Low-dose Computed Tomography Screening Research Articles

A Nested Case-Control Study of Lung Cancer for Immune Biomarkers

<h3>Purpose/Objective(s)</h3> Smoking is the leading cause of lung cancer, which is the leading cause of cancer mortality worldwide, with 1.2 million deaths a year. Lung cancer has a very poor prognosis; over half of people diagnosed die within one year of diagnosis and the 5-year survival is less than 18%. Prior to cancer development, smokers develop multiple lung problems associated with chronic inflammation, which can promote progression to cancer. The aim of the study was to examine if immune competence would enhance or reduce the risk of lung cancer development among high-risk smokers. The hypothesis is that smokers who developed lung cancer would have a higher frequency of chronic inflammation induced myeloid-derived suppressor cells (MDSC) and/or regulatory T cells (Treg), three years or more prior to lung cancer diagnosis (baseline), compared to smokers who remained cancer-free. Additionally, smokers who developed cancer would have higher levels of certain inflammatory cytokines at baseline. <h3>Materials/Methods</h3> A case-control study of incident lung cancer was conducted within the participants of the Pittsburgh Lung Screening Study (PLuSS), a longitudinal low-dose CT screening study for early detection of lung cancer among smokers with a history of heavy smoking (median 47 pack-years of cigarette smoking). Cases consisted of 40 current or former smokers who developed lung cancer during follow-up after repeated blood draws and the control group consisted of 40 PLuSS participants, free of cancer, who were individually matched to the index case by age, sex, smoking status, and year of blood draw. Live peripheral blood mononuclear cells (PBMC) were thawed and analyzed for MDSC, CD4 T cells, and Treg by flow cytometry. Cytokines and chemokines were quantified in two repeated serum samples per subject using the next generation multiplex immunoassays. <h3>Results</h3> There was no statistically significant difference in overall MDSC percentage of PBMC nor in subtypes (PMN-MDSC, M-MDSC and e-MDSC) between cases and controls. There was also no difference found for Tregs. However, CD4 T cells were elevated in lung cancer cases and were associated with an increased risk of lung cancer overall (odds ratio [OR] = 2.61, 95% confidence interval [CI] = 0.73-9.32, p trend = 0.1409). Lung cancer cases had significantly higher levels of serum inflammatory cytokines IL-17A and Il-12/IL-23p40 at both early (median 84 months) and late time points (7 months prior to cancer diagnosis) (all <i>P</i>s < 0.05). <h3>Conclusion</h3> Lung cancer cases are associated with elevated levels of CD4 T cells and pro-inflammatory cytokines, specifically IL-17A and IL-12/IL-23p40, as early as 7 years before cancer diagnosis. The study has the potential to identify immune cells and soluble factors that mediate lung cancer development in smokers and could be used as early biomarkers for risk assessment or early diagnosis of lung cancer.

Incidence of Head and Neck Cancer With Lung Cancer Screening: Secondary Analysis of a Randomized Controlled Trial.

To evaluate the incidence of head and neck cancers (HNC) in high-risk current and/or former smokers with screening low-dose computed tomography (LDCT) chest versus chest x-ray (CXR). Second analysis of randomized clinical trial. We performed a secondary analysis examining the incidence of HNC in the National Lung Screening Trial. This was a randomized trial comparing LDCT versus CXR screening for lung cancer detection in high-risk individuals (30 pack-year smokers who currently smoke or quit within the last 15 years, aged 55-74). We compared the incidence of HNC in participants screened with LDCT versus CXR. We performed subgroup analyses in participants with mucosal HNC (oral cavity, oropharynx, larynx, hypopharynx, nasal/sinus cavity, or nasopharynx) or nonmucosal HNC (thyroid or salivary gland) and examined survival in the two screening arms. This trial enrolled 53,452 participants with a median follow-up of 6.2 years after randomization. The incidence of HNC was 111.8 cases per 100,000 person-years in the LDCT group versus 87.1 cases per 100,000 person-years in the CXR group (rate ratio 1.30, 95% confidence interval [CI] 1.05-1.61). There were 11.7 deaths from HNC per 100,000 person-years in the LDCT group and 12.9 deaths per 100,000 person-years in the CXR group (hazard ratio 0.80, 95% CI 0.42-1.52). Participants screened with LDCT had a modestly higher incidence of HNC. As uptake and adherence of lung cancer screening guidelines improve, clinicians should recognize that incidental findings from screening may lead to increased detection of HNC. 3 Laryngoscope, 132:1609-1614, 2022.

Low-dose computed tomography screening, follow-up, and management of lung nodules – An expert consensus statement from Taiwan

Low-dose computed tomography screening, follow-up, and management of lung nodules – An expert consensus statement from Taiwan

Management of screen-detected lung nodule

Low-dose computed tomography screening has recently increased the detection rate of small pulmonary nodules. The surgical techniques and policies for managing screen-detected lung nodules are different from those for advanced lung cancer. In the past decade, several novel tumor localization methods and surgical management policies have been developed for such patients. In this article, we reviewed studies related to two different screen-detected lung nodule localization techniques at our institute. We also reviewed studies related to the surgical policies of sublobar resection and the application of nonintubated thoracoscopy in the management of screen-detected lung nodules at our institute. These novel techniques and surgical policies may be helpful to physicians in the management of screen-detected lung nodules.

Cost Effectiveness of Lung Cancer Screening With Low-Dose CT in Heavy Smokers in China.

Although lung cancer screening with low-dose CT (LDCT) can reduce lung cancer mortality by 20%, without an appropriate eligibility criteria, it may result in a waste of medical resources and a degree of unnecessary damage to participants' health. This study aims to give the optimal screening strategy in China based on cost-effectiveness analysis on pros and cons of different situations. From the perspective of primary healthcare system, a Markov model was built to simulate LDCT screening of 100,000 heavy smokers (>30 pack years) aged 40 in different situations. Model parameters mainly came from screening programs conducted in China and other countries, official public data, and published literature. Two indicators of primary outcome, incremental cost-effectiveness ratio (ICER) and net health benefits (NHB), were compared with those of no screening. Sensitivity analysis was conducted to evaluate model uncertainties. We defined the optimal strategy as the one with both acceptable cost effectiveness and maximal NHB. Base-case analysis results showed that for all screening strategies, ICERs were less than three times of GDP per capita. As for NHB results, it showed that when the willingness to pay for screening was less than three times of GPD per capita, the largest NHB was obtained in the strategy which started screening at 50 years old and this strategy showed stable performance in univariate and probabilistic sensitivity as well. PREVENTION RELEVANCE: LDCT screening is cost effective in heavy smokers in China, and the optimal age to start screening is suggested to be 50 years old.

Leveraging Value-Based Payment Models to Reduce Health Inequities in Radiology

Leveraging Value-Based Payment Models to Reduce Health Inequities in Radiology

Abstract PO-260: Screening of Brazilian underserved workers exposed to asbestos in loco with a mobile low dose computed tomography

Abstract Occupational exposure to asbestos is strongly associated with pleural and pulmonary fibrosis, lung cancer, and malignant mesothelioma. Although many countries, including Brazil, have recently banned the extraction and usage of asbestos, cases of pulmonary fibrosis and asbestos-related malignancy are still expected to increase, due to the long latency period of disease development. A proper response to this scenario primarily requires awareness and structured surveillance, but also access to screening and diagnostic methods in healthcare, restrict and unequally available in Brazil. Recent evidence suggests that Low Dose Computed Tomography (LDCT) may be an effective tool to screen malignancy in asbestos-exposed workers. Here we describe an initiative to improve screening with a mobile LDCT unit in an underserved population of workers of a former asbestos manufacture factory at Pedro Leopoldo, city, Minas Gerais state, Brazil. In partnership with ABREA (Associação Brasileira dos Expostos ao Amianto) workers with a history of direct or indirect asbestos exposure were included in September 2019, regardless of the exposure duration or respiratory symptoms, to whom an LDCT examination was offered. Thoracic radiologists searched for pleural plaques or nodules, pleural effusion, fibrosis-related findings, and lung nodules, and a structured report was filled in. Pulmonary nodules were managed according to Lung-Rads-1.1. Necessary supplementary investigations were referred to a tertiary oncological center, in which the malignancies were also to be treated. Two hundred and three men and twenty women underwent LDCT screening, the median age of 57 years, 89% directly engaged in asbestos manufacturing. Pleural plaques or nodules were identified in 19% of individuals, with a median exposure time of 13,5 years. Five individuals had moderate or marked signs of pulmonary fibrosis, and one was diagnosed with low-stage pulmonary adenocarcinoma, none of which were suspected under usual care. Although political interference had precluded full attendance of participants, proper treatment was guaranteed with the aid of the Labor Prosecutor Office. The mobile LDCT unit was successful in enhancing screening and awareness of this exposed and underserved population. Citation Format: Rodrigo Sampaio, Leonardo Almeida, Larissa Ferreira, Maraisa Costa, Ana Oliveira, Bruna Carvalho, Mauro Cardoso, Fabiana Vazquez, Henrique Silveira, Laércio Castilho-Neto, Fernanda Giannasi Fernanda Giannasi, Rui Reis. Screening of Brazilian underserved workers exposed to asbestos in loco with a mobile low dose computed tomography [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-260.

Abstract PO-268: Investigating patient barriers to low-dose computed tomography lung cancer screenings among the African American population

Abstract Background Lung cancer remains the leading cause of cancer death in the United States. Lung cancer screening (LCS) with Low-Dose Computerized Tomography (LDCT) has been found to reduce lung cancer mortality up to 26% and all-cause mortality by 7%. Yet, uptake of LCS is less than 4% among those eligible. African Americans (AAs) have the highest cancer mortality rate and are also more likely to die of lung cancer compared to whites. Furthermore, little research has been done to understand this groups in terms of their knowledge, awareness, and perceptions related to LCS, and the potential barriers or facilitators to LCS. Guided by the Health Believe Models, this study aims to examine the demographic, behavioral, and psychosocial profiles related to LCS in AAs, and identify the predictors to the uptake of LCS with LDCT. Methods We have recruited 200 AA patients eligible for LDCT for a case-control cohort (100 AAs who have completed a LDCT screening and 100 who did not) through the electric medical record of a safety-net hospital. We are currently conducting online and telephone surveys to collect information on participants' personal and family history, health literacy, beliefs, psychosocial factors, patient-provider relationship, knowledge of lung cancer, perception of screening and potential care cost, transportation barriers, and racial discrimination. Results We will conduct descriptive analysis of the sociodemographic characteristics and the modifiable lifestyle behaviors of the participants separately for those who completed LDCT and those who did not. We will then conduct bivariate analysis (chi-square and t-test) to compare various psychosocial and health-related factors by LDCT completion status. Finally, we will conduct binary logistic regression to examine the association between the predictors and LDCT completion. Conclusion The findings of this study will provide critical empirical evidence on the psychosocial facilitators and barriers to LDCT uptake among AAs, a vulnerable and medically underserved population. The facilitators and barriers identified in this study will be used to design both clinic-based and community-based behavioral intervention studies to promote LDCT uptake among eligible AAs. Citation Format: Alexander Nguyen, Lin Zhu, Ra'Ann Merceir, Grace X Ma, Cherie P Erkmen. Investigating patient barriers to low-dose computed tomography lung cancer screenings among the African American population [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-268.

Innovations in Bronchoscopy: Robotic-assisted Bronchoscopy

Low-dose computed tomography screening for lung cancer has led to the increased detection of peripheral pulmonary nodules (PPN). Bronchoscopic modalities of PPN biopsy (ultrathin bronchoscope, radial endobronchial ultrasound, electromagnetic navigational bronchoscopy) have not consistently shown diagnostic yields as high as ultrasound- or computed tomography-guided transthoracic needle aspiration or surgical lung biopsy. Robotic-assisted bronchoscopy gained US Food and Drug Administration approval in 2018 and 2019, and preliminary data have shown an improvement in the ability to navigate to PPN, obtain a diagnosis and evaluate tissue for molecular markers, all while maintaining a safety profile similar to that of traditional bronchoscopic methods. In this article, we aim to briefly summarize the data available on this novel technology and its potential for future applications.

Organ and Effective Doses Using Automation Organ Dose Estimation Software for Lung Cancer Screening Using Low-dose Computed Tomography

The purpose of this study was to evaluate the differences in the organ doses and the effective doses using three types of automated organ dose estimation software for low-dose computed tomography (CT) screening for lung cancer and to evaluate the correlations between each dose and size-specific dose estimates (SSDEs). Seventy-two adults who underwent low-dose CT screening for lung cancer were included, and the organ doses and the effective doses were calculated using each of automated organ dose estimation software. We evaluated differences between software for the organ doses and the effective doses and the correlations between each dose and SSDEs. Differences in organ doses and effective doses were observed among the software. The organ doses showed a strong correlation (r=0.833-0.995) with SSDEs for organs within the scan range. The effective doses showed a strong correlation (r=0.830-0.970) with SSDEs, although there were significant differences among the software. Although the organ doses and the effective doses differed between software, it may be possible to estimate them from SSDEs by using linear regression equations.

Can we increase efficiency of CT lung cancer screening by combining with CVD and COPD screening? Results of an early economic evaluation

ObjectivesEstimating the maximum acceptable cost (MAC) per screened individual for low-dose computed tomography (LDCT) lung cancer (LC) screening, and determining the effect of additionally screening for chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), or both on the MAC.MethodsA model-based early health technology assessment (HTA) was conducted to estimate whether a new intervention could be cost-effective by calculating the MAC at a willingness-to-pay (WTP) of €20k/quality-adjusted life-year (QALY) and €80k/QALY, for a population of current and former smokers, aged 50–75 years in The Netherlands. The MAC was estimated based on incremental QALYs gained from a stage shift assuming screened individuals are detected in earlier disease stages. Data were obtained from literature and publicly available statistics and validated with experts.ResultsThe MAC per individual for implementing LC screening at a WTP of €20k/QALY was €113. If COPD, CVD, or both were included in screening, the MAC increased to €230, €895, or €971 respectively. Scenario analyses assessed whether screening-specific disease high-risk populations would improve cost-effectiveness, showing that high-risk CVD populations were more likely to improve economic viability compared to COPD.ConclusionsThe economic viability of combined screening is substantially larger than for LC screening alone, primarily due to benefits from CVD screening, and is dependent on the target screening population, which is key to optimise the screening program. The total cost of breast and cervical cancer screening is lower (€420) than the MAC of Big-3, indicating that Big-3 screening may be acceptable from a health economic perspective.Key Points• Once-off combined low-dose CT screening for lung cancer, COPD, and CVD in individuals aged 50–75 years is potentially cost-effective if screening would cost less than €971 per screened individual.• Multi-disease screening requires detailed insight into the co-occurrence of these diseases to identify the optimal target screening population.• With the same target screening population and WTP, lung cancer-only screening should cost less than €113 per screened individual to be cost-effective.

Abstract PO-235: Changes in low-dose CT lung cancer screening patterns post-COVID-19

Abstract Purpose: Nationally, only 23% of lung cancer cases are diagnosed at an early stage and on top of that Black Americans with lung cancer are 16% less likely to be diagnosed early. If everyone currently eligible were screened, close to 48,000 lives could be saved. Interestingly, pre-COVID-19 17% of the individuals getting screened for lung cancer were Black, and post-COVID-19 36% are Black. This study aims to explore potential reasons for this sudden increase in low-dose CT lung cancer screenings in Black patients by examining variables in the electronic health record and by interviewing pundits in clinical oncology practice. Methods: 416 deidentified electronic health records were collected from a data repository at the Medical College of Wisconsin. We analyzed low-dose CT screening for lung cancer among Black and white patients pre- and post-COVID-19 (4 cohorts). The post-COVID-19 cohorts looked at screening from 1/1/2020 – 7/8/2021, compared to a proportionate time frame pre-COVID-19 (1/1/2018 – 7/8/2019). Because of low numbers of other racial/ethnic backgrounds (Asian, Hispanic, Pacific Islander, etc.), only Black and white patients were examined in this study. Variables examined include insurance status, marital status, age, COVID-19 testing or diagnosis, gender, employment status, comorbidities (cardiovascular disease, chronic obstructive pulmonary disease, diabetes and hypertension), and lung cancer diagnosis. Results: Employment status, lung cancer diagnosis, and gender were all significantly different between Black and white cohorts pre-COVID-19. Post-COVID-19, similar differences are seen in employment status, while patterns in lung cancer diagnosis, gender, and insurance status are contradictory. Black patients pre-COVID-19 had a higher incidence of being men and a lower incidence of lung cancer diagnosis. On the contrary, post-COVID-19 Black patients have a higher incidence of being women and lung cancer diagnosis, and additionally a higher incidence of Medicare use. Despite the drastic differences in healthcare before and after COVID-19, COVID-19 testing and diagnosis did not appear to be linked to increased lung cancer screenings for Black patients. However, in conversations with thoracic surgeons and community health workers, we learned of significant screening efforts within Black populations due to grants funded during the COVID-19 pandemic. Conclusions: In this study, insurance status was the strongest difference between the pre- and post-COVID-19 Black cohorts. In a conversation with thoracic surgeons, we learned that a major initiative was launched post-COVID-19 that increased insurance access for Black populations. Increasing access to healthcare appears to be a promising first step in eradicating lung cancer disparities in Black populations. So, this research could serve as a guidepost to provide policymakers, researchers and healthcare providers, as well as patients and families, with data that pinpoints where future resources should be aimed in the effort to end lung cancer and its corresponding health disparities. Citation Format: Katherine Hullin, Jessica Olson. Changes in low-dose CT lung cancer screening patterns post-COVID-19 [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-235.

Abstract IA-49: Facilitators and barriers to implementing low-dose CT screening for lung cancer in a tribal health system

Abstract Lung cancer is the leading cause of cancer mortality among American Indians and Alaska Natives (AI/AN), and many AI/AN communities have worse lung cancer incidence rates, survival, and death compared to the general population. Although lung cancer screening (LCS) with low-dose computed tomography is a grade-B USPSTF recommendation, uptake of LCS has been slow in most healthcare systems. LCS implementation among AI/AN has not been studied before in detail. To address this knowledge and implementation gap, a multi-phase, 5-year “Tribally Engaged Approaches to Lung Screening" (TEALS) study was launched in 2019 in partnership with the Choctaw Nation of Oklahoma. The overarching goal of this project is to co-design and test an LCS implementation program. This presentation will discuss what is being learned about potential facilitators and barriers to implementing LCS in a tribal health care setting. Findings may be pertinent to other health systems serving tribal, rural or underserved populations. Citation Format: Zsolt J. Nagykáldi. Facilitators and barriers to implementing low-dose CT screening for lung cancer in a tribal health system [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr IA-49.

COVID-19 Pandemic on smoking behavior changes among African American Smokers Eligible for LDCT Screening

Smoking has been observed to associate with an elevated severity of disease and risk of mortality among people with COVID-19. Additionally, African American smokers have higher rates of mortality from lung cancer than other racial/ethnic groups. Low dose computed tomography (LDCT) screening can detect lung cancer early to decrease lung cancer-specific mortality for current smokers but remains under-utilized among these population. However, we know little about the effect of COVID-19 pandemic on smoking behavior changes among African American smokers who qualify for LDCT screening. This study recruited 60 African American daily smokers seen in primary care clinics, who qualified to receive LDCT screening in a New Orleans, LA hospital. A total of 22 participants (36.7%) completed anonymous cross-sectional survey that collected demographic, disease history, tobacco use, and smoking cessation behaviors during the period of COVID-19 pandemic via phone interview. The majority were older (61.2 [SD=4.7]), female (77.3%), earned annual income less than $20,000 (100.0%), had Medicaid (63.6%), overweight/obesity (72.7%), planned to quit smoking within 6 months (52.4%), and would consider taking LDCT screening after COIVD-19 pandemic (95.2%). Half of smokers reported they have been diagnosed hypertension (47.6%), diabetes (52.4%), and arthritis (57.1%). Regarding health behavior changes, 42.9% smokers reported they smoked more, felt more stress (42.9%) and anxiety (33.4%) after COVID-19 outbreak. Smoking cessation programs may focus on this high-risk minority population in the post COVID-19 pandemic to help them decrease cigarette smoking and enhance their motivation to quit smoking.

Engaging veteran stakeholders to identify patient-centred research priorities for optimizing implementation of lung cancer screening.

BackgroundPatient engagement in research agenda setting is increasingly being seen as a strategy to improve the responsiveness of healthcare to patient priorities. Implementation of low‐dose computed tomography (LDCT) screening for lung cancer is suboptimal, suggesting that research is needed.ObjectivesThis study aimed to describe an approach by which a Veteran patient group worked with other stakeholders to develop a research agenda for LDCT screening and to describe the research questions that they prioritized.MethodsWe worked with Veterans organizations to identify 12 Veterans or family members at risk for or having experience with lung cancer to form a Patient Advisory Council (PAC). The PAC met repeatedly from June 2018 to December 2020, both independently and jointly, with stakeholders representing clinicians, health administrators and researchers to identify relevant research topics. The PAC prioritized these topics and then identified questions within these areas where research was needed using an iterative process. Finally, they ranked the importance of obtaining answers to these questions.ResultsPAC members valued the co‐learning generated by interactions with stakeholders, but emphasized the importance of facilitation to avoid stakeholders dominating the discussion. The PAC prioritized three broad research areas—(1) the impact of insurance on uptake of LDCT; (2) how best to inform Veterans about LDCT; and (3) follow‐up and impact of screening results. Using these areas as guides, PAC members identified 20 specific questions, ranking as most important (1) innovative outreach methods, (2) the impact of screening on psychological health, and (3) the impact of outsourcing scans from VA to non‐VA providers on completion of recommended follow‐up of screening results. The latter two were not identified as high priority by the stakeholder group.ConclusionsWe present an approach that facilitates co‐learning between Veteran patients and providers, researchers and health system administrators to increase patient confidence in their ability to contribute important information to a research agenda. The research questions prioritized by the Veterans who participated in this project illustrate that for this new screening technology, patients are concerned about the practical details of implementation (e.g., follow‐up) and the technology's impact on quality of life.Patient or Public ContributionVeterans and Veteran advocates contributed to our research team throughout the entire research process, including conceiving and co‐authoring this manuscript.

Understanding the lung cancer mortality reductions produced by low-dose CT screening-Authors' reply.

Understanding the lung cancer mortality reductions produced by low-dose CT screening-Authors' reply.

The Impact of COVID-19 on Risky Behaviors and Health Changes in African-American Smokers Who Are Eligible for LDCT Screening

The COVID-19 pandemic has disrupted much of day-to-day life in the US and around the world. Smokers have a higher risk of adverse outcomes due to COVID-19. This study investigated the impact of COVID-19 on risky behaviors and health changes in lower income African-American smokers eligible for Low dose computed tomography (LDCT) screening, who may be more adversely impacted by the COVID-19 pandemic. A total of 22 African-American daily smokers who were eligible for LDCT screening participated in this study. The mean age of participants was 61.2 years old (SD = 4.7), 77.3% of the smokers were female, all participants had an income below $20,000, and 63.6% were on Medicaid. Descriptive statistics were used to provide summary information on demographics, COVID-19, and health status. Results showed that participants increased cigarette smoking, spent more time on screens, increased sugary drink consumption, consumed more vegetables and fruits, and engaged in more gardening activities during the COVID-19 pandemic. However, participants also decreased physical activity time and slept less during the pandemic. In general, more than one-third of participants gained more body weight and reported increased stress and anxiety. Our results suggest that African-American smokers who qualify for LDCT screening should be encouraged to consider strategies not only for smoking cessation, but also risky behavior control and management.

Differences in detection patterns, characteristics, and outcomes of central and peripheral lung cancers in low-dose computed tomography screening.

BackgroundAlthough low-dose computed tomography (LDCT) screening is known to be effective for the detection of lung cancers localized in peripheral lung regions at a curable stage, limited data is available regarding the characteristics and outcomes of central lung cancers diagnosed in a screening cohort. This study aimed to determine whether LDCT screening could effectively detect central lung cancers at an early stage and offer survival benefits.MethodsWe analyzed 52,615 adults who underwent lung cancer screening with LDCT between May 2003 and Dec 2019 at a tertiary center in South Korea. Characteristics and outcomes of those diagnosed with lung cancer, stratified by screen-detection status and cancer location, were evaluated.ResultsA total of 352 individuals (281 screen-detected, 71 non-screen-detected) were diagnosed with lung cancer. Compared to screen-detected cancers, non-screen-detected cancers tended to be centrally-located (11.4% vs. 64.8%, P<0.001). Most non-screen-detected central cancers (89.1%) had a negative result on prior LDCT screening. Multivariable regression analyses revealed that for peripheral cancers, screen-detection was associated with a significantly lower probability of diagnosis at an advanced stage [III/IV, odds ratio (OR) =0.15, 95% confidence interval (CI): 0.05–0.45] and mortality [hazard ratio (HR) =0.33, 95% CI: 0.13–0.84]; however, the association was insignificant for central cancers. For screen-detected cancers, central location, compared to peripheral location, was significantly associated with a higher risk of diagnosis at an advanced stage (OR =20.83, 95% CI: 6.67–64.98) and mortality (HR =4.98, 95% CI: 2.26–10.97).ConclusionsUnlike for peripheral cancers, LDCT screening did not demonstrate an improvement in outcomes of central lung cancers, indicating an important limitation of LDCT screening and the need for developing novel modalities to screen and treat central lung cancer.

Lung cancer screening by volume computed tomography: thriving to high performance.

Low-dose volume CT screening for lung cancer leads to a significant decrease in lung-cancer-related mortality. However, optimisation of the post-screening protocol will be crucial for optimal healthcare. https://bit.ly/2ZkJPpH

Lung Nodule Malignancy Prediction in Sequential CT Scans: Summary of ISBI 2018 Challenge.

Lung cancer is by far the leading cause of cancer death in the US. Recent studies have demonstrated the effectiveness of screening using low dose CT (LDCT) in reducing lung cancer related mortality. While lung nodules are detected with a high rate of sensitivity, this exam has a low specificity rate and it is still difficult to separate benign and malignant lesions. The ISBI 2018 Lung Nodule Malignancy Prediction Challenge, developed by a team from the Quantitative Imaging Network of the National Cancer Institute, was focused on the prediction of lung nodule malignancy from two sequential LDCT screening exams using automated (non-manual) algorithms. We curated a cohort of 100 subjects who participated in the National Lung Screening Trial and had established pathological diagnoses. Data from 30 subjects were randomly selected for training and the remaining was used for testing. Participants were evaluated based on the area under the receiver operating characteristic curve (AUC) of nodule-wise malignancy scores generated by their algorithms on the test set. The challenge had 17 participants, with 11 teams submitting reports with method description, mandated by the challenge rules. Participants used quantitative methods, resulting in a reporting test AUC ranging from 0.698 to 0.913. The top five contestants used deep learning approaches, reporting an AUC between 0.87 - 0.91. The team's predictor did not achieve significant differences from each other nor from a volume change estimate (p =.05 with Bonferroni-Holm's correction).