of incisure signs are independently associated with malignant lung nodules.

Performance of lung cancer screening with low-dose CT in Gejiu, Yunnan: A population-based, screening cohort study.

BackgroundThe performance of lung cancer screening with low‐dose computed tomography (CT) (LDCT) in China is uncertain. This study aimed to evaluate the performance of LDCT lung cancer screening in the Chinese setting.MethodsIn 2014, a screening cohort of lung cancer with LDCT was established in Gejiu, Yunnan Province, a screening center of the Lung Cancer Screening Program in Rural China (LungSPRC). Participants received a baseline screening and four rounds of annual screening with LDCT in two local hospitals until June 2019. We analyzed the rates of participation, detection, early detection, and the clinical characteristics of lung cancer.ResultsA total of 2006 participants had complete baseline screening results with a compliance rate of 98.4%. Of these, 1411 were high‐risk and 558 were nonhigh‐risk participants. During this period, 40 lung cancer cases were confirmed, of these, 35 were screen‐detected, four were post‐screening and one was an interval case. The positive rate of baseline and annual screening was 9.7% and 9.0%, while the lung cancer detection rate was 0.4% and 0.6%, respectively. The proportion of early lung cancer increased from 37.5% in T0 to 75.0% in T4. Adenocarcinoma was the most common histological subtype. Lung cancer incidence according to the criteria of LungSPRC and National Lung Cancer Screening Trial (NLST) was 513.31 and 877.41 per 100 000 person‐years, respectively.ConclusionsThe program of lung cancer screening with LDCT showed a successful performance in Gejiu, Yunnan. However, further studies are warranted to refine a high‐risk population who will benefit most from LDCT screening and reduce the high false positive results.Key pointsThis study reports the results of lung cancer screening with LDCT in Gejiu, Yunnan, a high‐risk area of lung cancer, and it demonstrates that lung cancer screening with LDCT is effective in detecting early‐stage lung cancer. Our program provides an opportunity to explore the performance of LDCT lung cancer screening in the Chinese context.

Does low-dose computed tomography screening improve lung cancer-related outcomes?—a systematic review

: Screening with low-dose computed tomography (LDCT) can potentially decrease the mortality rate of lung cancer by detecting tumors at earlier stages. Although a number of guidelines exist on the implementation of screening and the management of screening-detected lesions, the field has progressed since those were written in terms of the clinical data now available and the greater range of surgical options now on offer to patients. This systematic review aims to provide an updated assessment of how LDCT screening may impact lung cancer-related outcomes in light of such recent data and surgical progress. A systematic literature search was conducted to identify articles focused on the use of LDCT to screen for primary non-small cell lung cancer in asymptomatic individuals. Of 2,880 articles identified, high quality papers reporting the results of 27 major studies were selected for in-depth analysis—including 17 observational studies (15 prospective and 2 retrospective), and 11 randomised-controlled trials. LDCT screening detected lung cancer in 0–8.2% of asymptomatic adults subject. These rates were demonstrated in most studies to be significantly higher than the lung cancer detection rate with no screening. Invasive procedures for benign lesions were performed in 0.07–1.9% of LDCT-screened subjects. Most LDCT screening-detected lung cancers presented in stage I, and 52–100% of patients with LDCT-detected lung cancer received surgery. Two large randomized-controlled trials showed that LDCT screening was associated with a 20.0% reduction in mortality when compared to chest X-ray (CXR) screening, and a 26% reduction in mortality when compared to no screening. LDCT screening is associated with: higher rates of lung cancer detection; diagnosis of lung cancer at an earlier stage; greater likelihood of surgical therapy being given; and lower mortality from lung cancer. The rate of ‘unnecessary’ interventions as a result of LDCT screening is low.

LDCT lung cancer screening in populations at different risk for lung cancer

IntroductionThe improvement of low-dose CT (LDCT) lung cancer screening selection criteria could help to include more individuals who have lung cancer, or in whom lung cancer will develop, while avoiding...

Real-world Clinical Implementation of Lung Cancer Screening-Evaluating Processes to Improve Screening Guidelines-Concordance.

Lung cancer screening (LCS) requires complex processes to identify eligible patients, provide appropriate follow-up, and manage findings. It is unclear whether LCS in real-world clinical settings will realize the same benefits as the National Lung Screening Trial (NLST). To evaluate the impact of process modifications on compliance with LCS guidelines during LCS program implementation, and to compare patient characteristics and outcomes with those in NLST. Retrospective cohort study. Kaiser Permanente Colorado (KPCO), a non-profit integrated healthcare system. A total of 3375 patients who underwent a baseline lung cancer screening low-dose computed tomography (S-LDCT) scan between May 2014 and June 2017. Among those receiving an S-LDCT, proportion who met guidelines-based LCS eligibility criteria before and after LCS process modifications, differences in patient characteristics and outcomes between KPCO LCS patients and the NLST cohort, and factors associated with a positive screen. After modifying LCS eligibility confirmation processes, patients receiving S-LDCT who met guidelines-based LCS eligibility criteria increased from 45.6 to 92.7% (P < 0.001). Prior to changes, patients were older (68 vs. 67years; P = 0.001), less likely to be current smokers (51.3% vs. 52.5%; P < 0.001), and less likely to have a ≥ 30-pack-year smoking history (50.0% vs. 95.3%; P < 0.001). Compared with NLST participants, KPCO LCS patients were older (67 vs. 60years; P < 0.001), more likely to currently smoke (52.3% vs. 48.1%; P < 0.001), and more likely to have pulmonary disease. Among those with a positive baseline S-LDCT, the lung cancer detection rate was higher at KPCO (9.4% vs. 3.8%; P < 0.001) and was positively associated with prior pulmonary disease. Adherence to LCS guidelines requires eligibility confirmation procedures. Among those with a positive baseline S-LDCT, comorbidity burden and lung cancer detection rates were notably higher than in NLST, suggesting that the study of long-term outcomes in patients undergoing LCS in real-world clinical settings is warranted.

Low-dose computerized tomography in lung cancer screening

Lung cancer screening has been a passionately debated topic since the late 1990s. Five-year survival is 53.5 %, 26.1 %, and 3.9 % when cancer is confined to the lung at the time of diagnosis, when there is regional nodal involvement, and when there is distant metastasis, respectively. The goal of lung cancer screening (LCS) is to shift the timing of the diagnosis to an earlier point, thus, the disease is localized to the lung, and then appropriate treatment can reduce the mortality of lung cancer. Study results from several lung cancer screening trials worldwide, including the United States, Japan, the Netherlands, Denmark, and Italy demonstrated that low-dose computerized tomography (LDCT) scanner used in LCS can increase the detection rate of lung cancer at an earlier stage. At the time of screening, the information about smoking cessation should be provided to all current smokers, while the multidisciplinary clinic affords a second opportunity to counsel patients about the benefits of quitting smoking. After two rounds of screening, there are fewer false positives as a result of comparison with the baseline screening CT that may reveal two years of pulmonary nodule stability. Decreasing the number of false -positive lung cancer screens is an area for future research. Genetic profiles and the results of the baseline screening examination can potentiate further refining the risk modeling. Risk modeling could define the frequency of follow-up in addition to who should be screened. In conclusion, LCS with LDCT has shown that there are indolent lung cancers that may not be fatal. Further studies are urgently needed if the maximization of the risk-benefit ratio in LCS has to be achieved.

Clinicopathological features of small-sized peripheral squamous cell lung cancer.

Recent advances in imaging technology have enhanced the detection rate of small-sized peripheral lung cancers. The present study aimed to identify the clinicopathological differences between patients with small-sized peripheral squamous cell carcinoma (SCC) and adenocarcinoma (ADC). Patients with lung cancer who underwent radical surgical resection at Gunma University Hospital between July 2007 and October 2012 were retrospectively analyzed. Patients who exhibited small-sized peripheral tumors (pathological size, ≤2 cm) located within the outer-third of the lung field on preoperative computed tomography were enrolled in the present study. A total of 26 patients were diagnosed with SCC and 214 with ADC. The results revealed that patients with SCC exhibited higher rates of pleural invasion, vascular invasion and lymphatic invasion compared with ADC patients. Additionally, the rate of postoperative recurrence was higher in patients with SCC compared with ADC patients. Patients with ADC were subsequently into two groups: Solid ADCs (sADC) and non-solid ADCs (nsADC), which included pure ground glass nodules and part-solid ADCs. The results revealed that the incidence of pleural invasion, vascular invasion and lymphatic invasion, and the rate of postoperative recurrence in patients with sADCs were similar to those with SCC, but were also significantly higher when compared with nsADC patients. The present study concluded that patients with SCC and sADC may not be suitable candidates for sublobar resection, despite exhibiting small tumors that are located in the peripheral lung.

Results of low-dose computed tomography as a regular health examination among Chinese hospital employees

ObjectiveLung cancer is traditionally more prevalent in the elderly patients, men, and smokers. However, as low-dose computed tomography (LDCT) is increasingly popular, we hypothesized the disease spectrum might change. MethodsLDCT was performed as a part of regular health examinations in 8392 of 15,686 employees from 6 hospitals in different regions of China in 2012 to 2018. Clinicopathologic characteristics, including age, sex, smoking status, radiologic features, tumor histology, and pathologic stage, were retrospectively analyzed. ResultsLDCT incidentally detected lung cancer (pathologically confirmed) in a total of 179 (2.1%) hospital employees. The lung cancer detection rate was significantly greater in female than male (2.5% vs 1.3%, P = .001) patients. There was also a greater detection rate among nonsmokers than smokers, although statistical significance was not reached (2.2% vs 1.4%, P = .092). The lung cancer detection rate was 1.0% in the “age ≤40 years” group, 2.6% in the “40 < age ≤55 years” group, and 2.9% in the “age >55 years” group (P < .001). Among the hospital employees with lung cancer, 171 (95.5%) presented as ground-glass opacity, 177 (98.9%) were lung adenocarcinoma, 170 (95.0%) were early stage 0/IA, and 177 (98.9%) received curative surgical resection as the initial treatment. After a median follow-up of 38 months, no disease recurrence or death was observed among these patients. ConclusionsLDCT detected lung cancer in a significant proportion of young, female, and nonsmoking employees. The vast majority of these lung cancers were early stage, with extremely good prognosis.

LDCT LUNG SCREENING SAVES LIVES BUT AT A LOW YIELD: ANALYSIS OF LDCT LUNG SCREENING POPULATION AT SEYH 2015-2018

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: To better understand the benefits and disadvantages of LDCT lung screening by analyzing patients who underwent LDCT lung screening at St Elizabeth hospital (SEH) from 2015 to 2018. METHODS: A retrospective study based on questionnaires and screening results that were collected from participants. RESULTS: There were a total of 1,340 person-year participants. There was high all abnormality detection rate (85%). The top three abnormalities were non-calcified nodule or mass > 4 mm (17%), other potentially significant abnormalities above diaphragm (15%) and cardiovascular abnormalities (15%). Based on the quality assurance tool Lung-RADS score, majority of the nodules (78%, 1046/1340) were assigned score of 1 to 3 (negative or benign findings). Among nodules suspicious for malignancy requesting additional diagnostic testing, 5.37% (Lung-RAD 4A, 72 patients) and 1.27% (4B, 17 patients). Among those patients with RADS 4A or 4B, 19 were diagnosed with lung cancer (3 small cell, 4 squamous cell, 12 adenocarcinoma). Based on AJCC tumor staging, lung screening detected mostly stage I (58%) while cancer registry detected mostly stage 4 (44%) cancer. Race, gender, symptoms and risk factor exposure were compared between lung cancer patients and the screening population. There were no significant differences between the two populations. Interestingly, about 60% in both groups reported exposure to second hand smoke, significantly higher than national nonsmoker second hand exposure rate of 25%. The distribution of PPY showed a bimodal distribution in both screening and lung cancer populations. About 68% (13 out of 19) of lung cancer patients had 100 PPY smoking history. However, smoking cessation was not favored by the screening population with only 6.7% (56 out of 830) of current smokers enrolled in a smoking cessation program. It was also striking that 47% (366 out of 774) of current smokers who were not enrolled in a smoking cessation program did not want further information on smoking cessation. CONCLUSIONS: LDCT lung screening detects lung cancer in early stages. However, based on current screening criteria, lung cancer detection rate was very low. A risk stratification model for selecting lung cancer screening candidates is needed. In addition, to reduce lung cancer incidence, smoking cessation remains the most effective method. Better strategies and more aggressive efforts are needed to promote smoking cessation especially in the high-risk groups. CLINICAL IMPLICATIONS: A risk stratification model for selecting lung cancer screening candidates is needed.Better strategies and more aggressive efforts are needed to promote smoking cessation especially in the high-risk groups. DISCLOSURES: No relevant relationships by Timothy Barreiro, source=Web Response No relevant relationships by David Gemmel, source=Web Response No relevant relationships by Yan Jiang, source=Web Response

Results of Lung Cancer Screening among Urban Residents in Kunming

背景与目的肺癌筛查是降低肺癌死亡率的有效措施。目前国际及全国范围内均推荐肺癌筛查，我国于2009年、2012年分别启动了大规模的农村、城市肺癌早诊早治项目，云南省先后于2009年、2014年参与相关项目，但目前云南省尚未报道大规模肺癌筛查的研究结果。本研究通过参加国家癌症中心牵头的城市癌症早诊早治项目，分析2014年-2018年云南省昆明市10, 154例城市居民肺癌筛查结果，评价城市癌症早诊早治肺癌筛查效果。方法以云南省昆明市40岁-74岁居民为研究对象，通过防癌风险问卷调查评估出肺癌高风险31, 824人，对高风险人群进行胸部低剂量螺旋计算机断层扫描（computed tomography, CT），分析肺癌的高风险率、筛查率和检出率。结果5年完成问卷调查150, 535人，评估出肺癌高危人群31, 824人，高风险率21.14%，共完成胸部低剂量螺旋CT筛查10, 154人，参与率31.91%。肺内结节检出率22.28%（2, 262/10, 154），其中 < 5 mm实性/部分实性结节检出率11.30%（1, 332/10, 154）、 < 8 mm非实性结节检出率2.20%（219/10, 154）、阳性结节检出率7.00%（711/10, 154）、疑似肺癌检出率0.60%（59/10, 154），肺癌检出率0.27%（27/10, 154）。男性阳性结节、 < 8 mm非实性结节及疑似肺癌检出率显著高于女性；阳性结节、 < 5 mm实性结节、疑似肺癌及确诊肺癌检出率随年龄增加而增高，60岁以上年龄组最高。结论低剂量螺旋CT适合肺癌高危人群筛查，有助于早期发现肺内的阳性结节和相关疾病，应重视60岁以上人群肺癌的筛查工作；了解了昆明市居民的肺部健康状况，提高了居民的肺癌防治意识，提高肺癌的早诊早治率。