Low-dose Helical Computed Tomography Screening Research Articles

Analysis of screening results and risk factors of high-risk populations of lung cancer in Nanchang city from 2018 to 2019

Objective: To collate and analyze the screening results of high-risk lung cancer populations in communities in Nanchang from 2018 to 2019, and to explore the lung-positive nodules and risk factors for lung cancer. Methods: Data of the screening subjects in 8 administrative districts and 15 street health service centers in Nanchang city, Jiangxi province from November 2018 to October 2019 were collected, people at high risk of lung cancer was assessed, clinical screening of high-risk groups of lung cancer was conducted by low-dose helical computed tomography (LDCT), and risk factors for suspected lung cancer and lung-positive nodules were analyzed. Results: Of the 25 871 people participated in screening, 5 220 were at high risk for lung cancer and 15 374 without other malignant tumors were at high risk. There were 2 417 cases participated in clinical LDCT screening, including 193 cases of lung-positive nodules, 67 cases of suspected lung cancer, 912 cases of other lung diseases, the positive rate of lung cancer or lung-positive nodules was 10.76% (260/2 417). Univariate analysis showed that age, coarse grain intake, oil intake, housing heating, passive smoking, alcohol consumption and mental trauma were associated with positive pulmonary nodules or lung cancer (all P<0.05). Multivariate analysis showed that gender, age, housing heating, smoking and drinking were related to the occurrence of lung nodules or lung cancer (all P<0.05). Conclusions: Men are more likely to develop lung cancer or lung-positive nodules than women. The age is an independent risk factor for lung-positive nodules or lung cancer. In a certain range, age will increase the incidence of lung cancer, housing heating may be the protective factor for lung cancer, while smoking and drinking are risk factors.

Lung cancer screening in Appalachian Kentucky: The impact of Lung-RADS on subsequent testing and cancer identification.

The National Lung Cancer Screening Trial (NLST) demonstrated the use of low dose helical computed tomography (LDCT) scans for lung cancer screening. However, the NLST was implemented in urban hospitals and prior to the Lung CT Screening Reporting and Data System (Lung-RADS). In this retrospective cohort study, 774 eligible patients received LDCT screening using Lung-RADS criteria. Eighty-four patients (10.9%) had subsequent testing performed compared to 24.2% in the NLST study. Of those with subsequent testing, 21.4% were diagnosed with lung cancer compared to only 4.6% in the NLST study. Lung-RADS significantly reduced unnecessary testing while identifying higher rates of lung cancer compared to the NLST.

MILD trial, strong confirmation of lung cancer screening efficacy.

In a landmark analysis, investigators of the Multicentric Italian Lung Detection (MILD) trial have confirmed 10-year mortality reductions with lung cancer screening using low-dose helical CT (LDCT). These data complement the reduced lung cancer-specific mortality reported in the National Lung Screening Trial and reinforce the rationale for broad implementation of LDCT screening in high-risk populations.

LDCT lung cancer screening eligibility and use of CT scans for lung cancer among sexual minorities

ObjectiveTo compare eligibility for lung cancer screening and receipt of a CT scan for lung cancer among sexual minorities. MethodsSecondary data analysis of cross-sectional data from older U.S. adults in the Behavioral Risk Factor Surveillance System survey during the 2017 cycle (n = 20,685). ResultsRates of eligibility for low-dose helical computed tomography (LDCT) were roughly twice as high among sexual minorities than among heterosexuals (21.1% vs. 11.7%). The odds of gay men and lesbian women indicating eligibility for LDCT screening were four to five times higher when compared to their heterosexual peers. No statistically significant differences were found between sexual minorities and heterosexuals with respect to having a CT scan for lung cancer in the past year. ConclusionsThere are potential sexual-identity-related disparities in the utilization of lung cancer screening among eligible smokers. Interventions are needed to increase awareness and uptake of lung cancer screening in order to detect and manage this common form of cancer in the U.S.

Delivering tobacco dependence treatment in lung cancer screening programs serving socioeconomically disadvantaged populations

Smokers with low socioeconomic status (SES) are at a higher risk for developing and dying from lung cancer due to limited access to health care services and higher smoking prevalence. In 2011, the National Lung Screening Trial (NLST) found that in patients at high risk for developing lung cancer, lung cancer screening with low-dose helical computed tomography (LDCT) resulted in a 20% reduction in mortality from lung cancer. Current smokers who undergo annual LDCT screening and quit smoking derive the greatest reduction in lung cancer mortality. Thus, providing both LDCT screening and tobacco dependence treatment to current smokers can dramatically reduce smoking-related morbidity and mortality. In this report, we summarize the Society for Research on Nicotine and Tobacco (SRNT) and the Association for the Treatment of Tobacco Use and Dependence (ATTUD) guidelines on integrating smoking cessation interventions into lung cancer screening programs. We discuss barriers, potential solutions, and ongoing research efforts on how to implement tobacco treatment within LDCT screening, particularly as it pertains to low SES populations.

Free Lung Cancer Screening Trends Toward a Twofold Increase in Lung Cancer Prevalence in the Underserved Southeastern United States.

The National Lung Screening Trial (NLST) reported that the prevalence of lung cancer in individuals at high risk for the disease is 1%, and that screening these individuals using low-dose helical computed tomography of the chest saves lives. To increase screening accessibility in the underserved southeastern United States, we developed a free lung screening program, modeled after the Lahey Hospital & Medical Center Free Lung Screening Program, for individuals meeting National Comprehensive Cancer Network high-risk criteria. This was a chart review of 264 participants screened in the first year of our program. Participants were divided into categories based on the Lung Imaging Reporting and Diagnostic System. Categories three and four were considered positive findings, with demographic and disease criteria collected on these patients. Of 264 participants screened, 28 (10.6%) were Lung Imaging Reporting and Diagnostic System category four, 23 (8.7%) were category three, 78 (29.5%) were category two, and 135 (51.1%) were category one. Eight of the 264 participants (3.0%) had lung cancer, with 75% detected in early stages. We found a lung cancer prevalence in our high-risk screened population of 3.0% (8 of 264). After adjusting for patients who were symptomatic on clinical evaluation, we report a prevalence of cancer at 2.2% compared with 1.1% in the first year of the National Lung Screening Trial and a prevalence of 1.9% versus 0.6% compared with the National Comprehensive Cancer Network criteria in the first 10 months at Lahey Hospital & Medical Center. This study justifies low-dose helical computed tomography screening in high-risk regions because lung cancer treatment before symptoms appear is more effective, and the prevalence of disease in the detectable preclinical phase is high.

Preface on "pulmonary nodules special issue for lung cancer".

The incidence of small pulmonary nodules (SPNs) is increasing as a result of the widespread use of multislice spiral computed tomography (CT) and the low-dose helical CT screening for lung cancer (1). A pulmonary nodule is definite as a well or poorly-circumscribed, approximately spherical, radiographic opacity less than or equal to 30mm in diameter that is completely surrounded by aerated lung and is not associated with atelectasis, hilar enlargement, or pleural effusion, which can be divided into solid and sub-solid nodules, with the latter group further subdivided between pure ground-glass opacity (GGO) and part-solid nodules (2).

The Case for Lung Cancer Screening: What Nurses Need to Know.

Lung cancer screening with low-dose helical computed tomography (LDCT) can improve high-risk individuals' chances of being diagnosed at an earlier stage and increase survival. The aims of this article are to present the risk factors associated with the development of lung cancer, identify patients at high risk for lung cancer qualifying for LDCT screening, and understand the importance of early lung cancer detection through the use of LDCT screening. PubMed and CINAHL® databases were searched with key words lung cancer screening to identify full-text academic articles from 2004-2014. This resulted in 529 articles from PubMed and 195 from CINAHL. PubMed offered suggestions for additional relevant journal articles. The National Comprehensive Cancer Network guidelines also provided substantial evidence-based information. Nurses need to provide support, education, and resources for patients undergoing lung cancer screening.

Lung cancer risk test trial: study design, participant baseline characteristics, bronchoscopy safety, and establishment of a biospecimen repository.

BackgroundThe Lung Cancer Risk Test (LCRT) trial is a prospective cohort study comparing lung cancer incidence among persons with a positive or negative value for the LCRT, a 15 gene test measured in normal bronchial epithelial cells (NBEC). The purpose of this article is to describe the study design, primary endpoint, and safety; baseline characteristics of enrolled individuals; and establishment of a bio-specimen repository.Methods/Design Eligible participants were aged 50–90 years, current or former smokers with 20 pack-years or more cigarette smoking history, free of lung cancer, and willing to undergo bronchoscopic brush biopsy for NBEC sample collection. NBEC, peripheral blood samples, baseline CT, and medical and demographic data were collected from each subject.DiscussionOver a two-year span (2010–2012), 403 subjects were enrolled at 12 sites. At baseline 384 subjects remained in study and mean age and smoking history were 62.9 years and 50.4 pack-years respectively, with 34 % current smokers. Obstructive lung disease (FEV1/FVC <0.7) was present in 157 (54 %). No severe adverse events were associated with bronchoscopic brushing. An NBEC and matched peripheral blood bio-specimen repository was established.The demographic composition of the enrolled group is representative of the population for which the LCRT is intended. Specifically, based on baseline population characteristics we expect lung cancer incidence in this cohort to be representative of the population eligible for low-dose Computed Tomography (LDCT) lung cancer screening. Collection of NBEC by bronchial brush biopsy/bronchoscopy was safe and well-tolerated in this population. These findings support the feasibility of testing LCRT clinical utility in this prospective study. If validated, the LCRT has the potential to significantly narrow the population of individuals requiring annual low-dose helical CT screening for early detection of lung cancer and delay the onset of screening for individuals with results indicating low lung cancer risk. For these individuals, the small risk incurred by undergoing once in a lifetime bronchoscopic sample collection for LCRT may be offset by a reduction in their CT-related risks. The LCRT biospecimen repository will enable additional studies of genetic basis for COPD and/or lung cancer risk.Trial registrationThe LCRT Study, NCT 01130285, was registered with Clinicaltrials.gov on May 24, 2010.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0178-4) contains supplementary material, which is available to authorized users.

Advance of lung cancer screening with low-dose spiral CT

肺癌已经成为全球范围内癌症死亡的首位死因，其5年生存率很低。肺癌的筛查和早期诊断是改善肺癌生存，降低肺癌死亡率的关键。低剂量螺旋CT是近20年肺癌筛查的热点，随机对照试验研究已经证实其可降低肺癌死亡率。但目前低剂量螺旋CT筛查仍存在一些问题。本文对近年来低剂量螺旋CT能否降低肺癌死亡率的争议、随机对照试验的结果及存在的问题进行综述，并对未来低剂量螺旋CT在肺癌筛查中的应用做一展望。

Abstract LB-89: A combined epigenetic and genetic biomarker panel for detection of lung cancer.

Abstract Introduction: Lung cancer is the leading cause of cancer-related deaths in human. However, there is no valid screening procedure or test available at the present time. Although National Lung Screening Trial (NLST) demonstrated, for the first time, that low-dose helical CT screening in high-risk population reduced lung cancer mortality by 20%, the procedure is associated with over 95% false positive results (Aberle DR et al. N Engl J Med. 2011, 365:395). A confirmatory test is urgently needed. We have been developing a combined epigenetic and genetic molecular biomarker panel to verify the presence of lung cancer on the blood samples. Methods: Lung cancer cell lines NCI-H69 (small cell carcinoma), NCI-H1299 and NCI-H460 (large cell lung cancer), NCI-H1781 and A549 (adenocarcinoma), NCI- H358 (bronchioalveolar carcinoma) and NCI-H520 (squamous cell carcinoma) were obtained from ATCC (Manassas, VA). Blood samples of patients with lung cancer (n=105) and non-cancer patients were collected at MU Health Care System with an IRB approval. Genomic DNA was extracted from cell lines, mononuclear cell fraction and plasma using QIAamp DNA mini kit and circulating nucleic acid kit (QIAGEN, Valencia, CA), respectively. Isolated DNAs were digested with 4 methylation sensitive restriction enzymes followed by PCR for DNA methylation assay. Genomic DNAs were also subject to allele-specific PCR for PT53, EGFR and BRAF gene mutation assay. All PCR reactions were carried out in an iQ5 Real-time PCR system (Bio-Rad, Hercules, CA). Results: Specific CGI DNA methylation of HOXA7, HOXA6 and PCDHGA12A was detected in all lung cancer cell lines except NCI-H1299 in HOXA7. Only NCI-H460 was positive for EGFR L858R mutation. Among patient blood samples, HOXA7 methylation was detectable in 9 out of 105 patient mononuclear cell DNAs, but neither in patient plasma nor in non-cancer patients or normal blood control DNAs. EGFR L858R mutation was detected in only 4 lung cancer patient DNA samples. The sensitivity of HOXA7 DNA methylation assay, determined by serial dilutions of cancer cell DNA into normal DNA, was 0.1%. Conclusion: A combined epigenetic DNA methylation and genetic mutation panel could be utilized for lung cancer detection or verification in patient blood sample. Citation Format: Michael X. Wang, Dan Guo, Mary Andersen, Vamsi Guntur. A combined epigenetic and genetic biomarker panel for detection of lung cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-89. doi:10.1158/1538-7445.AM2013-LB-89

Computed Tomography Screening for Lung Cancer: Has It Finally Arrived? Implications of the National Lung Screening Trial

The National Lung Screening Trial (NLST) has provided compelling evidence of the efficacy of lung cancer screening using low-dose helical computed tomography (LDCT) to reduce lung cancer mortality. The NLST randomized 53,454 older current or former heavy smokers to receive LDCT or chest radiography (CXR) for three annual screens. Participants were observed for a median of 6.5 years for outcomes. Vital status was available in more than 95% of participants. LDCT was positive in 24.2% of screens, compared with 6.9% of CXRs; more than 95% of all positive LDCT screens were not associated with lung cancer. LDCT detected more than twice the number of early-stage lung cancers and resulted in a stage shift from advanced to early-stage disease. Complications of LDCT screening were minimal. Lung cancer-specific mortality was reduced by 20% relative to CXR; all-cause mortality was reduced by 6.7%. The major harms of LDCT are radiation exposure, high false-positive rates, and the potential for overdiagnosis. This review discusses the risks and benefits of LDCT screening as well as an approach to LDCT implementation that incorporates systematic screening practice with smoking cessation programs and offers opportunities for better determination of appropriate risk cohorts for screening and for better diagnostic prediction of lung cancer in the setting of screen-detected nodules. The challenges of implementation are considered for screening programs, for primary care clinicians, and across socioeconomic strata. Considerations for future research to complement imaging-based screening to reduce the burden of lung cancer are discussed.

Lung Cancer Screening: Promise and Pitfalls

The results of the National Lung Screening Trial (NLST) have provided the medical community and American public with considerable optimism about the potential to reduce lung cancer mortality with imaging-based screening. Designed as a randomized trial, the NLST has provided the first evidence of screening benefit by showing a 20% reduction in lung cancer mortality and a 6.7% reduction in all-cause mortality with low dose helical computed tomography (LDCT) screening relative to chest X-ray. The major harms of LDCT screening include the potential for radiation-induced carcinogenesis; high false-positivity rates in individuals without lung cancer, and overdiagnosis. Following the results of the NLST, the National Comprehensive Cancer Network (NCCN) published the first of multiple lung cancer screening guidelines under development by major medical organizations. These recommendations amalgamated screening cohorts, practices, interpretations, and diagnostic follow-up based on the NLST and other published studies to provide guidance for the implementation of LDCT screening. There are major areas of opportunity to optimize implementation. These include standardizing practices in the screening setting, optimizing risk profiles for screening and for managing diagnostic evaluation in individuals with indeterminate nodules, developing interdisciplinary screening programs in conjunction with smoking cessation, and approaching all stakeholders systematically to ensure the broadest education and dissemination of screening benefits relative to risks. The incorporation of validated biomarkers of risk and preclinical lung cancer can substantially enhance the effectiveness screening programs.

The adenocarcinoma-specific stage shift in the Anti-lung Cancer Association project: Significance of repeated screening for lung cancer for more than 5 years with low-dose helical computed tomography in a high-risk cohort

Background We investigated whether a stage shift occurs during long-term repeated screening for lung cancer with low-dose helical computed tomography (LDCT) in a high-risk cohort. Methods A total of 2120 subjects (mean age, 63 years; 87% male and 83% smokers) were continuously recruited and underwent repeated screening with LDCT from 1993 through 2004. Results Nineteen lung cancers were detected at baseline examinations (prevalence cancers), and 57 lung cancers were detected at subsequent examinations (incidence cancers). For both prevalence cancers and incidence cancers, adenocarcinoma (74% and 63%, respectively), especially invasive adenocarcinoma (42% and 23%, respectively), was the most common histological diagnosis, and stage IA was the most common pathological stage (58% and 79%, respectively). The detection rate of incidence cancers other than bronchioloalveolar carcinoma became significantly higher after 5 years of LDCT examinations ( r = 0.50, P = 0.020). Moreover, both the percentage of cancers of stage II–IV and tumor size became significantly lower for invasive adenocarcinoma after 5 years of LDCT examinations ( r = −0.77, P = 0.007 and r = −0.60, P = 0.029, respectively). Conclusions Repeated screening for more than 5 years might demonstrate the efficacy of LDCT screening for lung cancer through an adenocarcinoma-specific stage shift.

What we could know from the semiannually repeated screening with low-dose helical CT in a high-risk cohort over 10 years: Update of Anti-Lung Cancer Association project

7568 Background: There have been several randomized trials of low-dose helical CT (LDCT) screening for lung cancer. However, all trials are in progress. Therefore, before they are completed, we summarized what we could know from an update of Anti-Lung Cancer Association project, which was regarded as a longer-term study with LDCT performed at shorter intervals and with a larger number of detected cancers than any other single-armed studies. Methods: Among 2,120 participants, 1,877 (mean age 64 years, 88% male, and 84% smoker) underwent semiannually repeated screening from 1993 to 2004 (median, 3.5 years). We investigated (1) survival of patients with screening detected lung cancers, (2) presence of a stage shift (indicator of a mortality benefit), (3) appropriate duration of repeated screening, (4) identification of high-risk group by age, sex, and smoking, and (5) appropriate screening intervals by high-risk group (6 months or 1 year). Results: (1) The 5- and 10-year survival rates were 84.5% and 84.5%, respectively, in repeated screening group (n = 57) and were 68.7% and 38.1%, respectively, in initial screening group (n = 19) (P = 0.208). (2) Only in invasive adenocarcinoma, both proportion of stage II to IV and tumor size were negatively correlated with duration of repeated screening (r = −0.77, P = 0.007 and r = − 0.60, P = 0.029, respectively). (3) Detection rate of all incidence cancers were positively correlated with duration of repeated screening (r = 0.50, P = 0.020). However, detection rate remained unchanged until 5 years of repeated screening. Moreover, stage shift did not occur until 5 years of repeated screening. (4) Female sex (HR 2.9, P = 0.015) and smoking (HR 2.7, P = 0.046) were demographic risk factors for lung cancer detection at repeated screening. The accumulated 10-year detection rates for female smokers (n = 91), male smokers (n = 1,557), and non-smokers (n = 229) were 15.1%, 6.2%, and 4.3%, respectively (P = 0.002). (5) The estimated relative cancer detection powers of annual screening to semiannual screening were 50% and 57% for female and male smokers with lung cancer, respectively. Conclusions: Semiannually repeated LDCT screening over 5 years might be beneficial to smokers, especially female smokers. No significant financial relationships to disclose.

The adenocarcinoma-specific stage shift: Closely-repeated low-dose helical CT screening in a high-risk cohort for 10 years

1006 Background: Trials of CT screening for lung cancer have not yet proven the presence of a stage shift, to say nothing of a mortality benefit. On the basis of an update from Anti-Lung Cancer Association project, we investigated whether the stage shift did occur during the long-term closely-repeated low-dose helical CT screening in a high-risk cohort. Methods: A total of2,120 participants (mean age 63 yrs, 87% male, and 83% smoker) underwent low-dose helical CT screening semiannually from 1993 to 2004 (median, 3.5 years). Results: Nineteen prevalence and 57 incidence lung cancers were detected. In comparison between baseline and repeated screening, the detection rate was 0.90% vs. 0.32% (P &lt; 0.001) and the tumor size was 24mm vs. 17mm (P = 0.018). Adenocarcinoma (74% and 63%) and stage IA (58% and 79%) were observed most commonly in both screen-groups, respectively, but their proportions showed no significant difference between groups, respectively. Regarding the survival of lung cancer patients, screening type was not a significant prognostic factor. In repeated screening,the detection rate oflung cancer except bronchioloalveolar carcinoma increased significantly depending on CT repeating times (r = 0.50, P = 0.020). Moreover, the proportion of stage II-IV and the tumor size decreased significantly only in invasive adenocarcinoma (r = -0.77, P = 0.007 and r = -0.60, P = 0.029, respectively). Conclusions: The adenocarcinoma-specific stage shift did occur in a high-risk cohort. Considering larger proportion of adenocarcinoma in this population, smokers might benefit from the long-term closely-repeated low-dose helical CT screening. No significant financial relationships to disclose.

P-274 The decreased detection rate and the stage shift in lung adenocarcinoma during long-term repeat low-dose helical CT screening

P-274 The decreased detection rate and the stage shift in lung adenocarcinoma during long-term repeat low-dose helical CT screening

Overview of observational studies of low‐dose helical computed tomography screening for lung cancer

Lung cancer is a substantial public health problem in Western countries. Evidence from previous controlled trials of chest radiography and sputum cytology does not support lung cancer screening, but computed tomography (CT) screening has recently emerged as a more sensitive screening tool. For the present article, the available observational studies of low-dose helical CT screening for lung cancer were reviewed. An evidence-based review of all published observational studies of low-dose helical CT screening for lung cancer, identified by an extensive search of Medline, was conducted. Eight observational studies of CT screening for lung cancer were identified. Relative to chest radiography, low-dose helical CT is a sensitive screening tool and can detect a high proportion of small lung cancers at an early and resectable stage. The yield of sputum cytology in addition to CT screening appears to be relatively low. To date, 5-year lung cancer survival of all individuals participating in baseline screening has not been reported for any of the studies. Although these preliminary studies are very promising, it remains to be proven that the early detection and treatment of lung cancer will lead to a reduction in mortality. This issue will be addressed by randomized controlled trials. In the interim, the long-term follow up of these observational studies could provide further insights.

Progression of Focal Pure Ground-Glass Opacity Detected by Low-Dose Helical Computed Tomography Screening for Lung Cancer

To clarify the progression of focal pure ground-glass opacity (pGGO) detected by low-dose helical computed tomography (CT) screening for lung cancer. A total of 15,938 low-dose helical CT examinations were performed in 2052 participants in the screening project, and 1566 of them were judged to have yielded abnormal findings requiring further examination. Patients with peripheral nodules exhibiting pGGO at the time of the first thin-section CT examination and confirmed histologically by thin-section CT after follow-up of more than 6 months were enrolled in the current study. Progression was classified based on the follow-up thin-section CT findings. The progression of the 8 cases was classified into 3 types: increasing size (n = 5: bronchioloalveolar carcinoma [BAC]), decreasing size and the appearance of a solid component (n = 2: BAC, n = 1; adenocarcinoma with mixed subtype [Ad], n = 1), and stable size and increasing density (n = 1: BAC). In addition, the decreasing size group was further divided into 2 subtypes: a rapid-decreasing type (Ad: n = 1) and a slow-decreasing type (BAC: n = 1). The mean period between the first thin-section CT and surgery was 18 months (range: 7-38 months). All but one of the follow-up cases of lung cancer were noninvasive whereas the remaining GGO with a solid component was minimally invasive. The pGGOs of lung cancer nodules do not only increase in size or density, but may also decrease rapidly or slowly with the appearance of solid components. Close follow-up until the appearance of a solid component may be a valid option for the management of pGGO.

ＣＴ検診の現況

ＣＴ検診の現況