Screening Test For Lung Cancer Research Articles

P4.04C.07 Improving the Efficiency of Lung Cancer Screening Through a Blood-based Lung Cancer Screening Test Prior to Low-Dose CT

P4.04C.07 Improving the Efficiency of Lung Cancer Screening Through a Blood-based Lung Cancer Screening Test Prior to Low-Dose CT

Clinical Validation of a Cell-Free DNA Fragmentome Assay for Augmentation of Lung Cancer Early Detection.

Lung cancer screening via annual low-dose computed tomography has poor adoption. We conducted a prospective case-control study among 958 individuals eligible for lung cancer screening to develop a blood-based lung cancer detection test that when positive is followed by a low-dose computed tomography. Changes in genome-wide cell-free DNA fragmentation profiles (fragmentomes) in peripheral blood reflected genomic and chromatin characteristics of lung cancer. We applied machine learning to fragmentome features to identify individuals who were more or less likely to have lung cancer. We trained the classifier using 576 cases and controls from study samples and validated it in a held-out group of 382 cases and controls. The validation demonstrated high sensitivity for lung cancer and consistency across demographic groups and comorbid conditions. Applying test performance to the screening eligible population in a 5-year model with modest utilization assumptions suggested the potential to prevent thousands of lung cancer deaths. Significance: Lung cancer screening has poor adoption. Our study describes the development and validation of a novel blood-based lung cancer screening test utilizing a highly affordable, low-coverage genome-wide sequencing platform to analyze cell-free DNA fragmentation patterns. The test could improve lung cancer screening rates leading to substantial public health benefits. See related commentary by Haber and Skates, p. 2025.

Implementing fragmentomics into real world screening interventions to evaluate clinical utility among individuals with elevated risk for lung cancer (FIRSTLUNG) L301.

TPS11189 Background: To optimize the impact of lung cancer screening at the healthcare system level, additional tools are needed to increase the benefits of screening. While low-dose computed tomography (LDCT) has been shown to improve lung cancer detection and reduce mortality, it is not without its risks, such as radiation exposure, false-positive results, and unnecessary interventions often leading to complications. The additional complexity of lung cancer screening is the subpar adherence to LDCT for eligible individuals, which undermines the benefits of screening. Therefore, there is a need for alternative non-invasive methodologies that exploit our understanding of the biology of cancer pathogenesis. This clinical utility study aims to observe how a non–invasive blood-based test impacts physician behavior and LDCT utilization. Methods: FIRSTLUNG 301 (NCT06145750) is a prospective, cluster randomized controlled trial (RCT) to observe the impact of the DELFI Lung cancer screening test on lung cancer screening utilization in primary care practices. Enrolled practices must meet the eligibility criteria of having a minimum of 50 actively engaged individuals in the practice eligible for lung cancer screening per the 2021 USPSTF criteria. These practices will be randomized 1:1:2 to Arm A1 (control), Arm A2 (control), or Arm B (intervention). Arm A practices will be randomized 1:1 into two groups (A1:A2) to observe the standard of care for lung cancer screening. Practices in A1 will be observed; practices in A2 will receive standard education on lung cancer screening for CME credit. Randomizing within Arms A1 and A2 aims to delineate the impact standard lung cancer screening education may have on utilization. Arm B (intervention) practices will receive education and have access to order the blood-based test for screen-eligible individuals that remained unscreened. The primary study endpoint is the proportion of practice-identified lung cancer screen-eligible individuals receiving a screening CT order and scan during the study period in the entirety of Arm A (control) versus Arm B (intervention). This RCT aims to understand the utilization and impact on lung cancer screening uptake after the DELFI blood-based test intended to inform clinical guidelines and policies focused on improving patient care and health outcomes. Progress: The study was initiated on October 31, 2023, with practice randomization. As of February 2024, the study is open for enrollment with an estimated primary study completion date of December 2025. Clinical trial information: NCT06145750 .

Racial/Ethnic disparities in exposure to neighborhood violence and lung cancer risk in Chicago

BackgroundDespite the lower prevalence and frequency of smoking, Black adults are disproportionately affected by lung cancer. Exposure to chronic stress generates heightened immune responses, which creates a cell environment conducive to lung cancer development. Residents in poor and segregated neighborhoods are exposed to increased neighborhood violence, and chronic exposure to violence may have downstream physiological stress responses, which may explain racial disparities in lung cancer in predominantly Black urban communities. MethodsWe utilized retrospective electronic medical records of patients who underwent a screening or diagnostic test for lung cancer at an academic medical center in Chicago to examine the associations between lung cancer diagnosis and individual characteristics (age, gender, race/ethnicity, and smoking status) and neighborhood-level homicide rate. We then used a synthetic population to estimate the neighborhood-level lung cancer risk to understand spatial clusters of increased homicide rates and lung cancer risk. ResultsOlder age and former/current smoking status were associated with increased odds of lung cancer diagnosis. Hispanic patients were more likely than White patients to be diagnosed with lung cancer, but there was no statistical difference between Black and White patients in lung cancer diagnosis. The odds of being diagnosed with lung cancer were significantly higher for patients living in areas with the third and fourth quartiles of homicide rates compared to the second quartile of homicide rates. Furthermore, significant spatial clusters of increased lung cancer risk and homicide rates were observed on Chicago's South and West sides. ConclusionsNeighborhood violence was associated with an increased risk of lung cancer. Black residents in Chicago are disproportionately exposed to neighborhood violence, which may partially explain the existing racial disparity in lung cancer. Incorporating neighborhood violence exposure into lung cancer risk models may help identify high-risk individuals who could benefit from lung cancer screening.

Association between sulfur microbial diet and the risk of colorectal cancer precursors in older adults.

Sulfur microbial diet (SMD), related to the enrichment of sulfur-metabolizing gut bacteria, has been confirmed to be linked to an elevated risk of early-onset colorectal adenoma in young females. However, it remains unclear whether SMD is associated with the risk of colorectal adenoma in older people, who are at greater risk for colorectal cancer. All data on participants in this study were retrieved from the intervention arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening test. Participants' adherence to this dietary pattern was assessed using SMD score. Hazard ratios (HR) and 95% confidence intervals (CI) were adopted in Cox proportional hazards regression models to assess the link between SMD score and the incidence of colorectal adenoma in participants included in the study. Specific stratified analyses were constructed to assess whether this association changed in different conditions, whereas the robustness of the association was examined through sensitivity analyses. The mean baseline age of participants was 62.1 (SD 5.2) years (range 54.0-75.0 years). During 19,468,589 person-years of follow-up, 992 colorectal adenoma cases were documented in a total of 17,627 included participants. In a fully adjusted model, an increased risk of colorectal adenoma was determined in participants in the highest quartile of SMD score in comparison with those in the lowest quartile (HRquartile4 vs. HRquartile1 = 1.23; 95% CI: 1.02, 1.47; p = 0.017 for trend). This positive association between SMD score and adenoma risk was more evident in participants who were current or former smokers (p = 0.029 for interaction). In this study, our results support a role for the SMD in the carcinogenicity of colorectal cancer precursors among older adults. Nevertheless, these results require validation through more research.

Primary Care Practitioner Perceptions on the Follow-up of Abnormal Cancer Screening Test Results

Health care systems focus on delivering routine cancer screening to eligible individuals, yet little is known about the perceptions of primary care practitioners (PCPs) about barriers to timely follow-up of abnormal results. To describe PCP perceptions about factors associated with the follow-up of abnormal breast, cervical, colorectal, and lung cancer screening test results. Survey study of PCPs from 3 primary care practice networks in New England between February and October 2020, prior to participating in a randomized clinical trial to improve follow-up of abnormal cancer screening test results. Participants were physicians and advanced practice clinicians from participating practices. Self-reported process, attitudes, knowledge, and satisfaction about the follow-up of abnormal cancer screening test results. Overall, 275 (56.7%) PCPs completed the survey (range by site, 34.9%-71.9%) with more female PCPs (61.8% [170 of 275]) and general internists (73.1% [201 of 275]); overall, 28,7% (79 of 275) were aged 40 to 49 years. Most PCPs felt responsible for managing abnormal cancer screening test results with the specific cancer type being the best factor (range, 63.6% [175 of 275] for breast to 81.1% [223 of 275] for lung; P < .001). The PCPs reported limited support for following up on overdue abnormal cancer screening test results. Standard processes such as automated reports, reminder letters, or outreach workers were infrequently reported. Major barriers to follow-up of abnormal cancer screening test results across all cancer types included limited electronic health record tools (range, 28.5% [75 of 263]-36.5%[96 of 263]), whereas 50% of PCPs felt that there were major social barriers to receiving care for abnormal cancer screening test results for colorectal cancer. Fewer than half reported being very satisfied with the process of managing abnormal cancer screening test results, with satisfaction being greatest for breast cancer (46.9% [127 of 271]) and lowest for cervical (21.8% [59 of 271]) and lung cancer (22.4% [60 of 268]). In this survey study of PCPs, important deficiencies in systems for managing abnormal cancer screening test results were reported. These findings suggest a need for comprehensive organ-agnostic systems to promote timely follow-up of abnormal cancer screening results using a primary care-focused approach across the range of cancer screening tests.

Natural Language Processing to Identify Abnormal Breast, Lung, and Cervical Cancer Screening Test Results from Unstructured Reports to Support Timely Follow-up.

Cancer screening and timely follow-up of abnormal results can reduce mortality. One barrier to follow-up is the failure to identify abnormal results. While EHRs have coded results for certain tests, cancer screening results are often stored in free-text reports, which limit capabilities for automated decision support. As part of the multilevel Follow-up of Cancer Screening (mFOCUS) trial, we developed and implemented a natural language processing (NLP) tool to assist with real-time detection of abnormal cancer screening test results (including mammograms, low-dose chest CT scans, and Pap smears) and identification of gynecological follow-up for higher risk abnormalities (i.e. colposcopy) from free-text reports. We demonstrate the integration and implementation of NLP, within the mFOCUS system, to improve the follow-up of abnormal cancer screening results in a large integrated healthcare system. The NLP pipelines have detected scenarios when guideline-recommended care was not delivered, in part because the provider mis-identified the text-based result reports.

Cancer Screening among Rural People Who Use Drugs: Colliding Risks and Barriers.

Rural cancer disparities are associated with lesser healthcare access and screening adherence. The opioid epidemic may increase disparities as people who use drugs (PWUD) frequently experience healthcare-associated stigmatizing experiences which discourage seeking routine care. Rural PWUD were recruited to complete surveys and interviews exploring cancer (cervical, breast, colorectal, lung) risk, screening history, and healthcare experiences. From July 2020–July 2021 we collected 37 surveys and 8 interviews. Participants were 24.3% male, 86.5% White race, and had a mean age of 44.8 years. Females were less likely to report seeing a primary care provider on a regular basis, and more likely to report stigmatizing healthcare experiences. A majority of females reporting receiving recommendations and screens for cervical and breast cancer, but only a minority were adherent. Similarly, only a minority of males and females reported receiving screening tests for colorectal and lung cancer. Screening rates for all cancers were substantially below those for the US generally and rural areas specifically. Interviews confirmed stigmatizing healthcare experiences and suggested screening barriers and possible solutions. The opioid epidemic involves millions of individuals and is disproportionately experienced in rural communities. To avoid exacerbating existing rural cancer disparities, methods to engage PWUD in cancer screening need to be developed.

Lung Cancer Screening Eligibility and Use: A Population Health Perspective of One Community.

BACKGROUND Low-dose chest CT (LDCT) is the only effective screening test for lung cancer. Annual lung cancer screening (LCS) is recommended by the US Preventive Services Task Force (USPSTF) for individuals at high risk for primary lung neoplasm.METHODS We retrospectively identified patients receiving LCS from January 2016 through March 2018 whose residential addresses were within our health center's county. We estimated driving distance from the patient's address to our health center and obtained sociodemographic characteristics from the electronic health record (EHR). The census-tract-level LCS-eligible population size was estimated, and their population characteristics determined via US Census Bureau, Centers for Disease Control and Prevention (CDC), and Behavioral Risk Factor Surveillance System (BRFSS) data. The Cochran-Mantel-Haenszel test was used to determine differences amongst the LCS-eligible and LCS-enrolled populations. Multivariable regression was used to determine the effects of sociodemographic characteristics on LCS eligibility.RESULTS There was modest correlation between census-tract-level LCS-eligible population size and LCS enrollment (r = 0.68, P < .001). 5.9% (364/6185) of the estimated LCS-eligible population in our county received LCS, with census-tract LCS rates ranging from 1.5% to 12.5%. Nonwhite race status (Hispanic and African American) was associated with decreased likelihood of LCS enrollment compared to White race (OR = 95% CI, 0.765 [0.61, 0.95] and 0.031 [0.008, 0.124], respectively). Older age, Medicaid, and uninsured statuses were positively correlated with LCS eligibility (P ≤ .01).LIMITATIONS This analysis comprises a single county. Other LCS facilities within our health system in neighboring counties, as well as individuals receiving LCS outside of our health system, are not captured.CONCLUSIONS The uptake of LCS remains low, with disproportionately lower screening rates amongst Hispanic and African American populations. Medicaid and uninsured patients in our community are also more likely to be LCS-eligible. These populations may be targets for interventions aimed at increasing LCS awareness and uptake.

Multilevel Follow-up of Cancer Screening (mFOCUS): Protocol for a multilevel intervention to improve the follow-up of abnormal cancer screening test results

IntroductionWhile substantial attention is focused on the delivery of routine preventive cancer screening, less attention has been paid to systematically ensuring that there is timely follow-up of abnormal screening test results. Barriers to completion of timely follow-up occur at the patient, provider, care team and system levels. MethodsIn this pragmatic cluster randomized controlled trial, primary care sites in three networks are randomized to one of four arms: (1) standard care, (2) “visit-based” reminders that appear in a patient's electronic health record (EHR) when it is accessed by either patient or providers (3) visit based reminders with population health outreach, and (4) visit based reminders, population health outreach, and patient navigation with systematic screening and referral to address social barriers to care. Eligible patients in participating practices are those overdue for follow-up of an abnormal results on breast, cervical, colorectal and lung cancer screening tests. ResultsThe primary outcome is whether an individual receives follow-up, specific to the organ type and screening abnormality, within 120 days of becoming eligible for the trial. Secondary outcomes assess the effect of intervention components on the patient and provider experience of obtaining follow-up care and the delivery of the intervention components. ConclusionsThis trial will provide evidence for the role of a multilevel intervention on improving the follow-up of abnormal cancer screening test results. We will also specifically assess the relative impact of the components of the intervention, compared to standard care. Trial registrationClinicalTrials.gov NCT03979495

Plexin C1: A novel screening test for lung cancer

Background/Aim: Lung cancer, where early diagnosis is particularly important, is one of the leading causes of death worldwide. Unfortunately, patients with lung cancer present at advanced stages. Biomarkers are needed to detect cancer at an earlier stage. In the present study, we aimed to emphasize that Plexin C1 level can be used in the early diagnosis of patients with lung cancer. Methods: This prospective case-control study included 50 patients with lung cancer who presented between May 2020-September 2020 (25 males and 25 females) in the patient group and 40 healthy individuals (23 males and 17 females) in the control group. All patients with lung cancer underwent routine preoperative tests. Additionally, the preoperative Plexin C1 levels of all patients were measured with the ELISA method and compared between the patient and control groups, and with respect to cancer staging. Results: The median Plexin C1 levels in the patient and control groups were 9.5 ng/mL and 4.0 ng/mL, respectively (P<0.001). The patients with Stage 4 tumors had significantly higher serum Plexin C1 levels than those with Stage 1, Stage 2, and Stage 3 tumors (P<0.001). Also, Plexin C1 levels were higher in patients with greater depth of invasion (P<0.001), more lymph node involvement (P<0.001), and distant metastasis (P<0.001). Conclusion: Plexin C1 can be used as a predictive biomarker at the time of diagnosis for lung cancer, and for cancer stage discrimination to show early, advanced, or metastatic disease.

Receipt of Tobacco Treatment and One-Year Smoking Cessation Rates Following Lung Cancer Screening in the Veterans Health Administration.

Implementation of effective smoking cessation interventions in lung cancer screening has been identified as a high-priority research gap, but knowledge of current practices to guide process improvement is limited due to the slow uptake of screening and dearth of data to assess cessation-related practices and outcomes under real-world conditions. To evaluate cessation treatment receipt and 1-year post-screening cessation outcomes within the largest integrated healthcare system in the USA-the Veterans Health Administration (VHA). Design Observational study using administrative data from electronic medical records (EMR). Patients Currently smoking Veterans who received a first lung cancer screening test using low-dose CT (LDCT) between January 2014 and June 2018. Main Outcomes Tobacco treatment received within the window of 30 days before and 30 days after LDCT; 1-year quit rates based on EMR Smoking Health Factors data 6-18 months after LDCT. Key Results Of the 47,609 current smokers screened (95.3% male), 8702 (18.3%) received pharmacotherapy and/or behavioral treatment for smoking cessation; 531 (1.1%) received both. Of those receiving pharmacotherapy, only one in four received one of the most effective medications: varenicline (12.1%) or combination nicotine replacement therapy (14.3%). Overall, 5400 Veterans quit smoking-a rate of 11.3% (missing=smoking) or 13.5% (complete case analysis). Treatment receipt and cessation were associated with numerous sociodemographic, clinical, and screening-related factors. One-year quit rates for Veterans receiving lung cancer screening in VHA are similar to those reported in LDCT clinical trials and cohort studies (i.e., 10-17%). Only 1% of Veterans received the recommended combination of pharmacotherapy and counseling, and the most effective pharmacotherapies were not the most commonly received ones. The value of screening within VHA could be improved by addressing these treatment gaps, as well as the observed disparities in treatment receipt or cessation by race, rurality, and psychiatric conditions.

Abstract 2608: Lung cancer prevention and an early detection educational intervention in minority and underserved communities

Abstract Purpose: Lung cancer is the leading cause of cancer death in African Americans (AAs). The 5-year relative survival rate for localized lung cancer among AAs is 52%; however, only 16% of lung cancer cases are detected at this early stage. Even when lung cancer is diagnosed early, AAs are less likely than whites to receive life-saving surgery. Procedures: An educational intervention was delivered in 16 sites across the CSRA: 12 AA churches, three Federally-Qualified Health Centers, and one Community Center serving low-income and minority families. Community Health Workers at each site were selected and trained to deliver the educational content in four (4) 90-minute weekly sessions to participants in their congregation/facility. Content included cancer risk factors, the health consequences of tobacco use, tobacco cessation for current smokers, and the benefits of low-dose computed tomography (LDCT) screening for lung cancer. Pre- and post-intervention “site surveys” were administered to individuals who were members/visitors of the intervention sites (i.e. members of the church, patients at the FQHC, and visitors of the Community Center) to assess community changes in knowledge, attitudes and beliefs regarding lung cancer following the intervention. This report is on the surveys completed anonymously by the people at the sites, not on those enrolled in the study. Results: Data were collected from 2136 participants (n=1404 baseline and 732 follow-up). Baseline and follow-up surveys were independent observations. Approximately 70.1% of respondents were female, 29.9% male, and 91.9% AA. There was significant improvement in the self-reported frequency of exercise among respondents, with 41.5% reporting 2-3 days of exercise at follow-up compared to 34.2% at baseline (p=0.006). Other significant findings include: current smoking status decreased from 13.5% at baseline to 8.0% at follow-up (p=0.001); knowledge of the recommended screening test for lung cancer increased from 35.2% at baseline to 43.4% at follow-up (p=0.002); men who have had a Prostate Specific Antigen (PSA) blood test within the last year increased from 54.4% at baseline to 72.2% at follow-up (p=0.006); and women answering whether they had ever had a mammogram increased from 78.0% at baseline to 86.6% at follow-up (p&amp;lt;0.001). Conclusion: AAs are at greater risk for lung cancer incidence and mortality due to low access to quality healthcare, education, and prevention efforts. This project demonstrates that education and prevention efforts can be used to increase community knowledge about lung cancer and cancer risk factors, provide resources to decrease risk factors (smoking cessation) and increase access to screening for early detection. These efforts are promising for reducing cancer incidence and increasing early detection, and decreasing mortality rates among AAs who suffer disproportionate cancer health disparities. Citation Format: Samantha J. Sojourner, Marlo M. Vernon, Ghadeer Albashir, Justin X. Moore, Stephen W. Looney, Martha S. Tingen. Lung cancer prevention and an early detection educational intervention in minority and underserved communities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2608.

Q&A: Ned Sharpless on COVID-19 and Cancer Prevention.

Q&A: Ned Sharpless on COVID-19 and Cancer Prevention.

Application of chemoresistive gas sensors and chemometric analysis to differentiate the fingerprints of global volatile organic compounds from diseases. Preliminary results of COPD, lung cancer and breast cancer

BackgroundAnalysis of volatile organic compounds (VOCs) in exhaled breath has been proposed as a screening method that discriminates between disease and healthy subjects, few studies evaluate whether these chemical fingerprints are specific when compared between diseases. We evaluated global VOCs and their discrimination capacity in chronic obstructive pulmonary disease (COPD), lung cancer, breast cancer and healthy subjects by chemoresistive sensors and chemometric analysis. MethodsA cross-sectional study was conducted with the participation of 30 patients with lung cancer, 50 with breast cancer, 50 with COPD and 50 control subjects. Each participant's exhaled breath was analyzed with the electronic nose. A multivariate analysis was carried: principal component analysis (PCA) and, canonical analysis of principal coordinates (CAP). Twenty single-blind samples from the 4 study groups were evaluated by CAP. ResultsA separation between the groups of patients to the controls was achieved through PCA with explanations of >90% of the data and with a correct classification of 100%. In the CAP of the 4 study groups, discrimination between the diseases was obtained with 2 canonical axes with a correct general classification of 91.35%. This model was used for the prediction of the single-blind samples resulting in correct classification of 100%. ConclusionsThe application of chemoresistive gas sensors and chemometric analysis can be used as a useful tool for a screening test for lung cancer, breast cancer and COPD since this equipment detects the set of VOCs present in the exhaled breath to generate a characteristic chemical fingerprint of each disease.

Design and rationale of an intervention to improve cancer prevention using clinical decision support and shared decision making: A clinic-randomized trial

BackgroundDespite decades of research the gap in primary and secondary cancer prevention services in the U. S. remains unacceptably wide. Innovative interventions are needed to address this persistent challenge. Electronic health records linked with Web-based clinical decision support may close this gap, especially if delivered to both patients and their providers. ObjectivesThe Cancer Prevention Wizard (CPW) study is an implementation, clinic-randomized trial designed to achieve these aims: 1) assess impact of the Cancer Prevention Wizard-Clinical Decision Support (CPW-CDS) alone and CPW-CDS plus Shared Decision Making Tools (CPW + SDMTs) compared to usual care (UC) on tobacco cessation counseling and drugs, HPV vaccinations, and screening tests for breast, cervical, colorectal, or lung cancer; 2) assess cost of the CPW-CDS intervention; and 3) describe critical facilitators and barriers for CPW-CDS implementation, use, and clinical impact using a mixed-methods approach supported by the CFIR and RE-AIM frameworks. Methods34 predominantly rural, primary care clinics were randomized to CPW-CDS, CPW + SMDTs, or UC. Between August 2018 and October 2020, primary care providers and their patients who met inclusion criteria in intervention clinics were exposed to the CPW-CDS with or without SDMTs. Study outcomes at 12 months post index visit include patients up to date on screening tests and HPV vaccinations, overall healthcare costs, and diagnostic codes and billing levels for cancer prevention services. ConclusionsWe will test in rural primary care settings whether CPW-CDS with or without SDMTs can improve delivery of primary and secondary cancer prevention services. The trial and analyses are ongoing with results expected in 2021.

Classification of lung nodules in CT images using conditional generative adversarial – convolutional neural network

Based on Global Cancer 2015 statistics, the lung cancer of all types constitutes 27% of overall cancers while 19.5% of cancer deaths are due to lung cancer. In lieu of this, an effective lung cancer screening test using Computed Tomography (CT) scan is crucial to detect cancer at the early stage. The interpretation of the CT images requires an advanced CAD system of high accuracy for instance, in classifying the lung nodules. Recently, Deep Learning method that is Convolution Neural Network (CNN) shows an outstanding success in lung nodules classification. However, the training of CNN requires a great number of images. Such a requirement is an issue in the case of medical images. Generative adversarial network (GAN) has been introduced to generate new image datasets for CNN training. Thus, the main objective of this study is to compare the performance of CNN architectures with and without the implementation of GAN for lung nodules classification in CT images. Here, the study used Conditional GAN (cGAN) to generate benign nodules images. The classification accuracy of the combined cGAN-CNN architecture was compared among CNN pretraining networks namely GoogleNet, ShuffleNet, DenseNet, and MobileNet based on classification accuracy, specificity, sensitivity, and AUC-ROC values. The experiment was tested on LIDC-IDRI database. The results showed cGAN-CNN architecture improves the overall classification accuracy as compared to CNN alone with the cGAN-ShuffleNet architecture performed the best, achieving 98.38% accuracy, 98.13% specificity, 100% sensitivity and AUC-ROC at 99.90%. Overall, the classification performance of CNN can be improved by integrating GAN architecture to mitigate the constraint of having a large medical image dataset, in this case, CT lung nodules images.

Updated Analysis of Complication Rates Associated With Invasive Diagnostic Procedures After Lung Cancer Screening

This case-control study compares complication rates associated with invasive diagnostic procedures before and after Medicare and Medicaid coverage of lung cancer screening tests.

Preoperative AminoIndex Cancer Screening (AICS) abnormalities predict postoperative recurrence in patients undergoing curative resection for non-small cell lung cancer

BackgroundAminoIndex™ Cancer Screening (AICS (lung)) was developed as a screening test for lung cancer using a multivariate analysis of plasma-free amino acid (PFAA) profiles. According to the developed index composed of PFAA, the probability of lung cancer was categorized into AICS (lung) ranks A, B, and C in order of increasing risk. The aim of the present study was to investigate the relationship between the preoperative AICS (lung) rank and surgical outcomes in patients who underwent curative resection for non-small cell lung cancer (NSCLC).MethodsPreoperative blood samples were collected from 297 patients who underwent curative resection for NSCLC between 2006 and 2015. PFAA concentrations were measured. The relationship between the preoperative AICS (lung) rank and clinicopathological factors was examined. The effects of the preoperative AICS (lung) rank on postoperative outcomes were also analyzed.ResultsThe AICS (lung) rank was A in 93 patients (31.3%), B in 82 (27.6%), and C in 122 (41.1%). The AICS (lung) rank did not correlate with any clinicopathological factors, except for age. Based on follow-up data (median follow-up period of 6 years), postoperative recurrence was observed in 22 rank A patients (23.7%), 15 rank B (18.3%) and 49 rank C (40.2%). In the univariate analysis, preoperative AICS (lung) rank C was a worse factor of recurrence-free survival (p = 0.0002). The multivariate analysis identified preoperative AICS (lung) rank C (HR: 2.17, p = 0.0005) as a significant predictor of postoperative recurrence, particularly in patients with early-stage disease or adenocarcinoma.ConclusionPreoperative AICS (lung) rank C is a high-risk predictor of postoperative recurrence in patients undergoing curative resection for NSCLC.

Evaluating Knowledge, Attitudes, and Beliefs About Lung Cancer Screening Using Crowdsourcing

Lung cancer screening, despite its proven mortality benefit, remains vastly underutilized. Previous studies examined knowledge, attitudes, and beliefs to better understand the reasons underlying the low screening rates. These investigations may have limited generalizability because of traditional participant recruitment strategies and examining only subpopulations eligible for screening. The current study used crowdsourcing to recruit a broader population to assess these factors in a potentially more general population. A 31-item survey was developed to assess knowledge, attitudes, and beliefs regarding screening among individuals considered high risk for lung cancer by the United States Preventive Services Task Force. Amazon's crowdsourcing platform (Mechanical Turk) was used to recruit subjects. Among the 240 respondents who qualified for the study, 106 (44%) reported knowledge of a screening test for lung cancer. However, only 36 (35%) correctly identified low-dose CT scanning as the appropriate test. A total of 222 respondents (93%) reported believing that early detection of lung cancer has the potential to save lives, and 165 (69%) were willing to undergo lung cancer screening if it was recommended by their physician. Multivariable regression analysis found that knowledge of lung cancer screening, smoking status, chronic pulmonary disease, and belief in the efficacy of early detection of lung cancer were associated with willingness to screen. Although a minority of individuals at high risk for lung cancer are aware of screening, the majority believe that early detection saves lives and would pursue screening if recommended by their primary care physician. Health systems may increase screening rates by improving patient and physician awareness of lung cancer screening.