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Lin MY, Liu T, Gatsonis C, Sicks JD, Shih S, Carlos RC, Gareen IF. Utilization of Diagnostic Procedures After Lung Cancer Screening in the National Lung Screening Trial. J Am Coll Radiol 2023; 20:1022-1030. [PMID: 37423348 PMCID: PMC10755856 DOI: 10.1016/j.jacr.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/25/2022] [Accepted: 03/02/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE To examine utilization patterns of diagnostic procedures after lung cancer screening among participants enrolled in the National Lung Screening Trial. METHODS Using a sample of National Lung Screening Trial participants with abstracted medical records, we assessed utilization of imaging, invasive, and surgical procedures after lung cancer screening. Missing data were imputed using multiple imputation by chained equations. For each procedure type, we examined utilization within a year after the screening or until the next screen, whichever came first, across arms (low-dose CT [LDCT] versus chest X-ray [CXR]) and by screening results. We also explored factors associated with having these procedures using multivariable negative binomial regressions. RESULTS After baseline screening, our sample had 176.5 and 46.7 procedures per 100 person-years for those with a false-positive and negative result, respectively. Invasive and surgical procedures were relatively infrequent. Among those who screened positive, follow-up imaging and invasive procedures were 25% and 34% less frequent in those screened with LDCT, compared with CXR. Postscreening utilization of invasive and surgical procedures was 37% and 34% lower at the first incidence screen compared with baseline. Participants with positive results at baseline were six times more likely to undergo additional imaging than those with normal findings. DISCUSSION Use of imaging and invasive procedures to evaluate abnormal findings varied by screening modality, with a lower rate for LDCT than CXR. Invasive and surgical workup were less prevalent after subsequent screening examinations compared with baseline screening. Utilization was associated with older age but not gender, race or ethnicity, insurance status, or income.
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Affiliation(s)
- Meng-Yun Lin
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Tao Liu
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island; Department of Biostatistics, Brown University of Public Health, Providence, Rhode Island
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island; Department of Biostatistics, Brown University of Public Health, Providence, Rhode Island
| | - JoRean D Sicks
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Stephannie Shih
- Department of Biostatistics, Brown University of Public Health, Providence, Rhode Island
| | - Ruth C Carlos
- Division of Abdominal Radiology, University of Michigan, Ann Arbor, Michigan; Editor-in-Chief of JACR
| | - Ilana F Gareen
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island.
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Cooley-Rieders K, Glenn C, Van Haren RM, Salfity H, Starnes SL. A decade of surgical outcomes in a structured lung cancer screening program. J Thorac Cardiovasc Surg 2023; 166:1245-1253.e1. [PMID: 36858845 DOI: 10.1016/j.jtcvs.2023.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Lung cancer screening can decrease mortality. The majority of screen-detected cancers are early stage and undergo surgical resection. However, there are little data regarding the outcomes of surgical treatment outside of clinical trials. The purpose of this study was to compare the outcomes of curative resection for screen-detected lung cancers with nonscreened, incidentally detected cancers at an institution with a structured screening program. METHODS Patients undergoing lung cancer curative resection from January 2012 to June 2021 were identified from a prospective database. Baseline patient characteristics, tumor characteristics, and outcomes were compared between cancer detected from screening and cancer detected incidentally. RESULTS There were 199 patients in the incidental group and 82 patients in the screened group. Mean follow-up was 33.3 ± 25 months. The screened group had more African Americans (P = .04), a higher incidence of emphysema (P = .02), less prior cancers (P < .01), and more pack-years smoked (P < .01). The screened group had a smaller size (1.74 vs 2.31 cm, P < .01); however, pathologic stage was similar, with the majority being stage I. Postoperative morbidity, 30-day mortality, and overall and recurrence-free survival were similar between groups. Only 48.7% of the incidental group met current US Preventative Services Task Force screening criteria (age 50-80 years, ≥20 pack-year smoking history). CONCLUSIONS Screen-detected lung cancers have excellent postoperative and long-term outcomes with curative resection, similar to incidentally detected cancers. A large portion of incidentally detected lung cancers do not meet current screening guidelines, which is an opportunity for further refinement of eligibility.
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Affiliation(s)
- Keaton Cooley-Rieders
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carter Glenn
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Hai Salfity
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sandra L Starnes
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Pozzessere C, von Garnier C, Beigelman-Aubry C. Radiation Exposure to Low-Dose Computed Tomography for Lung Cancer Screening: Should We Be Concerned? Tomography 2023; 9:166-177. [PMID: 36828367 PMCID: PMC9964027 DOI: 10.3390/tomography9010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/26/2023] Open
Abstract
Lung cancer screening (LCS) programs through low-dose Computed Tomography (LDCT) are being implemented in several countries worldwide. Radiation exposure of healthy individuals due to prolonged CT screening rounds and, eventually, the additional examinations required in case of suspicious findings may represent a concern, thus eventually reducing the participation in an LCS program. Therefore, the present review aims to assess the potential radiation risk from LDCT in this setting, providing estimates of cumulative dose and radiation-related risk in LCS in order to improve awareness for an informed and complete attendance to the program. After summarizing the results of the international trials on LCS to introduce the benefits coming from the implementation of a dedicated program, the screening-related and participant-related factors determining the radiation risk will be introduced and their burden assessed. Finally, future directions for a personalized screening program as well as technical improvements to reduce the delivered dose will be presented.
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Affiliation(s)
- Chiara Pozzessere
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Correspondence:
| | - Christophe von Garnier
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Catherine Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
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4
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Lewis JA, Samuels LR, Denton J, Matheny ME, Maiga A, Slatore CG, Grogan E, Kim J, Sherrier RH, Dittus RS, Massion PP, Keohane L, Roumie CL, Nikpay S. The Association of Health Care System Resources With Lung Cancer Screening Implementation. Chest 2022; 162:701-711. [PMID: 35413280 PMCID: PMC9529611 DOI: 10.1016/j.chest.2022.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/04/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Veterans Health Administration issued policy for lung cancer screening resources at eight Veterans Affairs Medical Centers (VAMCs) in a demonstration project (DP) from 2013 through 2015. Research Question Do policies that provide resources increase lung cancer screening rates? Study Design and Methods Data from eight DP VAMCs (DP group) and 20 comparable VAMCs (comparison group) were divided into before DP (January 2011-June 2013), DP (July 2013-June 2015), and after DP (July 2015-December 2018) periods. Coprimary outcomes were unique veterans screened per 1,000 eligible per month and those with 1-year (9-15 months) follow-up screening. Eligible veterans were estimated using yearly counts and the percentage of those with eligible smoking histories. Controlled interrupted time series and difference-in-differences analyses were performed. Results Of 27,746 veterans screened, the median age was 66.5 years and most were White (77.7%), male (95.6%), and urban dwelling (67.3%). During the DP, the average rate of unique veterans screened at DP VAMCs was 17.7 per 1,000 eligible per month, compared with 0.3 at comparison VAMCs. Adjusted analyses found a higher rate increase at DP VAMCs by 0.93 screening per 1,000 eligible per month (95% CI, 0.25-1.61) during this time, with an average facility-level difference of 17.4 screenings per 1,000 eligible per month (95% CI, 12.6-22.3). Veterans with 1-year follow-up screening also increased more rapidly at DP VAMCs during the DP, by 0.39 screening per 1,000 eligible per month (95% CI, 0.18-0.60), for an average facility-level difference of 7.2 more screenings per 1,000 eligible per month (95% CI, 5.2-9.2). Gains were not maintained after the DP. Interpretation In this cohort, provision of resources for lung cancer screening implementation was associated with an increase in veterans screened and those with 1-year follow-up screening. Screening gains associated with the DP were not maintained.
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Affiliation(s)
- Jennifer A Lewis
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Veterans Health Administration - Tennessee Valley Healthcare System, Medicine Service, Nashville, TN; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN.
| | - Lauren R Samuels
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Jason Denton
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Michael E Matheny
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Amelia Maiga
- Department of General Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Christopher G Slatore
- Veterans Health Administration-Portland Health Care System, Center to Improve Veteran Involvement in Care Pulmonary & Critical Care Medicine, Portland, OR
| | - Eric Grogan
- Veterans Health Administration - Tennessee Valley Healthcare System, Thoracic Surgery, Nashville, TN; Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jane Kim
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC
| | | | - Robert S Dittus
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Pierre P Massion
- Veterans Health Administration - Tennessee Valley Healthcare System, Medicine Service, Nashville, TN; Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Laura Keohane
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Christianne L Roumie
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN
| | - Sayeh Nikpay
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
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Milligan MG, Lennes IT, Hawari S, Khandekar MJ, Colson Y, Shepard JAO, Frank A, Sequist LV, Willers H, Keane FK. Incidence of Radiation Therapy Among Patients Enrolled in a Multidisciplinary Pulmonary Nodule and Lung Cancer Screening Clinic. JAMA Netw Open 2022; 5:e224840. [PMID: 35357454 PMCID: PMC8972030 DOI: 10.1001/jamanetworkopen.2022.4840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE The number of pulmonary nodules discovered incidentally or through screening programs has increased markedly. Multidisciplinary review and management are recommended, but the involvement of radiation oncologists in this context has not been defined. OBJECTIVE To assess the role of stereotactic body radiation therapy among patients enrolled in a lung cancer screening program. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was performed at a pulmonary nodule and lung cancer screening clinic from October 1, 2012, to September 31, 2019. Referrals were based on chest computed tomography with Lung Imaging Reporting and Data System category 4 finding or an incidental nodule 6 mm or larger. A multidisciplinary team of practitioners from radiology, thoracic surgery, pulmonology, medical oncology, and radiation oncology reviewed all nodules and coordinated workup and treatment as indicated. EXPOSURES Patients referred to the pulmonary nodule and lung cancer screening clinic with an incidental or screen-detected pulmonary nodule. MAIN OUTCOMES AND MEASURES The primary outcome was the proportion of patients undergoing therapeutic intervention with radiation therapy, stratified by the route of detection of their pulmonary nodules (incidental vs screen detected). Secondary outcomes were 2-year local control and metastasis-free survival. RESULTS Among 1150 total patients (median [IQR] age, 66.5 [59.3-73.7] years; 665 [57.8%] female; 1024 [89.0%] non-Hispanic White; 841 [73.1%] current or former smokers), 234 (20.3%) presented with screen-detected nodules and 916 (79.7%) with incidental nodules. For patients with screen-detected nodules requiring treatment, 41 (17.5%) received treatment, with 31 (75.6%) undergoing surgery and 10 (24.4%) receiving radiation therapy. Patients treated with radiation therapy were older (median [IQR] age, 73.8 [67.1 to 82.1] vs 67.6 [61.0 to 72.9] years; P < .001) and more likely to have history of tobacco use (67 [95.7%] vs 128 [76.6%]; P = .001) than those treated with surgery. Fifty-eight patients treated with radiation therapy (82.9%) were considered high risk for biopsy, and treatment recommendations were based on a clinical diagnosis of lung cancer after multidisciplinary review. All screened patients who received radiation therapy had stage I disease and were treated with stereotactic body radiation therapy. For all patients receiving stereotactic body radiation therapy, 2-year local control was 96.3% (95% CI, 91.1%-100%) and metastasis-free survival was 94.2% (95% CI, 87.7%-100%). CONCLUSIONS AND RELEVANCE In this unique prospective cohort, 1 in 4 patients with screen-detected pulmonary nodules requiring intervention were treated with stereotactic body radiation therapy. This finding highlights the role of radiation therapy in a lung cancer screening population and the importance of including radiation oncologists in the multidisciplinary management of pulmonary nodules.
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Affiliation(s)
- Michael G. Milligan
- Harvard Radiation Oncology Program, Boston, Massachusetts
- Department of Radiation Oncology, Massachusetts General Hospital, Boston
| | - Inga T. Lennes
- Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital, Boston
| | - Saif Hawari
- Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital, Boston
| | - Melin J. Khandekar
- Department of Radiation Oncology, Massachusetts General Hospital, Boston
| | - Yolonda Colson
- Department of Surgery, Massachusetts General Hospital, Boston
| | | | - Angela Frank
- Department of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
| | - Lecia V. Sequist
- Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital, Boston
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Boston
| | - Florence K. Keane
- Department of Radiation Oncology, Massachusetts General Hospital, Boston
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Chiew KL, Sundaresan P, Jalaludin B, Chong S, Vinod SK. Quality indicators in lung cancer: a review and analysis. BMJ Open Qual 2021; 10:bmjoq-2020-001268. [PMID: 34344690 PMCID: PMC8336169 DOI: 10.1136/bmjoq-2020-001268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 07/25/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Kim-Lin Chiew
- Macarthur Cancer Therapy Centre, South Western Sydney Cancer Service, Campbelltown, New South Wales, Australia .,South Western Sydney Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Puma Sundaresan
- Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Shanley Chong
- Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- South Western Sydney Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia.,Liverpool Cancer Therapy Centre, South Western Sydney Cancer Service, Liverpool, New South Wales, Australia
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Mitchell J, Benamore R, Gleeson F, Belcher E. Computed tomography follow-up identifies radically treatable new primaries after resection for lung cancer. Eur J Cardiothorac Surg 2021; 57:771-778. [PMID: 31651938 DOI: 10.1093/ejcts/ezz284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The optimal imaging programme for the follow-up of patients who have undergone resection of primary lung cancer is yet to be determined. We investigated the incidence and patterns of new and recurrent malignancy after resection for early-stage lung cancer in patients enrolled into a computed tomography (CT) follow-up programme. METHODS We reviewed the outcomes of consecutive patients who underwent CT follow-up after resection of early-stage primary lung cancer at the Oxford University Hospitals NHS Foundation Trust, between 2013 and 2017. RESULTS Four hundred and sixty-six consecutive patients underwent resection of primary lung cancer between 1 January 2013 and 31 March 2017. Three hundred and thirty-one patients (71.0%) were enrolled in CT follow-up. The median follow-up was 98 weeks (range 26-262). Sixty patients (18.2%) were diagnosed with programme-detected malignancy. Recurrence was diagnosed in 36 patients (10.9%), new primary lung cancer in 16 patients (4.8%) and non-lung primary tumours in 8 patients (2.4%). A routine CT scan identified the majority of new primary lung cancers (84.2%) and those with disease recurrence (85.7%). The majority of programme-detected malignancies were radically treatable (55%). The median survival of programme-detected cancers was 92.4 versus 23.0 weeks for patients with clinically detected tumours (P < 0.0001). Utilizing the CT scout image as a surrogate for chest X-ray, the sensitivity of this modality was 16.95% (8.44-28.97%) and specificity was 89.83% (79.17-96.18%). Negative likelihood ratio was 0.92 (0.8-1.07). CONCLUSIONS CT follow-up of surgically treated primary lung cancer patients identifies malignancy at a stage where radical treatment is possible in the majority of patients. Chest X-ray follow-up may not be of benefit following lung cancer resection.
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Affiliation(s)
- Jenny Mitchell
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel Benamore
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Fergus Gleeson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Elizabeth Belcher
- Department of Thoracic Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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8
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Jonas DE, Reuland DS, Reddy SM, Nagle M, Clark SD, Weber RP, Enyioha C, Malo TL, Brenner AT, Armstrong C, Coker-Schwimmer M, Middleton JC, Voisin C, Harris RP. Screening for Lung Cancer With Low-Dose Computed Tomography: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2021; 325:971-987. [PMID: 33687468 DOI: 10.1001/jama.2021.0377] [Citation(s) in RCA: 209] [Impact Index Per Article: 69.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Lung cancer is the leading cause of cancer-related death in the US. OBJECTIVE To review the evidence on screening for lung cancer with low-dose computed tomography (LDCT) to inform the US Preventive Services Task Force (USPSTF). DATA SOURCES MEDLINE, Cochrane Library, and trial registries through May 2019; references; experts; and literature surveillance through November 20, 2020. STUDY SELECTION English-language studies of screening with LDCT, accuracy of LDCT, risk prediction models, or treatment for early-stage lung cancer. DATA EXTRACTION AND SYNTHESIS Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings. Data were not pooled because of heterogeneity of populations and screening protocols. MAIN OUTCOMES AND MEASURES Lung cancer incidence, lung cancer mortality, all-cause mortality, test accuracy, and harms. RESULTS This review included 223 publications. Seven randomized clinical trials (RCTs) (N = 86 486) evaluated lung cancer screening with LDCT; the National Lung Screening Trial (NLST, N = 53 454) and Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON, N = 15 792) were the largest RCTs. Participants were more likely to benefit than the US screening-eligible population (eg, based on life expectancy). The NLST found a reduction in lung cancer mortality (incidence rate ratio [IRR], 0.85 [95% CI, 0.75-0.96]; number needed to screen [NNS] to prevent 1 lung cancer death, 323 over 6.5 years of follow-up) with 3 rounds of annual LDCT screening compared with chest radiograph for high-risk current and former smokers aged 55 to 74 years. NELSON found a reduction in lung cancer mortality (IRR, 0.75 [95% CI, 0.61-0.90]; NNS to prevent 1 lung cancer death of 130 over 10 years of follow-up) with 4 rounds of LDCT screening with increasing intervals compared with no screening for high-risk current and former smokers aged 50 to 74 years. Harms of screening included radiation-induced cancer, false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, and increases in distress. For every 1000 persons screened in the NLST, false-positive results led to 17 invasive procedures (number needed to harm, 59) and fewer than 1 person having a major complication. Overdiagnosis estimates varied greatly (0%-67% chance that a lung cancer was overdiagnosed). Incidental findings were common, and estimates varied widely (4.4%-40.7% of persons screened). CONCLUSIONS AND RELEVANCE Screening high-risk persons with LDCT can reduce lung cancer mortality but also causes false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, increases in distress, and, rarely, radiation-induced cancers. Most studies reviewed did not use current nodule evaluation protocols, which might reduce false-positive results and invasive procedures for false-positive results.
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Affiliation(s)
- Daniel E Jonas
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Department of Internal Medicine, The Ohio State University, Columbus
| | - Daniel S Reuland
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Shivani M Reddy
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- RTI International, Research Triangle Park, North Carolina
| | - Max Nagle
- Michigan Medicine, University of Michigan, Ann Arbor
| | - Stephen D Clark
- Department of Internal Medicine, Virginia Commonwealth University, Richmond
| | - Rachel Palmieri Weber
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Charli Armstrong
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Manny Coker-Schwimmer
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Jennifer Cook Middleton
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Christiane Voisin
- RTI International, University of North Carolina at Chapel Hill Evidence-based Practice Center
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
| | - Russell P Harris
- Department of Medicine, University of North Carolina at Chapel Hill
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
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9
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Sands J, Tammemägi MC, Couraud S, Baldwin DR, Borondy-Kitts A, Yankelevitz D, Lewis J, Grannis F, Kauczor HU, von Stackelberg O, Sequist L, Pastorino U, McKee B. Lung Screening Benefits and Challenges: A Review of The Data and Outline for Implementation. J Thorac Oncol 2021; 16:37-53. [PMID: 33188913 DOI: 10.1016/j.jtho.2020.10.127] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/18/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide, accounting for almost a fifth of all cancer-related deaths. Annual computed tomographic lung cancer screening (CTLS) detects lung cancer at earlier stages and reduces lung cancer-related mortality among high-risk individuals. Many medical organizations, including the U.S. Preventive Services Task Force, recommend annual CTLS in high-risk populations. However, fewer than 5% of individuals worldwide at high risk for lung cancer have undergone screening. In large part, this is owing to delayed implementation of CTLS in many countries throughout the world. Factors contributing to low uptake in countries with longstanding CTLS endorsement, such as the United States, include lack of patient and clinician awareness of current recommendations in favor of CTLS and clinician concerns about CTLS-related radiation exposure, false-positive results, overdiagnosis, and cost. This review of the literature serves to address these concerns by evaluating the potential risks and benefits of CTLS. Review of key components of a lung screening program, along with an updated shared decision aid, provides guidance for program development and optimization. Review of studies evaluating the population considered "high-risk" is included as this may affect future guidelines within the United States and other countries considering lung screening implementation.
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Affiliation(s)
- Jacob Sands
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Martin C Tammemägi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Sebastien Couraud
- Acute Respiratory Disease and Thoracic Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon Cancer Institute; EMR-3738 Therapeutic Targeting in Oncology, Lyon Sud Medical Faculty, Lyon 1 University, Lyon, France
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Andrea Borondy-Kitts
- Lung Cancer and Patient Advocate, Consultant Patient Outreach & Research Specialist, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - David Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer Lewis
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Fred Grannis
- City of Hope National Medical Center, Duarte, California
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology and Translational Lung Research Center, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology and Translational Lung Research Center, Member of the German Center for Lung Research (DZL), University Hospital Heidelberg, Heidelberg, Germany
| | - Lecia Sequist
- Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts
| | - Ugo Pastorino
- Thoracic Surgery Unit, Department of Research, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Brady McKee
- Division of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts
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Surgery and invasive diagnostic procedures for benign disease are rare in a large low-dose computed tomography lung cancer screening program. J Thorac Cardiovasc Surg 2020; 161:790-802.e2. [PMID: 33023746 DOI: 10.1016/j.jtcvs.2020.08.109] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/10/2020] [Accepted: 08/02/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Lung cancer screening with low-dose chest computed tomography improves survival. However, concerns about overdiagnosis and unnecessary interventions persist. We reviewed our lung cancer screening program to determine the rate of surgery and invasive procedures for nonmalignant disease. METHODS We reviewed all patients undergoing lung cancer screening from January 2012 to June 2017 with follow-up through January 2019. Patients with suspicious findings (Lung CT Screening Reporting and Data System 4) were referred for further evaluation. RESULTS Of 3280 patients screened, 345 (10.5%) had Lung CT Screening Reporting and Data System 4 findings. A total of 311 patients had complete follow-up, of whom 93 (29.9%) were diagnosed with lung cancer. Eighty-three patients underwent lung surgery (2.5% of screened patients). Forty patients underwent lobectomy (48.2%), 3 patients (3.6%) underwent bilobectomy, and 40 patients (48.2%) underwent sublobar resection. Fourteen patients underwent surgery for benign disease (0.43% of screened patients). Fifty-four patients, 5 with benign disease, had at least 1 invasive diagnostic procedure but never underwent surgery. The incidence of any invasive intervention for nonmalignant disease was 0.95% (31/3280 patients). There were no postprocedural deaths within 60 days. Twenty-five patients (0.76%) underwent stereotactic body radiation therapy; 19 patients (76%) had presumed lung cancer without pretreatment pathologic confirmation. CONCLUSIONS Surgical resection for benign disease occurred in 0.43% of patients undergoing lung cancer screening. The combined incidence of any invasive diagnostic or therapeutic intervention, including surgical resection, for benign disease was only 0.95%. Periprocedural complications were rare. These results indicate that concern over unnecessary interventions is overstated and should not hinder adoption of lung cancer screening. A multidisciplinary team approach, including thoracic surgeons, is critical to maintain an appropriate rate of interventions in lung cancer screening.
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Jaklitsch MT, Jacobson FL. The future of lung cancer screening with low-dose computed tomography. J Thorac Cardiovasc Surg 2020; 160:289-294. [DOI: 10.1016/j.jtcvs.2019.11.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 11/16/2022]
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12
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Dezube AR, Jaklitsch MT. New evidence supporting lung cancer screening with low dose CT & surgical implications. Eur J Surg Oncol 2020; 46:982-990. [DOI: 10.1016/j.ejso.2020.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/07/2020] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
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13
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Song G, Qiu T, Xuan Y, Zhao Y, Jiao W. [Clinical Application of Vectorial Localization of Peripheral Pulmonary Nodules Guided by Electromagnetic Navigation Bronchoscopy in Thoracic Surgery]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 22:709-713. [PMID: 31771740 PMCID: PMC6885414 DOI: 10.3779/j.issn.1009-3419.2019.11.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
背景与目的 随着计算机断层扫描技术(computed tomography scans, CT)的广泛应用,越来越多的肺小结节被发现,一些需要外科手术处理的结节数量也在增加。胸腔镜手术中对于不可直视及触摸到的肺外周小结节的准确定位较为困难。虽然目前一些常用的定位技术能够带来比较好的定位效果,如CT引导的穿刺定位和电磁导航支气管镜(electromagnetic navigation bronchoscopy, ENB)系统引导的亚甲兰染色定位,但同时仍存在着气胸、出血及定位不准确的问题。ENB引导的矢量定位法是我中心首创的一种新型定位技术,该技术避免了前两种 方法 可能出现的胸膜损伤或者定位区域扩大的问题,为ENB引导的定位技术提供了一定的指导。本文回顾性分析胸腔镜术前通过ENB引导矢量定位的临床结果来确定该方法的临床应用价值。方法回顾性分析2017年10月-2018年10月于青岛大学附属医院胸外科行ENB矢量定位法进行胸腔镜手术前定位的患者资料,统计患者临床资料、肺小结节影像学特征,评估该方法临床应用的安全性及有效性。 结果 我们成功实施了22例患者的22个肺外周结节在ENB引导下矢量定位和腔镜下楔形切除(22/22, 100%)。结节平均大小为(11.0±3.6)mm,距脏层胸膜表面距离为(16.5±6.2)mm;ENB系统显示屏导航定位装置(locatable guide, LG)与病灶距离为(14.5±10.1)mm,离体标本标记与病灶距离为(15.3±11.0)mm,ENB矢量定位平均时间为(17.5±4.2)min,无定位点LG发生移位(0.0%)。手术过程无中转开胸(0.0%),患者术中及术后未见明显并发症(0.0%),术后平均住院时间为(3.8±1.2)d,无围手术期患者死亡(0.0%)。术后病理结果为恶性肿瘤者19例,均得到了完全切除。 结论 我们应用ENB引导的矢量定位法在肺外周小结节术前定位和微创切除的初步经验提示该方法安全、可行、有效,可作为ENB操作中可选的一种定位方式。胸外科临床医师可以进一步研究该方法并应用到临床操作中。
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Affiliation(s)
- Guisong Song
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Tong Qiu
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Yunpeng Xuan
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Yandong Zhao
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266003, China
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von Itzstein MS, Gupta A, Kernstine KH, Mara KC, Khanna S, Gerber DE. Increased reporting but decreased mortality associated with adverse events in patients undergoing lung cancer surgery: Competing forces in an era of heightened focus on care quality? PLoS One 2020; 15:e0231258. [PMID: 32271810 PMCID: PMC7145007 DOI: 10.1371/journal.pone.0231258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/19/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Advances in surgical techniques have improved clinical outcomes and decreased complications. At the same time, heightened attention to care quality has resulted in increased identification of hospital-acquired adverse events. We evaluated these divergent effects on the reported safety of lung cancer resection. METHODS AND MATERIALS We analyzed hospital-acquired adverse events in patients undergoing lung cancer resection using the National Hospital Discharge Survey (NHDS) database from 2001-2010. Demographics, diagnoses, and procedures data were abstracted using ICD-9 codes. We used the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSI) to identify hospital-acquired adverse events. Weighted analyses were performed using t-tests and chi-square. RESULTS A total of 302,444 hospitalizations for lung cancer resection and were included in the analysis. Incidence of PSI increased over time (28% in 2001-2002 vs 34% in 2009-2010; P<0.001). Those with one or more PSI had increased in-hospital mortality (aOR = 11.1; 95% CI, 4.7-26.1; P<0.001) and prolonged hospitalization (12.5 vs 7.8 days; P<0.001). However, among those with PSI, in-hospital mortality decreased over time, from 17% in 2001-2002 to 2% in 2009-2010. CONCLUSIONS In a recent ten-year period, documented rates of adverse events associated with lung cancer resection increased. Despite this increase in safety events, we observed that mortality decreased. Because such metrics may be incorporated into hospital rankings and reimbursement considerations, adverse event coding consistency and content merit further evaluation.
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Affiliation(s)
- Mitchell S. von Itzstein
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Arjun Gupta
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Kemp H. Kernstine
- Department of Cardiothoracic Surgery, UT Southwestern Medical Center, Dallas, TX, United States of America
| | - Kristin C. Mara
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Sahil Khanna
- Division of Gastroenterology, Mayo Clinic, Rochester, MN, United States of America
| | - David E. Gerber
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, United States of America
- Department of Population & Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States of America
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center Dallas, TX, United States of America
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Madariaga ML, Lennes IT, Best T, Shepard JAO, Fintelmann FJ, Mathisen DJ, Gaissert HA. Multidisciplinary selection of pulmonary nodules for surgical resection: Diagnostic results and long-term outcomes. J Thorac Cardiovasc Surg 2019; 159:1558-1566.e3. [PMID: 31669016 DOI: 10.1016/j.jtcvs.2019.09.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 08/22/2019] [Accepted: 09/07/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Pulmonary nodules found incidentally or by lung cancer screening differ in prevalence, risk profile, and diagnostic intervention. The results of surgical intervention for incidental versus screening lung nodules during multidisciplinary Pulmonary Nodule and Lung Cancer Screening Clinic (PNLCSC) follow-up have not been reported. METHODS All patients evaluated at a PNLCSC from 2012 to 2018 following referral by primary care physicians, specialist physicians, or self-referral after computed tomography (CT) identified nodules on routine diagnostic CT (incidental group) or lung cancer screening CT (screening group) were included. Follow-up interval, invasive intervention, histology, postoperative events, survival, and recurrence were compared. RESULTS Of 747 patients evaluated in the PNLCSC, 129 (17.2%) underwent surgical intervention. The surgical cohort consisted of 104 (80.6%) incidental and 25 (19.3%) screening patients followed over a mean of 122 and 70 days, respectively. More benign lesions were excised in the incidental group (20.2%, 21/104)-representing 3.3% (21/632) of all incidental nodules evaluated-than in the screening group (4%, 1/25) (P = .038). Operative mortality was zero. Among 99 patients with primary lung cancer, 87% (screening) and 86.8% (incidental) were pathologic stage Ia. Complete follow-up was available in 725 of 747 (97%), and no patient developed progressive disease. Disease-free survival at 5 years was 74.9% (incidental) and 89.3% (screening) (P = .48). CONCLUSIONS A unique multidisciplinary PNLCSC for incidental and lung cancer screening-detected nodules with individualized risk assessment reliably identifies primary and metastatic tumors while exposing few patients to diagnostic excision for benign disease. Longer-term outcomes, strategies to limit radiation exposure, and cost control need further study.
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Affiliation(s)
- Maria Lucia Madariaga
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Inga T Lennes
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Till Best
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Mass
| | - Jo-Anne O Shepard
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Mass
| | - Florian J Fintelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, Mass
| | - Douglas J Mathisen
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Henning A Gaissert
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass.
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McNulty W, Baldwin D. Management of pulmonary nodules. BJR Open 2019; 1:20180051. [PMID: 33178935 PMCID: PMC7592490 DOI: 10.1259/bjro.20180051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/05/2022] Open
Abstract
Pulmonary nodules are frequently detected during clinical practice and require a structured approach in their management in order to identify early lung cancers and avoid harm from over investigation. The article reviews the 2015 British Thoracic Society guidelines for the management of pulmonary nodules and the evidence behind them.
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Affiliation(s)
- William McNulty
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - David Baldwin
- Nottingham University Hospitals NHS Trust, City Campus, Hucknall Road, Nottingham, England
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17
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Qiu T, Yu B, Xuan Y, Luan H, Jiao W. Vectorial localization of peripheral pulmonary lesion guided by electromagnetic navigation: A novel method for diagnostic surgical resection without dye marking. Thorac Cancer 2018; 9:502-504. [PMID: 29473313 PMCID: PMC5879059 DOI: 10.1111/1759-7714.12610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/28/2022] Open
Abstract
We describe a novel method using electromagnetic navigation bronchoscopy (ENB) without dye marking to perform vectorial localization for an impalpable peripheral lesion in the right lower lobe during diagnostic surgical resection in a 52‐year‐old woman. After the ENB registration process, the anesthetist changed the single‐lumen endotracheal tube to a double‐lumen endobronchial tube. Guided by the ENB system, the operator delivered the probe of the locatable guide to the planned site through the right lumen of the endobronchial tube. The ENB system allows calculation of the direction and distance between the probe and the lesion, confirming the relative location of the lesion. The locatable guide was retained during surgery as an intraoperative indicator, rather than applying dye marking. During video‐assisted thoracoscopic surgery, the protuberant visceral pleura poked by the probe accurately indicated the relative location of the lesion. Accordingly, we performed precise wedge resection for diagnosis, followed by lobectomy, resulting in a diagnosis of invasive adenocarcinoma. Vectorial localization is an alternative method of ENB‐guided localization to peripheral pulmonary lesions, which can provide the accurate location of such lesions for diagnostic surgical resection.
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Affiliation(s)
- Tong Qiu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Baohua Yu
- Operating Room, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yunpeng Xuan
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haihong Luan
- Department of Anesthesia, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenjie Jiao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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Muñoz-Largacha JA, Steiling KA, Kathuria H, Charlot M, Fitzgerald C, Suzuki K, Litle VR. Initial surgical experience following implementation of lung cancer screening at an urban safety net hospital. J Thorac Cardiovasc Surg 2018. [PMID: 29534906 DOI: 10.1016/j.jtcvs.2017.12.135] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Safety net hospitals provide care mostly to low-income, uninsured, and vulnerable populations, in whom delays in cancer screening are established barriers. Socioeconomic barriers might pose important challenges to the success of a lung cancer screening program at a safety net hospital. We aimed to determine screening follow-up compliance, rates of diagnostic and treatment procedures, and the rate of cancer diagnosis in patients classified as category 4 by the Lung CT Screening Reporting and Data System (Lung-RADS 4). METHODS We conducted a retrospective review of all patients enrolled in our multidisciplinary lung cancer screening program between March 2015 and July 2016. Demographics, smoking status, Lung-RADS score, and number of diagnostic and therapeutic interventions and cancer diagnoses were captured. RESULTS A total of 554 patients were screened over a 16-month period. The mean patient age was 63 years (range, 47-85 years), and 60% were male. The majority (92%; 512 of 554) were classified as Lung-RADS 1 to 3, and 8% (42 of 554) were classified as Lung-RADS 4. Among the Lung-RADS 4 patients, 98% (41 of 42) completed their recommended follow-up; 29% (12 of 42) underwent a diagnostic procedure, for an overall diagnostic intervention rate of 2% (12 of 554). Eleven of these 12 patients had cancer, and 1 patient had sarcoidosis. The overall rate of surgical resection was 0.9% (5 of 554), and the rate of diagnostic intervention for noncancer diagnosis was 0.1% (1 of 554). CONCLUSIONS Implementation of a multidisciplinary lung cancer screening program at a safety net hospital is feasible. Compliance with follow-up and interventional recommendations in Lung-RADS 4 patients was high despite anticipated social challenges. Overall diagnostic and surgical resection rates and interventions for noncancer diagnosis were low in our initial experience.
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Affiliation(s)
- Juan A Muñoz-Largacha
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, Mass
| | - Katrina A Steiling
- Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Hasmeena Kathuria
- Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Marjory Charlot
- Division of Hematology and Medical Oncology, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Carmel Fitzgerald
- Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Kei Suzuki
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, Mass
| | - Virginia R Litle
- Division of Thoracic Surgery, Department of Surgery, Boston University School of Medicine, Boston, Mass.
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Gilbert CR, Ely R, Fathi JT, Louie BE, Wilshire CL, Modin H, Aye RW, Farivar AS, Vallières E, Gorden JA. The economic impact of a nurse practitioner–directed lung cancer screening, incidental pulmonary nodule, and tobacco-cessation clinic. J Thorac Cardiovasc Surg 2018; 155:416-424. [DOI: 10.1016/j.jtcvs.2017.07.086] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/08/2017] [Accepted: 07/15/2017] [Indexed: 11/16/2022]
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Hammer MM, Nachiappan AC, Barbosa EJM. Limited Utility of Pulmonary Nodule Risk Calculators for Managing Large Nodules. Curr Probl Diagn Radiol 2017; 47:23-27. [PMID: 28571906 DOI: 10.1067/j.cpradiol.2017.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/23/2017] [Accepted: 04/06/2017] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES The optimal management of large pulmonary nodules, at higher risk for lung cancer, has not been determined, and it remains unclear as to which patients should undergo follow-up imaging vs invasive tissue diagnosis via biopsy or surgical resection. MATERIALS AND METHODS Through search of radiology reports, 86 nodules from our institution were identified using the inclusion criterion of solid nodules measuring greater than 8mm. We evaluated these nodules with a number of risk prediction calculators, including the Brock University model, and compared these against the proven diagnosis. RESULTS Of 86 nodules, 59 (69%) nodules were malignant. The most accurate predictive model, the Brock University calculator, underestimated the risk for this group at 33%. At its optimal threshold, this model had a positive predictive value of 81% and negative predictive value of 53%. Notwithstanding the low negative predictive value, the positive predictive value was no better than patients clinically selected for biopsy (86% of biopsies were malignant). CONCLUSION Existing nodule risk prediction calculators are of limited usage in guiding the management of large pulmonary nodules. At present, the accuracy of these models in this setting is inferior to expert clinical judgment, and future work is needed to develop management algorithms for higher-risk nodules.
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Affiliation(s)
- Mark M Hammer
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Arun C Nachiappan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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