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Bbosa R, Gui H, Luo F, Liu F, Efio-Akolly K, Chen YPP. MRUNet-3D: A multi-stride residual 3D UNet for lung nodule segmentation. Methods 2024; 226:89-101. [PMID: 38642628 DOI: 10.1016/j.ymeth.2024.04.008] [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: 07/01/2023] [Revised: 02/02/2024] [Accepted: 04/07/2024] [Indexed: 04/22/2024] Open
Abstract
Obtaining an accurate segmentation of the pulmonary nodules in computed tomography (CT) images is challenging. This is due to: (1) the heterogeneous nature of the lung nodules; (2) comparable visual characteristics between the nodules and their surroundings. A robust multi-scale feature extraction mechanism that can effectively obtain multi-scale representations at a granular level can improve segmentation accuracy. As the most commonly used network in lung nodule segmentation, UNet, its variants, and other image segmentation methods lack this robust feature extraction mechanism. In this study, we propose a multi-stride residual 3D UNet (MRUNet-3D) to improve the segmentation accuracy of lung nodules in CT images. It incorporates a multi-slide Res2Net block (MSR), which replaces the simple sequence of convolution layers in each encoder stage to effectively extract multi-scale features at a granular level from different receptive fields and resolutions while conserving the strengths of 3D UNet. The proposed method has been extensively evaluated on the publicly available LUNA16 dataset. Experimental results show that it achieves competitive segmentation performance with an average dice similarity coefficient of 83.47 % and an average surface distance of 0.35 mm on the dataset. More notably, our method has proven to be robust to the heterogeneity of lung nodules. It has also proven to perform better at segmenting small lung nodules. Ablation studies have shown that the proposed MSR and RFIA modules are fundamental to improving the performance of the proposed model.
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Affiliation(s)
- Ronald Bbosa
- School of Computer Science, Wuhan University, Wuhan, China.
| | - Hao Gui
- School of Computer Science, Wuhan University, Wuhan, China
| | - Fei Luo
- School of Computer Science, Wuhan University, Wuhan, China
| | - Feng Liu
- School of Computer Science, Wuhan University, Wuhan, China
| | | | - Yi-Ping Phoebe Chen
- Department of Computer Science and Information Technology, La Trobe University, Melbourne, Australia
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2
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Ezegbogu M, Wilkinson E, Reid G, Rodger EJ, Brockway B, Russell-Camp T, Kumar R, Chatterjee A. Cell-free DNA methylation in the clinical management of lung cancer. Trends Mol Med 2024; 30:499-515. [PMID: 38582623 DOI: 10.1016/j.molmed.2024.03.007] [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: 12/07/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/08/2024]
Abstract
The clinical use of cell-free DNA (cfDNA) methylation in managing lung cancer depends on its ability to differentiate between malignant and healthy cells, assign methylation changes to specific tissue sources, and elucidate opportunities for targeted therapy. From a technical standpoint, cfDNA methylation analysis is primed as a potential clinical tool for lung cancer screening, early diagnosis, prognostication, and treatment, pending the outcome of elaborate validation studies. Here, we discuss the current state of the art in cfDNA methylation analysis, examine the unique features and limitations of these new methods in a clinical context, propose two models for applying cfDNA methylation data for lung cancer screening, and discuss future research directions.
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Affiliation(s)
- Mark Ezegbogu
- Department of Pathology, Dunedin School of Medicine, University of Otago, New Zealand
| | - Emma Wilkinson
- Department of Pathology, Dunedin School of Medicine, University of Otago, New Zealand
| | - Glen Reid
- Department of Pathology, Dunedin School of Medicine, University of Otago, New Zealand
| | - Euan J Rodger
- Department of Pathology, Dunedin School of Medicine, University of Otago, New Zealand
| | - Ben Brockway
- Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Takiwai Russell-Camp
- Department of Medicine, Dunedin School of Medicine, University of Otago, New Zealand
| | - Rajiv Kumar
- St George's Cancer Care Centre, 131 Leinster Road, Christchurch, 8014, New Zealand
| | - Aniruddha Chatterjee
- Department of Pathology, Dunedin School of Medicine, University of Otago, New Zealand; SoHST Faculty, UPES University, Dehradun 248007, India.
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3
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Abstract
Several randomized and observational studies on lung cancer screening held in Europe significantly contributed to the knowledge on low-dose computed tomography screening targets in high-risk individuals with smoking history and older than 50 years. In particular, steps forward have been made in the field of risk modeling, screening interval, diagnostic protocol with volumetry, optimization, overdiagnosis estimation, oncological outcome, oncological risk due to radiation exposure, recruitment, and communication strategy.
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Affiliation(s)
- Piergiorgio Muriana
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Francesca Rossetti
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Pierluigi Novellis
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy
| | - Giulia Veronesi
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Via Olgettina 60, Milan 20132, Italy; School of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 48, Milan 20132, Italy.
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4
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Schütte W, Gütz S, Nehls W, Blum TG, Brückl W, Buttmann-Schweiger N, Büttner R, Christopoulos P, Delis S, Deppermann KM, Dickgreber N, Eberhardt W, Eggeling S, Fleckenstein J, Flentje M, Frost N, Griesinger F, Grohé C, Gröschel A, Guckenberger M, Hecker E, Hoffmann H, Huber RM, Junker K, Kauczor HU, Kollmeier J, Kraywinkel K, Krüger M, Kugler C, Möller M, Nestle U, Passlick B, Pfannschmidt J, Reck M, Reinmuth N, Rübe C, Scheubel R, Schumann C, Sebastian M, Serke M, Stoelben E, Stuschke M, Thomas M, Tufman A, Vordermark D, Waller C, Wolf J, Wolf M, Wormanns D. [Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]. Pneumologie 2023; 77:671-813. [PMID: 37884003 DOI: 10.1055/a-2029-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
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Affiliation(s)
- Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)
| | - Sylvia Gütz
- St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig
| | - Wiebke Nehls
- Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring
| | - Torsten Gerriet Blum
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | - Wolfgang Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord
| | | | - Reinhard Büttner
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin
| | | | - Sandra Delis
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Nikolas Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine
| | | | - Stephan Eggeling
- Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin
| | - Jochen Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg
| | - Nikolaj Frost
- Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin
| | - Frank Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg
| | | | - Andreas Gröschel
- Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster
| | | | | | - Hans Hoffmann
- Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München
| | - Rudolf M Huber
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen
| | - Klaus Junker
- Klinikum Oststadt Bremen, Institut für Pathologie, Bremen
| | - Hans-Ulrich Kauczor
- Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Marcus Krüger
- Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau
| | | | - Miriam Möller
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau
| | - Ursula Nestle
- Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach
| | | | - Joachim Pfannschmidt
- Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Martin Reck
- Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf
| | - Niels Reinmuth
- Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg
| | | | | | - Martin Sebastian
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt
| | - Monika Serke
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | | | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Michael Thomas
- Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle
| | - Cornelius Waller
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg
| | | | - Martin Wolf
- Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel
| | - Dag Wormanns
- Evangelische Lungenklinik, Radiologisches Institut, Berlin
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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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Rivera MP, Gudina AT, Cartujano-Barrera F, Cupertino P. Disparities Across the Continuum of Lung Cancer Care. Clin Chest Med 2023; 44:531-542. [PMID: 37517833 DOI: 10.1016/j.ccm.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Despite the overall decline in lung cancer incidence and mortality, minority populations continue to bear a higher disease burden. Lung cancer remains the leading cause of cancer-related death in the United States and disproportionately impacts minority populations. Social determinants of health-including low-socioeconomic status, lack of health insurance, and access to health care- disproportionately impact racial, ethnic, and rural populations resulting in direct consequences on lung cancer disparities.
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Affiliation(s)
- M Patricia Rivera
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 692, Rochester, NY 14642, USA.
| | - Abdi T Gudina
- University of Rochester Medical Center, 265 Crittenden Boulevard, Rm 2-223, Rochester, NY 14642, USA
| | | | - Paula Cupertino
- University of Rochester Medical Center, 601 Elmwood Avenue, Box SURG, Rochester, NY 14642, USA
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7
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Bonney A, Malouf R, Marchal C, Manners D, Fong KM, Marshall HM, Irving LB, Manser R. Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. Cochrane Database Syst Rev 2022; 8:CD013829. [PMID: 35921047 PMCID: PMC9347663 DOI: 10.1002/14651858.cd013829.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lung cancer is the most common cause of cancer-related death in the world, however lung cancer screening has not been implemented in most countries at a population level. A previous Cochrane Review found limited evidence for the effectiveness of lung cancer screening with chest radiography (CXR) or sputum cytology in reducing lung cancer-related mortality, however there has been increasing evidence supporting screening with low-dose computed tomography (LDCT). OBJECTIVES: To determine whether screening for lung cancer using LDCT of the chest reduces lung cancer-related mortality and to evaluate the possible harms of LDCT screening. SEARCH METHODS We performed the search in collaboration with the Information Specialist of the Cochrane Lung Cancer Group and included the Cochrane Lung Cancer Group Trial Register, Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Library, current issue), MEDLINE (accessed via PubMed) and Embase in our search. We also searched the clinical trial registries to identify unpublished and ongoing trials. We did not impose any restriction on language of publication. The search was performed up to 31 July 2021. SELECTION CRITERIA: Randomised controlled trials (RCTs) of lung cancer screening using LDCT and reporting mortality or harm outcomes. DATA COLLECTION AND ANALYSIS: Two review authors were involved in independently assessing trials for eligibility, extraction of trial data and characteristics, and assessing risk of bias of the included trials using the Cochrane RoB 1 tool. We assessed the certainty of evidence using GRADE. Primary outcomes were lung cancer-related mortality and harms of screening. We performed a meta-analysis, where appropriate, for all outcomes using a random-effects model. We only included trials in the analysis of mortality outcomes if they had at least 5 years of follow-up. We reported risk ratios (RRs) and hazard ratios (HRs), with 95% confidence intervals (CIs) and used the I2 statistic to investigate heterogeneity. MAIN RESULTS: We included 11 trials in this review with a total of 94,445 participants. Trials were conducted in Europe and the USA in people aged 40 years or older, with most trials having an entry requirement of ≥ 20 pack-year smoking history (e.g. 1 pack of cigarettes/day for 20 years or 2 packs/day for 10 years etc.). One trial included male participants only. Eight trials were phase three RCTs, with two feasibility RCTs and one pilot RCT. Seven of the included trials had no screening as a comparison, and four trials had CXR screening as a comparator. Screening frequency included annual, biennial and incrementing intervals. The duration of screening ranged from 1 year to 10 years. Mortality follow-up was from 5 years to approximately 12 years. None of the included trials were at low risk of bias across all domains. The certainty of evidence was moderate to low across different outcomes, as assessed by GRADE. In the meta-analysis of trials assessing lung cancer-related mortality, we included eight trials (91,122 participants), and there was a reduction in mortality of 21% with LDCT screening compared to control groups of no screening or CXR screening (RR 0.79, 95% CI 0.72 to 0.87; 8 trials, 91,122 participants; moderate-certainty evidence). There were probably no differences in subgroups for analyses by control type, sex, geographical region, and nodule management algorithm. Females appeared to have a larger lung cancer-related mortality benefit compared to males with LDCT screening. There was also a reduction in all-cause mortality (including lung cancer-related) of 5% (RR 0.95, 95% CI 0.91 to 0.99; 8 trials, 91,107 participants; moderate-certainty evidence). Invasive tests occurred more frequently in the LDCT group (RR 2.60, 95% CI 2.41 to 2.80; 3 trials, 60,003 participants; moderate-certainty evidence). However, analysis of 60-day postoperative mortality was not significant between groups (RR 0.68, 95% CI 0.24 to 1.94; 2 trials, 409 participants; moderate-certainty evidence). False-positive results and recall rates were higher with LDCT screening compared to screening with CXR, however there was low-certainty evidence in the meta-analyses due to heterogeneity and risk of bias concerns. Estimated overdiagnosis with LDCT screening was 18%, however the 95% CI was 0 to 36% (risk difference (RD) 0.18, 95% CI -0.00 to 0.36; 5 trials, 28,656 participants; low-certainty evidence). Four trials compared different aspects of health-related quality of life (HRQoL) using various measures. Anxiety was pooled from three trials, with participants in LDCT screening reporting lower anxiety scores than in the control group (standardised mean difference (SMD) -0.43, 95% CI -0.59 to -0.27; 3 trials, 8153 participants; low-certainty evidence). There were insufficient data to comment on the impact of LDCT screening on smoking behaviour. AUTHORS' CONCLUSIONS: The current evidence supports a reduction in lung cancer-related mortality with the use of LDCT for lung cancer screening in high-risk populations (those over the age of 40 with a significant smoking exposure). However, there are limited data on harms and further trials are required to determine participant selection and optimal frequency and duration of screening, with potential for significant overdiagnosis of lung cancer. Trials are ongoing for lung cancer screening in non-smokers.
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Affiliation(s)
- Asha Bonney
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Reem Malouf
- National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, UK
| | | | - David Manners
- Respiratory Medicine, Midland St John of God Public and Private Hospital, Midland, Australia
| | - Kwun M Fong
- Thoracic Medicine Program, The Prince Charles Hospital, Brisbane, Australia
- UQ Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Henry M Marshall
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Louis B Irving
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Renée Manser
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Mei J, Cheng MM, Xu G, Wan LR, Zhang H. SANet: A Slice-Aware Network for Pulmonary Nodule Detection. IEEE TRANSACTIONS ON PATTERN ANALYSIS AND MACHINE INTELLIGENCE 2022; 44:4374-4387. [PMID: 33687839 DOI: 10.1109/tpami.2021.3065086] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Lung cancer is the most common cause of cancer death worldwide. A timely diagnosis of the pulmonary nodules makes it possible to detect lung cancer in the early stage, and thoracic computed tomography (CT) provides a convenient way to diagnose nodules. However, it is hard even for experienced doctors to distinguish them from the massive CT slices. The currently existing nodule datasets are limited in both scale and category, which is insufficient and greatly restricts its applications. In this paper, we collect the largest and most diverse dataset named PN9 for pulmonary nodule detection by far. Specifically, it contains 8,798 CT scans and 40,439 annotated nodules from 9 common classes. We further propose a slice-aware network (SANet) for pulmonary nodule detection. A slice grouped non-local (SGNL) module is developed to capture long-range dependencies among any positions and any channels of one slice group in the feature map. And we introduce a 3D region proposal network to generate pulmonary nodule candidates with high sensitivity, while this detection stage usually comes with many false positives. Subsequently, a false positive reduction module (FPR) is proposed by using the multi-scale feature maps. To verify the performance of SANet and the significance of PN9, we perform extensive experiments compared with several state-of-the-art 2D CNN-based and 3D CNN-based detection methods. Promising evaluation results on PN9 prove the effectiveness of our proposed SANet. The dataset and source code is available at https://mmcheng.net/SANet/.
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9
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Agrawal S, Goel AD, Gupta N, Lohiya A. Role of low dose computed tomography on lung cancer detection and mortality - an updated systematic review and meta-analysis. Monaldi Arch Chest Dis 2022; 93. [PMID: 35727220 DOI: 10.4081/monaldi.2022.2284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Chest low dose computed tomography (LDCT) is reported to be a sensitive tool for the detection of lung cancer at asymptomatic stage, thus reducing mortality. The review assesses the effect of LDCT screening on all-cause mortality, lung cancer mortality and incidence rates. We conducted literature searches of PubMed, SCOPUS, and the Cochrane Library from inception through January 2020 to identify relevant studies assessing the diagnostic accuracy of LDCT for lung cancer. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for reporting this meta-analysis and review. The inclusion criteria were a) Randomized control trials, b) Comparing LDCT to any other form of screening or standard of care, and (c) Primary outcome studied: all-cause mortality, lung cancer-specific mortality, rate of early detection of lung cancer. A total of 11 studies encompassing 97,248 patients were included. When compared with controls (no screening or CXR), LDCT screening was associated with statistically significant reduction in lung cancer mortality (pooled RR 0.86; 95% CI 0.75-0.98); low heterogeneity was observed (I2= 27.86). However, LDCT screening was not associated with statistically significant reduction in all-cause mortality (RR =0.96; 95% CI: 0.92 -1.01). Notably, the LDCT screening was associated with statistically significant increase in lung cancer detection (RR =1.76; 95% CI: 1.14-2.72). LDCT screening has the potential to reduce mortality due to lung cancer among high-risk individuals. LDCT could be considered as a screening modality after careful assessment of other factors like prevalence of TB, proportion of high-risk population, cost, access and availability of LDCT.
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Affiliation(s)
- Sumita Agrawal
- ConsultantPulmonary Medicine and Critical Care, Medipulse Hospital, Jodhpur.
| | - Akhil Dhanesh Goel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur.
| | - Nitesh Gupta
- Nodal Officer COVID19 Outbreak, Department of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi.
| | - Ayush Lohiya
- Kalyan Singh Super Specialty Cancer Institute, Lucknow.
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10
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Grover H, King W, Bhattarai N, Moloney E, Sharp L, Fuller L. Systematic review of the cost-effectiveness of screening for lung cancer with low dose computed tomography. Lung Cancer 2022; 170:20-33. [DOI: 10.1016/j.lungcan.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/23/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022]
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11
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Nielsen AH, Fredberg U. Earlier diagnosis of lung cancer. Cancer Treat Res Commun 2022; 31:100561. [PMID: 35489228 DOI: 10.1016/j.ctarc.2022.100561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this article is to review options for more rapid diagnosis of lung cancer at an earlier stage, thereby improving survival. These options include screening, allowing general practitioners to refer patients directly to low-dose computed tomography scan instead of a chest X-ray and the abolition of the "visitation filter", i.e. hospital doctors' ability to reject referrals from general practitioners without prior discussion with the referring doctor.
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12
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Jacobsen KK, Schnohr P, Jensen GB, Bojesen SE. AHRR (cg5575921) methylation safely improves specificity of lung cancer screening eligibility criteria: A cohort study. Cancer Epidemiol Biomarkers Prev 2022; 31:758-765. [DOI: 10.1158/1055-9965.epi-21-1059] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/19/2021] [Accepted: 01/04/2022] [Indexed: 11/16/2022] Open
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Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest 2021; 160:e427-e494. [PMID: 34270968 PMCID: PMC8727886 DOI: 10.1016/j.chest.2021.06.063] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part because of the results of the National Lung Screening Trial (NLST). Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, and increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not. METHODS Approved panelists reviewed previously developed key questions using the Population, Intervention, Comparator, Outcome format to address the benefit and harms of low-dose CT screening, and key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analyses were performed when enough evidence was available. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and ungraded statements were drafted, voted on, and revised until consensus was reached. RESULTS The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in seven graded recommendations and nine ungraded consensus statements. CONCLUSIONS Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can impact this balance.
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Affiliation(s)
| | | | | | - Tanner J Caverly
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI; University of Michigan Medical School, Ann Arbor, MI
| | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, MA; Boston University School of Medicine, Boston, MA
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Leleu O, Basille D, Auquier M, Clarot C, Hoguet E, Baud M, Lenel S, Milleron B, Berna P, Jounieaux V. Results of Second Round Lung Cancer Screening by Low-Dose CT scan - French Cohort Study (DEP-KP80). Clin Lung Cancer 2021; 23:e54-e59. [PMID: 34764039 DOI: 10.1016/j.cllc.2021.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Over the last few years, lung cancer screening by low-dose CT scan has demonstrated a decrease in lung cancer mortality. While this method has been in use since 2013 in the United States of America, no European country has yet implemented a systematic screening program. We hereby report the results from the second round of screening from a French cohort study. PATIENTS AND METHODS DEP KP80 is a prospective study evaluating lung cancer screening by means of three low-dose computer tomography (CT) scans at 1-year intervals in 1,307 participants, aged 55 to 74 years old, all smokers or former smokers, having quit within the last 15 years, with over 30 pack years. The results of the first round demonstrated it was possible to conduct effective screening in real-life situations. RESULTS Participation was lower in this second round than in the first (35.3% vs. 73.1%, P < .001). The rate of negative results was significantly higher and that of undetermined results lower than those produced in the first round. Overall, 75% of cancers revealed were Stage 1 and 87.5% benefitted from surgical treatment. The incidence of cancer in the second round was 2.43%. CONCLUSION As with the first round, the results of this second round confirm the feasibility and efficacy of lung cancer screening. The lower participation rate for this second round is proof of the need to improve awareness among participants and healthcare professionals of the relevance of committing to an annual screening program.
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Affiliation(s)
- Olivier Leleu
- Department of Pulmonology, Centre Hospitalier d'Abbeville, Abbeville, France.
| | | | | | - Caroline Clarot
- Department of Pulmonology, Centre Hospitalier d'Abbeville, Abbeville, France
| | - Estelle Hoguet
- Department of Pulmonology, Centre Hospitalier d'Abbeville, Abbeville, France
| | - Mickael Baud
- Department of Pulmonology, Centre Hospitalier d'Abbeville, Abbeville, France
| | - Sabrina Lenel
- Department of Pulmonology, Centre Hospitalier d'Abbeville, Abbeville, France
| | - Bernard Milleron
- Intergroupe francophone de cancérologie thoracique (IFCT), Paris, France
| | - Pascal Berna
- Department of Thoracic surgery, CHU Amiens, Amiens, France
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15
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Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report - Executive Summary. Chest 2021; 160:1959-1980. [PMID: 34270965 DOI: 10.1016/j.chest.2021.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part due to the results of the National Lung Screening Trial. Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, as well as increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not. METHODS Approved panelists reviewed previously developed key questions using the PICO (population, intervention, comparator, and outcome) format to address the benefit and harms of low-dose CT screening, as well as key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the GRADE approach. Meta-analyses were performed where appropriate. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and un-graded statements were drafted, voted on, and revised until consensus was reached. RESULTS The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in 7 graded recommendations and 9 ungraded consensus statements. CONCLUSIONS Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen detected findings, and the effectiveness of smoking cessation interventions, can impact this balance.
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Affiliation(s)
| | | | | | - Tanner J Caverly
- Ann Arbor VA Center for Clinical Management Research and University of Michigan Medical School , Madison, WI
| | - Jeffrey P Kanne
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System and Boston University School of Medicine, Boston, MA
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Abstract
PURPOSE OF REVIEW Lung cancer remains the leading cause of cancer-related death in the United States, with poor overall 5-year survival. Early detection and diagnosis are key to survival as demonstrated in lung cancer screening trials. However, with increasing implementation of screening guidelines and use of computed tomography, there has been a sharp rise in the incidence of indeterminate pulmonary nodules (IPNs). Risk stratification of IPNs, particularly those in the intermediate-risk category, remains challenging in clinical practice. Individual risk factors, imaging characteristics, biomarkers, and prediction models are currently used to assist in risk stratifying patients, but such strategies remain suboptimal. This review focuses on established risk stratification methods, current areas of research, and future directions. RECENT FINDINGS The multitude of yearly incidental and screening-detected IPNs, its management-related healthcare costs, and risk of invasive procedures provides a strong rationale for risk stratification efforts. The development of new molecular and imaging biomarkers to discriminate benign from malignant lung nodules shows great promise. Yet, risk stratification methods need integration into the diagnostic workflow and await validation in prospective, biomarker-driven clinical trials. SUMMARY Novel biomarkers and new imaging analysis, including radiomics and deep-learning methods, have been developed to optimize the risk stratification of IPNs. While promising, additional validation and clinical studies are needed before they can be part of routine clinical practice.
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Affiliation(s)
- Rafael Paez
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center
| | - Michael N Kammer
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center
- Department of Chemistry, Vanderbilt University
| | - Pierre Massion
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center
- Cancer Early Detection and Prevention Initiative, Vanderbilt-Ingram Cancer Center
- Pulmonary and Critical Care Section, Medical Service, Tennessee Valley Healthcare System, Nashville Campus, Nashville, Tennessee, USA
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17
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Passiglia F, Cinquini M, Bertolaccini L, Del Re M, Facchinetti F, Ferrara R, Franchina T, Larici AR, Malapelle U, Menis J, Passaro A, Pilotto S, Ramella S, Rossi G, Trisolini R, Novello S. Benefits and Harms of Lung Cancer Screening by Chest Computed Tomography: A Systematic Review and Meta-Analysis. J Clin Oncol 2021; 39:2574-2585. [PMID: 34236916 DOI: 10.1200/jco.20.02574] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE This meta-analysis aims to combine and analyze randomized clinical trials comparing computed tomography lung screening (CTLS) versus either no screening (NS) or chest x-ray (CXR) in subjects with cigarette smoking history, to provide a precise and reliable estimation of the benefits and harms associated with CTLS. MATERIALS AND METHODS Data from all published randomized trials comparing CTLS versus either NS or CXR in a highly tobacco-exposed population were collected, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Subgroup analyses by comparator (NS or CXR) were performed. Pooled risk ratio (RR) and relative 95% CIs were calculated for dichotomous outcomes. The certainty of the evidence was assessed using the GRADE approach. RESULTS Nine eligible trials (88,497 patients) were included. Pooled analysis showed that CTLS is associated with: a significant reduction of lung cancer-related mortality (overall RR, 0.87; 95% CI, 0.78 to 0.98; NS RR, 0.80; 95% CI, 0.69 to 0.92); a significant increase of early-stage tumors diagnosis (overall RR, 2.84; 95% CI 1.76 to 4.58; NS RR, 3.33; 95% CI, 2.27 to 4.89; CXR RR, 1.52; 95% CI, 1.04 to 2.23); a significant decrease of late-stage tumors diagnosis (overall RR, 0.75; 95% CI, 0.68 to 0.83; NS RR, 0.67; 95% CI, 0.56 to 0.80); a significant increase of resectability rate (NS RR, 2.57; 95% CI, 1.76 to 3.74); a nonsignificant reduction of all-cause mortality (overall RR, 0.99; 95% CI, 0.94 to 1.05); and a significant increase of overdiagnosis rate (NS, 38%; 95% CI, 14 to 63). The analysis of lung cancer-related mortality by sex revealed nonsignificant differences between men and women (P = .21; I-squared = 33.6%). CONCLUSION Despite there still being uncertainty about overdiagnosis estimate, this meta-analysis suggested that the CTLS benefits outweigh harms, in subjects with cigarette smoking history, ultimately supporting the systematic implementation of lung cancer screening worldwide.
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Affiliation(s)
- Francesco Passiglia
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano (TO), Italy
| | - Michela Cinquini
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Marzia Del Re
- Unit of Clinical Pharmacology and Pharmacogenetics, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Francesco Facchinetti
- Université Paris-Saclay, Institut Gustave Roussy, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Roberto Ferrara
- Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Tindara Franchina
- Department of Human Pathology "G. Barresi," University of Messina, Messina, Italy
| | - Anna R Larici
- Sacro Cuore Catholic University, Policlinico A. Gemelli Foundation, Rome, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples "Federico II," Naples, Italy
| | - Jessica Menis
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology Department, Istituto Oncologico Veneto IRCCS, Padova, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Pilotto
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sara Ramella
- Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Giulio Rossi
- Pathologic Anatomy, Azienda USL della Romagna, S. Maria delle Croci Hospital of Ravenna and Degli Infermi Hospital of Rimini, Rimini, Italy
| | - Rocco Trisolini
- Interventional Pulmonology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Novello
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano (TO), Italy
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18
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Luo B, Mao G, Ma H, Chen S. The role of seven autoantibodies in lung cancer diagnosis. J Thorac Dis 2021; 13:3660-3668. [PMID: 34277058 PMCID: PMC8264704 DOI: 10.21037/jtd-21-835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/08/2021] [Indexed: 11/06/2022]
Abstract
Background To investigate the expression and diagnostic value of seven autoantibodies (P53, PGP9.5, SOX2, GAGE7, GBU4-5, MAGE, and CACE) in lung cancer patients. Methods A total of 370 patients were admitted to the Thoracic Surgery of the First Affiliated Hospital of Suzhou University from 2017 to 2019, including 305 patients with lung cancer and 65 patients with benign lesions. The concentrations of the seven autoantibodies were determined by enzyme linked immunosorbent assay (ELISA).The expression levels of each antibody were compared between the two groups, and the levels of each antibody between lung cancer patients with different pathological types were also compared. We aimed to analyze the diagnostic efficiency of single antibody detection combined with seven antibodies, and also to explore whether there were differences among the positive rates of each antibody in sex, age, smoking history, pathological classification, and clinical stages in the lung cancer group. Results The expression levels of seven autoantibodies in the lung cancer group were higher than those in the benign lesion group. In the lung cancer group, the expression levels of the seven autoantibodies did not vary statistically among different pathological types. The area under the curve of combined detection of the seven antibodies reached 0.735, and the Y-index reached 0.35, which was higher than that of single antibody detection. P53 exhibited the highest sensitivity and lowest specificity; meanwhile, PGP9.5, SOX2, GAGE7, GBU4-5, and MAGEA1 exhibited low sensitivity and high specificity. The sensitivity and specificity of the CAGE were approximately 60%, respectively. There was no statistical difference in the positive rate of each antibody in age, smoking history, and clinical stage. The positive rate of MAGEA1 and CAGE was statistically different in sex, and the positive rate of MAGEA1 was statistically different in pathological classification. Conclusions The seven autoantibodies of lung cancer can potentially be used as an auxiliary examination method for the early diagnosis of lung cancer.
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Affiliation(s)
- Bin Luo
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Guocai Mao
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haitao Ma
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shaomu Chen
- Department of Thoracic Surgery, First Affiliated Hospital of Soochow University, Suzhou, China
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Goudemant C, Durieux V, Grigoriu B, Berghmans T. [Lung cancer screening with low dose computed tomography : a systematic review]. Rev Mal Respir 2021; 38:489-505. [PMID: 33994043 DOI: 10.1016/j.rmr.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/26/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bronchial cancer, often diagnosed at a late stage, is the leading cause of cancer death. As early detection could potentially lead to curative treatment, several studies have evaluated low-dose chest CT (LDCT) as a screening method. The main objective of this work is to determine the impact of LDCT screening on overall mortality of a smoking population. METHODS Systematic review of randomised controlled screening trials comparing LDCT with no screening or chest x-ray. RESULTS Thirteen randomised controlled trials were identified, seven of which reported mortality results. NSLT showed a significant reduction of 6.7% in overall mortality and 20% in lung cancer mortality after 6.5 years of follow-up. NELSON showed a significant reduction in lung cancer mortality of 24% at 10 years among men. LUSI and MILD showed a reduction in lung cancer mortality of 69% at 8 years among women and 39% at 10 years, respectively. CONCLUSION Screening for bronchial cancer is a complex issue. Clarification is needed regarding the selection of individuals, the definition of a positive result and the attitude towards a suspicious nodule.
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Affiliation(s)
- C Goudemant
- Département des soins intensifs & urgences oncologiques et clinique d'oncologie thoracique, institut Jules-Bordet, Rue Héger-Bordet 1, 1000 Bruxelles, Belgique.
| | - V Durieux
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles
| | - B Grigoriu
- Département des soins intensifs & urgences oncologiques et clinique d'oncologie thoracique, institut Jules-Bordet, Rue Héger-Bordet 1, 1000 Bruxelles, Belgique
| | - T Berghmans
- Département des soins intensifs & urgences oncologiques et clinique d'oncologie thoracique, institut Jules-Bordet, Rue Héger-Bordet 1, 1000 Bruxelles, Belgique
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20
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Bintein F, Yannoutsos A, Chatellier G, Fontaine M, Damotte D, Paterlini-Bréchot P, Meyer G, Duchatelle V, Marini V, Schwering KL, Labrousse C, Beaussier H, Zins M, Salmeron S, Lajonchère JP, Priollet P, Emmerich J, Trédaniel J. Patients with atherosclerotic peripheral arterial disease have a high risk of lung cancer: Systematic review and meta-analysis of literature. JOURNAL DE MÉDECINE VASCULAIRE 2021; 46:53-65. [PMID: 33752847 DOI: 10.1016/j.jdmv.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Lung cancer and atherosclerosis share common risk factors. Literature data suggest that the prevalence of lung malignancy in patients with peripheral arterial disease (PAD) is higher than in the general population. Our goal was to determine, through a systematic literature review, the prevalence of lung cancer in patients with PAD. METHODS We consulted available publications in the Cochrane library, MEDLINE, PUBMED, EMBASE, and ClinicalTrials.gov. We included all articles, written in English or French, published between 1990 and 2020 reporting the prevalence of lung cancer in patients with PAD (atherosclerotic aortic aneurysm or peripheral occlusive diseases). Patients with coronary artery disease, cardiac valvulopathy or carotid stenosis were not included. We did not include case reports. We performed a critical analysis of each article. Data were collected from two independent readers. A fixed effect model meta-analysis allowed to estimate a summary prevalence rate. RESULTS We identified 303 articles, and selected 19 articles according to selection criteria. A total of 16849 patients were included (mean age 68.3 years, 75.1% of males). Aortic aneurysms were found in 29% of patients and atherosclerotic occlusive disease in 66% of patients. Lung cancer was identified in 538 patients, representing a prevalence of 3%. DISCUSSION Lung cancer is found in 3% of patients with atherosclerotic PAD. This prevalence is higher than that found in lung cancer screening programs performed in the general population of smokers and former smokers. These patients should be screened for lung cancer. Their selection may dramatically increase the benefit of lung cancer screening.
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Affiliation(s)
- F Bintein
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France.
| | - A Yannoutsos
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France; Inserm UMR 1153 Center of Research in Epidemiology and Statistics, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - G Chatellier
- Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - D Damotte
- Hôpital Cochin, AP-HP, 75014 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Unité Inserm U1138, centre de recherche des Cordeliers, Paris, France
| | | | - G Meyer
- Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - V Duchatelle
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - V Marini
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | | | - C Labrousse
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - H Beaussier
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - M Zins
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - S Salmeron
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - J-P Lajonchère
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - P Priollet
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France
| | - J Emmerich
- Groupe hospitalier Paris Saint-Joseph, 75014 Paris, France; Inserm UMR 1153 Center of Research in Epidemiology and Statistics, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - J Trédaniel
- Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Unité Inserm UMR-S 1124, toxicologie, pharmacologie et signalisation cellulaire, Paris, France
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21
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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: 202] [Impact Index Per Article: 67.3] [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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22
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Real-World Lung Cancer CT Screening Performance, Smoking Behavior, and Adherence to Recommendations: Lung-RADS Category and Smoking Status Predict Adherence. AJR Am J Roentgenol 2021; 216:919-926. [PMID: 32755178 DOI: 10.2214/ajr.20.23637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND. Low-dose CT (LDCT) lung cancer screening (LCS) has been shown to decrease mortality in persons with a significant smoking history. However, adherence in real-world LCS programs is significantly lower than in randomized controlled trials. OBJECTIVE. The purpose of this article is to assess real-world LDCT LCS performance and factors predictive of adherence to LCS recommendations. METHODS. We retrospectively identified all persons who underwent at least two LCS examinations from 2014 to 2019. Patient demographics, smoking history and behavior changes, Lung-RADS category, PPV, NPV, and adherence to screening recommendations were recorded. Predictors of adherence were assessed via univariate comparisons and multivariate logistic regression. RESULTS. A total of 260 persons returned for follow-up LDCT (57.7% had two, 34.2% had three, 7.7% had four, and 0.4% had five LDCT examinations). A total of 43 of 260 (16.5%) had positive (Lung-RADS category 3 or above) scans, of which 27 of 260 persons (10.3%) were graded as Lung-RADS category 3, eight of 260 (3.1%) were category 4A, six of 260 (2.3%) were category 4B, and two of 260 (0.8%) were category 4X. Cancer was diagnosed in four of the 260 (three with lung cancer and one with metastatic melanoma). A total of 143 of 260 (55.0%) persons were current smokers at baseline and 121 of 260 (46.5%) were current smokers at the last round of LCS. LCS had sensitivity of 100.0%, specificity of 84.8%, PPV of 9.3%, and NPV of 100%. Overall adherence was 43.0% but increased progressively with higher Lung-RADS category (Lung-RADS 1: 33.2%; Lung-RADS 2: 46.3%; Lung-RADS 3: 53.8%; Lung-RADS 4A: 77.8%; Lung-RADS 4B: 83.3%; Lung-RADS 4X: 100%; p < .001). was also higher in former versus current smokers (50.0% vs 36.2%; p < .001). Being a former smoker and having a nodule that is Lung-RADS category 3 or greater were the only significant independent predictors of adherence. CONCLUSION. Our real-world LCS program showed very high sensitivity and NPV, but moderate specificity and very low PPV. Adherence to LCS recommendations increased with former versus current smokers and in those with positive (Lung-RADS categories 3, 4A, 4B, or 4X) LCS examinations. Adherence was less than 50.0% in current smokers and persons with negative (Lung-RADS categories 1 or 2) LCS examinations. CLINICAL IMPACT. Our results offer a road map for targeted performance improvement by focusing on LCS subjects less likely to remain in the program, such as persons with negative LCS examinations and persons who continue to smoke, potentially improving LCS cost effectiveness and maximizing its societal benefits.
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23
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Pérez-Sánchez C, Barbarroja N, Pantaleão LC, López-Sánchez LM, Ozanne SE, Jurado-Gámez B, Aranda E, Lopez-Pedrera C, Rodríguez-Ariza A. Clinical Utility of microRNAs in Exhaled Breath Condensate as Biomarkers for Lung Cancer. J Pers Med 2021; 11:111. [PMID: 33572343 PMCID: PMC7916163 DOI: 10.3390/jpm11020111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/25/2021] [Accepted: 02/06/2021] [Indexed: 12/19/2022] Open
Abstract
This study represents a novel proof of concept of the clinical utility of miRNAs from exhaled breath condensate (EBC) as biomarkers of lung cancer (LC). Genome-wide miRNA profiling and machine learning analysis were performed on EBC from 21 healthy volunteers and 21 LC patients. The levels of 12 miRNAs were significantly altered in EBC from LC patients where a specific signature of miR-4507, miR-6777-5p and miR-451a distinguished these patients with high accuracy. Besides, a distinctive miRNA profile between LC adenocarcinoma and squamous cell carcinoma was observed, where a combined panel of miR-4529-3p, miR-8075 and miR-7704 enabling discrimination between them. EBC levels of miR-6777-5p, 6780a-5p and miR-877-5p predicted clinical outcome at 500 days. Two additional miRNA signatures were also associated with other clinical features such as stage and invasion status. Dysregulated EBC miRNAs showed potential target genes related to LC pathogenesis, including CDKN2B, PTEN, TP53, BCL2, KRAS and EGFR. We conclude that EBC miRNAs might allow the identification, stratification and monitorization of LC, which could lead to the development of precision medicine in this and other respiratory diseases.
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Affiliation(s)
- Carlos Pérez-Sánchez
- Department of Medicine, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0AW, UK
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain; (L.M.L.-S.); (B.J.-G.); (E.A.); (C.L.-P.); (A.R.-A.)
| | - Nuria Barbarroja
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain; (L.M.L.-S.); (B.J.-G.); (E.A.); (C.L.-P.); (A.R.-A.)
| | - Lucas C. Pantaleão
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Welcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.P.); (S.E.O.)
| | - Laura M. López-Sánchez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain; (L.M.L.-S.); (B.J.-G.); (E.A.); (C.L.-P.); (A.R.-A.)
| | - Susan E. Ozanne
- Metabolic Research Laboratories and MRC Metabolic Diseases Unit, Welcome Trust-MRC Institute of Metabolic Science, Addenbrooke’s Hospital, University of Cambridge, Cambridge CB2 0QQ, UK; (L.C.P.); (S.E.O.)
| | - Bernabé Jurado-Gámez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain; (L.M.L.-S.); (B.J.-G.); (E.A.); (C.L.-P.); (A.R.-A.)
| | - Enrique Aranda
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain; (L.M.L.-S.); (B.J.-G.); (E.A.); (C.L.-P.); (A.R.-A.)
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), 28029 Madrid, Spain
| | - Chary Lopez-Pedrera
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain; (L.M.L.-S.); (B.J.-G.); (E.A.); (C.L.-P.); (A.R.-A.)
| | - Antonio Rodríguez-Ariza
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Córdoba, Spain; (L.M.L.-S.); (B.J.-G.); (E.A.); (C.L.-P.); (A.R.-A.)
- Centro de Investigación Biomédica en Red en Cáncer (CIBERONC), 28029 Madrid, Spain
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24
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Duan XQ, Wang XL, Zhang LF, Liu XZ, Zhang WW, Liu YH, Dong CH, Zhao XH, Chen L. Establishment and validation of a prediction model for the probability of malignancy in solid solitary pulmonary nodules in northwest China. J Surg Oncol 2021; 123:1134-1143. [PMID: 33497476 DOI: 10.1002/jso.26356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES To construct a prediction model of solitary pulmonary nodules (SPNs), to predict the possibility of malignant SPNs in patients aged 15-85 years in northwest China for clinical diagnostic and therapeutic decision-making. METHODS The features of SPNs were assessed by multivariate logistic regression, followed by visualization using a nomogram. Hosmer lemeshow was applied to evaluate the fitting degree of the model. The area under the receiver operating characteristic (ROC) curve was identified to determine the discriminative ability of the model. RESULTS Lobulation, spiculation, pleural-tag, carcinoembryonic antigen, neuron-specific enolase, and total serum protein were independent predictors of malignant pulmonary nodules (p < .05). Lobulation (100 points) scored the highest in the nomogram, and the Hosmer-Lemeshow goodness-of-fit statistic was 0.805 (p > .05). The area under curve (AUC) of the modeling and validation groups using logistic regression were 0.859 (95% CI, 0.805-0.903) and 0.823 (95% CI, 0.738-0.890), respectively. Moreover, the AUC of our model was higher than that of the Mayo model, VA model, and Peking University (AUC 0.823 vs. 0.655 vs. 0.603 vs. 0.521). CONCLUSION Our prediction model is more suitable for predicting the possibility of malignant SPNs in northwest China, and can be calculated using a nomogram to determine further treatments.
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Affiliation(s)
- Xue-Qin Duan
- Department of Oncology, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shanxi, China
| | - Xiao-Li Wang
- Department of Ophthalmology, Xi'an fourth hospital, Xi'an, Shanxi, China
| | - Li-Fen Zhang
- Department of Oncology, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shanxi, China
| | - Xi-Zhi Liu
- Department of Oncology, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shanxi, China
| | - Wen-Wen Zhang
- Department of Oncology, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shanxi, China
| | - Yi-Hui Liu
- Cancer Center, People's Hospital of Ningxia Hui Autonomous Region, Ningxia, China
| | - Chun-Hui Dong
- Department of Oncology, Ninth Hospital of Xi'an, Xi'an, Shanxi, China
| | - Xin-Han Zhao
- Department of Oncology, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shanxi, China
| | - Ling Chen
- Department of Oncology, The First Affiliated Hospital of Xi'an JiaoTong University, Xi'an, Shanxi, China
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25
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Huang HY, Lu MW, Chen MC, Chang HM, Kuo CH, Lin SM, Wang CH, Chung FT. Clinic image surveillance reduces mortality in patients with primary hepato-gastrointestinal cancer who develop second primary lung cancer: A STROBE-compliant retrospective study. Medicine (Baltimore) 2020; 99:e23440. [PMID: 33327274 PMCID: PMC7738109 DOI: 10.1097/md.0000000000023440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Second primary cancer is prevalent in patients with gastrointestinal (GI) cancer, for which lung cancer is the most common and associated with high lethality. Image screening for lung cancer was proved to be effective in early diagnosis and lower mortality. However, trials of screen for lung cancer generally excluded patients with a previous diagnosis of malignancy. The study aimed to investigate the outcome of second primary lung cancer and the factor that improve survival in patients with hepato-GI cancer.A total of 276 patients with secondary lung cancer were found among 3723 newly-diagnosed lung cancer patients diagnosed in Chang Gung Memorial Hospital, between 2010 and 2014. Patients' clinical characteristics, stages and survival were recorded and analyzed. The patients were separated into 2 groups: Group I was defined as lung cancer detected in original primary cancer clinic and group II patients defined as lung cancer detected in other medical places.Sixty-nine cases with primary GI-hepatic and secondary lung cancer were diagnosed (42 (60.8%) in Group I and 27 (39.1%) in Group II). Although both groups had comparable primary cancer stages and treatment, more patients in Group I than Group II were diagnosed as early stage lung cancer (stage I-II: 40.5% vs 11.1%; P = .023). Group II had larger lung tumor sizes than Group I (4.7 vs 3.5 cm; P = .025). Group I showed better 5-year overall survival than Group II (P = .014, median survival: 27 vs 10 months). Among Group II, only 37% had received image follow up in clinic compared with 67% of Group I cases (P = .025). Patients with chest image follow up in clinics also had better 5-year overall survival (P = .043).GI-hepatic cancer was the most common primary malignancy in the lung cancer cohort. Patients had better survival outcome when secondary lung cancer was diagnosed in original primary cancer clinic. Chest image screening strategy may contribute better survival in secondary lung cancer due to detection at an earlier stage.
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Affiliation(s)
- Hung-Yu Huang
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- College of Medicine, Chang Gung University
| | - Min-Wei Lu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan
- Medical Education Department, Far Eastern Memorial Hospital, New Taipei City
| | - Mei-Chi Chen
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan
- Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan
| | - Hsiu-Mei Chang
- Department of Respiratory Care, New Taipei City Municipal TuCheng Hospital, Managed by Chang Gung Medical Foundation, New Taipei City
| | - Chih-Hsi Kuo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- College of Medicine, Chang Gung University
| | - Shu-Min Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- College of Medicine, Chang Gung University
| | - Chun-Hua Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- College of Medicine, Chang Gung University
| | - Fu-Tsai Chung
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Saint Paul's Hospital
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taipei
- College of Medicine, Chang Gung University
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan
- Department of Respiratory Care, New Taipei City Municipal TuCheng Hospital, Managed by Chang Gung Medical Foundation, New Taipei City
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan
- Department of Thoracic Medicine, New Taipei City Municipal TuCheng Hospital, Managed by Chang Gung Medical Foundation, New Taipei City, Taiwan
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26
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Kim YW, Kang HR, Kwon BS, Lim SY, Lee YJ, Park JS, Cho YJ, Yoon HI, Lee KW, Lee JH, Lee CT. Low-dose chest computed tomographic screening and invasive diagnosis of pulmonary nodules for lung cancer in never-smokers. Eur Respir J 2020; 56:13993003.00177-2020. [PMID: 32482786 DOI: 10.1183/13993003.00177-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/22/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although lung cancer screening using low-dose computed tomography (LDCT) is now widely used in clinical practice, the characteristics and outcomes of diagnostic procedures related to screen-detected nodules in never-smokers remain unclear. We aimed to determine the incidence of nodules considered for invasive biopsy and evaluate the final diagnoses and procedure-related complications in never-smokers in comparison to ever-smokers who underwent LDCT screening. METHODS We evaluated 37 436 asymptomatic adults (17 968 never-smokers and 19 468 ever-smokers) who underwent LDCT screening for lung cancer between January 2009 and December 2018 at a tertiary centre in South Korea. The rates of invasive diagnostic procedures for detected nodules and related complications, and the diagnostic outcomes were determined in the never-smoker and ever-smoker groups. RESULTS Among the never-smokers, 2908 (16.2%) out of 17 968 had positive nodules. Overall, 139 (0.77%) out of 17 968 never-smokers and 194 (1.00%) out of 19 468 ever-smokers underwent invasive biopsy (p=0.022). Lung cancer was diagnosed in 84 (0.47%) out of 17 968 never-smokers and 123 (0.63%) out of 19 468 ever-smokers (p=0.032). The proportions of participants diagnosed with benign disease after invasive biopsy (false-positive) were 50 (0.28%) out of 17 968 and 69 (0.35%) out of 19 468 in the never-smoker and ever-smoker groups, respectively (p=0.191). Multivariate analyses revealed no significant associations of smoking with the risk of a false-positive diagnosis (OR 0.98, 95% CI 0.62-1.57) and complications (OR 1.33, 95% CI 0.65-3.73) after biopsy. Of the 84 never-smokers with lung cancer, 82 (97.6%) had adenocarcinoma, and 75 (89.3%) were in stage I with a favourable prognosis. CONCLUSIONS LDCT screening in never-smokers resulted in a notable detection rate of lung nodules, which warranted invasive biopsy. The lung cancer detection rate was lower in never-smokers than in ever-smokers. However, no significant differences in the false-positive and complication rates were observed between the two groups. Accordingly, a more specifically tailored management strategy is needed for screen-detected nodules in Asian never-smokers.
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Affiliation(s)
- Yeon Wook Kim
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hye-Rin Kang
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byoung Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyung Won Lee
- Dept of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Ho Lee
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea .,Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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27
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Choe W, Chae JD, Lee BH, Kim SH, Park SY, Nimse SB, Kim J, Warkad SD, Song KS, Oh AC, Hong YJ, Kim T. 9G Test TM Cancer/Lung: A Desirable Companion to LDCT for Lung Cancer Screening. Cancers (Basel) 2020; 12:cancers12113192. [PMID: 33143045 PMCID: PMC7692999 DOI: 10.3390/cancers12113192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Lung cancer is the most common cause of cancer-related deaths globally. Patients diagnosed at early-stage (0–I) have a higher survival rate than the metastasized stages (III–IV). Thus, there is great potential to reduce mortality by diagnosing lung cancer at stage 0~I through community screening. LDCT is a promising method, but it has a high false-positive rate. Therefore, a biomarker test that can be used in combination with LDCT for lung cancer screening to reduce false-positive rates is highly awaited. The present study evaluated the applicability of 9G testTM Cancer/Lung test to detect stage 0~IV lung cancer. 9G testTM Cancer/Lung test detects stage I, stage II, stage III, and stage IV cancers with the sensitivities of 77.5%, 78.1%, 67.4%, and 33.3%, respectively, at the specificity of 97.3%. These results indicate that the 9G testTM Cancer/Lung can be used in conjunction with LDCT to screen lung cancer. Abstract A complimentary biomarker test that can be used in combination with LDCT for lung cancer screening is highly desirable to improve the diagnostic capacity of LDCT and reduce the false-positive rates. Most importantly, the stage I lung cancer detection rate can be dramatically increased by the simultaneous use of a biomarker test with LDCT. The present study was conducted to evaluate 9G testTM Cancer/Lung’s sensitivity and specificity in detecting Stage 0~IV lung cancer. The obtained results indicate that the 9G testTM Cancer/Lung can detect lung cancer with overall sensitivity and specificity of 75.0% (69.1~80.3) and 97.3% (95.0~98.8), respectively. The detection of stage I, stage II, stage III, and stage IV cancers with sensitivities of 77.5%, 78.1%, 67.4%, and 33.3%, respectively, at the specificity of 97.3% have never been reported before. The receiver operating characteristic curve analysis allowed us to determine the population-weighted AUC of 0.93 (95% CI, 0.91–0.95). These results indicate that the 9G testTM Cancer/Lung can be used in conjunction with LDCT to screen lung cancer. Furthermore, obtained results indicate that the use of 9G testTM Cancer/Lung with LDCT for lung cancer screening can increase stage I cancer detection, which is crucial to improve the currently low 5-year survival rates.
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Affiliation(s)
- Wonho Choe
- Nowon Eulji Medical Center, Department of Laboratory Medicine, Eulji University, Seoul 01830, Korea
| | - Jeong Don Chae
- Nowon Eulji Medical Center, Department of Laboratory Medicine, Eulji University, Seoul 01830, Korea
| | - Byoung-Hoon Lee
- Nowon Eulji Medical Center, Department of Pulmonology and Allergy, Eulji University, Seoul 01830, Korea
| | - Sang-Hoon Kim
- Nowon Eulji Medical Center, Department of Pulmonology and Allergy, Eulji University, Seoul 01830, Korea
| | - So Young Park
- Nowon Eulji Medical Center, Department of Pulmonology and Allergy, Eulji University, Seoul 01830, Korea
| | - Satish Balasaheb Nimse
- Institute of Applied Chemistry and Department of Chemistry, Hallym University, Chuncheon 24252, Korea
| | - Junghoon Kim
- Institute of Applied Chemistry and Department of Chemistry, Hallym University, Chuncheon 24252, Korea
| | | | - Keum-Soo Song
- Biometrix Technology, Inc. 2-2 Bio Venture Plaza 56, Chuncheon 24232, Korea
| | - Ae-Chin Oh
- Departments of Laboratory Medicine, Korea Cancer Center Hospital, Seoul 01812, Korea
| | - Young Jun Hong
- Departments of Laboratory Medicine, Korea Cancer Center Hospital, Seoul 01812, Korea
| | - Taisun Kim
- Institute of Applied Chemistry and Department of Chemistry, Hallym University, Chuncheon 24252, Korea
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Abstract
BACKGROUND Randomized controlled trials have evaluated the efficacy of low-dose CT (LDCT) lung cancer screening on lung cancer (LC) outcomes. OBJECTIVE Meta-analyze LDCT lung cancer screening trials. METHODS We identified studies by searching PubMed, Google Scholar, the Cochrane Registry, ClinicalTrials.gov , and reference lists from retrieved publications. We abstracted data on study design features, stage I LC diagnoses, LC and overall mortality, false positive results, harm from invasive diagnostic procedures, overdiagnosis, and significant incidental findings. We assessed study quality using the Cochrane risk-of-bias tool. We used random-effects models to calculate relative risks and assessed effect modulators with subgroup analyses and meta-regression. RESULTS We identified 9 studies that enrolled 96,559 subjects. The risk of bias across studies was judged to be low. Overall, LDCT screening significantly increased the detection of stage I LC, RR = 2.93 (95% CI, 2.16-3.98), I2 = 19%, and reduced LC mortality, RR = 0.84 (95% CI, 0.75-0.93), I2 = 0%. The number needed to screen to prevent an LC death was 265. Women had a lower risk of LC death (RR = 0.69, 95% CI, 0.40-1.21) than men (RR = 0.86, 95% CI, 0.66-1.13), p value for interaction = 0.11. LDCT screening did not reduce overall mortality, RR = 0.96 (95% CI, 0.91-1.01), I2 = 0%. The pooled false positive rate was 8% (95% CI, 4-18); subjects with false positive results had < 1 in 1000 risk of major complications following invasive diagnostic procedures. The most valid estimates for overdiagnosis and significant incidental findings were 8.9% and 7.5%, respectively. DISCUSSION LDCT screening significantly reduced LC mortality, though not overall mortality, with women appearing to benefit more than men. The estimated risks for false positive results, screening complications, overdiagnosis, and incidental findings were low. Long-term survival data were available only for North American and European studies limiting generalizability.
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29
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Marel M, Padr R, Fila L, Rakita D, Casas Mendez F, Capkova L, Capek V, Pavlik R. Biopsy of lung lesions under CT control. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 165:390-394. [PMID: 32955039 DOI: 10.5507/bp.2020.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES With the increasing number of detected lung nodules and the need for morphological verification, the number of CT- controlled biopsies is increasing. The aim of this study was to assess the risks and benefits of these biopsies. METHODS This is a prospective and observational study. We evaluated 101 punctures performed on a group of 90 consecutive patients in the Department of Radiology. RESULTS In patients with a mean age of 66 years, with mostly accidentally detected lung nodules, we observed complications 38 times. The most common were minor pneumothoraxes or insignificant bleedings. In 6 patients, the complications were more serious, 5 times the pneumothoraxes required chest drainage, once massive hemoptysis was recorded. The lesions were successfully biopsied 78 times, the target was missed 23 times. The diagnosis of lung cancer (LC) was confirmed in 60 patients, 49 LCs were verified by puncture under CT control. 42% (25/60) of patients with LC were diagnosed in TNM stages I and II. 23% (14/60) of patients with LC were treated surgically. The remaining 30 patients most often suffered from lung metastazes (13/30), in 8 of them an inflammatory lung disease was diagnosed. 69 patients underwent bronchoscopy, in only 19% (13/69) it contributed to the diagnosis. In a model "screening like" group of 49 patients with only randomly detected lung deposits, we diagnosed LC in 76% (37/49). 49% (18/37) were in TNM stage I and II, 11 were treated surgically. CONCLUSIONS CT-controlled biopsy of lung lesions is an effective and safe diagnostic method.
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Affiliation(s)
- Miloslav Marel
- Department of Pulmonology, University Hospital Motol and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radek Padr
- Department of Radiology, University Hospital Motol, and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Libor Fila
- Department of Pulmonology, University Hospital Motol and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dmitry Rakita
- Department of Pulmonology, University Hospital Motol and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Fernando Casas Mendez
- Department of Pulmonology, University Hospital Motol and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Linda Capkova
- Department of Pathology and Molecular Medicine, University Hospital Motol, and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vaclav Capek
- Bioinformatics Centre, University Hospital Motol, and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radim Pavlik
- Department of Radiology, University Hospital Motol, and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
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30
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Liew CJY, Leong LCH, Teo LLS, Ong CC, Cheah FK, Tham WP, Salahudeen HMM, Lee CH, Kaw GJL, Tee AKH, Tsou IYY, Tay KH, Quah R, Tan BP, Chou H, Tan D, Poh ACC, Tan AGS. A practical and adaptive approach to lung cancer screening: a review of international evidence and position on CT lung cancer screening in the Singaporean population by the College of Radiologists Singapore. Singapore Med J 2020; 60:554-559. [PMID: 31781779 DOI: 10.11622/smedj.2019145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lung cancer is the leading cause of cancer-related death around the world, being the top cause of cancer-related deaths among men and the second most common cause of cancer-related deaths among women in Singapore. Currently, no screening programme for lung cancer exists in Singapore. Since there is mounting evidence indicating a different epidemiology of lung cancer in Asian countries, including Singapore, compared to the rest of the world, a unique and adaptive approach must be taken for a screening programme to be successful at reducing mortality while maintaining cost-effectiveness and a favourable risk-benefit ratio. This review article promotes the use of low-dose computed tomography of the chest and explores the radiological challenges and future directions.
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Affiliation(s)
| | | | - Lynette Li San Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Foong Koon Cheah
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Wei Ping Tham
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | | | - Chau Hung Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | - Augustine Kim Huat Tee
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
| | - Ian Yu Yan Tsou
- Department of Diagnostic Radiology, Mount Elizabeth Hospital, Singapore
| | - Kiang Hiong Tay
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Raymond Quah
- Department of Diagnostic Radiology, Farrer Park Hospital, Singapore
| | - Bien Peng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Hong Chou
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Daniel Tan
- Department of Diagnostic Radiology Oncology, Farrer Park Hospital, Singapore
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31
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Janssens E, van Meerbeeck JP, Lamote K. Volatile organic compounds in human matrices as lung cancer biomarkers: a systematic review. Crit Rev Oncol Hematol 2020; 153:103037. [PMID: 32771940 DOI: 10.1016/j.critrevonc.2020.103037] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022] Open
Abstract
Volatile organic compounds (VOCs) have shown potential as non-invasive breath biomarkers for lung cancer, but their unclear biological origin currently limits clinical applications. This systematic review explores headspace analysis of VOCs in patient-derived body fluids and lung cancer cell lines to pinpoint lung cancer-specific VOCs and uncover their biological origin. A search was performed in the databases MEDLINE and Web of Science. Twenty-two articles were included in this systematic review. Since there is no standardised approach to analyse VOCs, a plethora of techniques and matrices/cell lines were explored, which is reflected in the various VOCs identified. However, comparing VOCs in the headspace of urine, blood and pleural effusions from patients and lung cancer cell lines showed some overlapping VOCs, indicating their potential use in lung cancer diagnosis. This review demonstrates that VOCs are promising biomarkers for lung cancer. However, due to lack of inter-matrix consensus, standardised prospective trials will have to be conducted to validate clinically relevant biomarkers.
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Affiliation(s)
- Eline Janssens
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium; Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium
| | - Jan P van Meerbeeck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium; Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium; Pulmonology and Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Kevin Lamote
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium; Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium; Department of Internal Medicine, Ghent University, Ghent, Belgium.
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32
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Serum cotinine verification of self-reported smoking status among adults eligible for lung cancer screening in the 1999-2018 National Health and Nutrition Examination Survey. Lung Cancer 2020; 144:49-56. [DOI: 10.1016/j.lungcan.2020.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/15/2022]
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33
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34
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Martín-Sánchez JC, González-Marrón A, Lidón-Moyano C, Matilla-Santander N, Fu M, Vidal C, Garcia M, Martinez-Sanchez JM. Smoking pattern and risk of lung cancer among women participating in cancer screening programmes. J Public Health (Oxf) 2020; 42:90-97. [PMID: 30608591 DOI: 10.1093/pubmed/fdy221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/25/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The aim of this study was to describe the smoking prevalence, the smoking pattern, and the risk of lung cancer among women who participated in a cancer screening (breast, cervical and colorectal) in Spain. METHODS We used data from the Spanish National Health Survey of 2011-12, a cross-sectional study of the adult Spanish population from women in the age of participation in the population cancer screening. We used two definitions of the high risk of lung cancer according to the National Lung Screening Trial (NLST) criteria and the NELSON criteria. RESULTS Participation in screening was 76.6% in breast cancer, 6.6% in colorectal cancer, and 70.3% in cervical cancer. The percentage of current smokers was 17.1 of women who participated breast cancer, 15.4 of women who participated colorectal cancer, and 26.1 of women who participated cervical cancer. According to NLST criteria, the percentage of current smokers women who had a high risk of lung cancer was 23.1 for breast cancer, 23.5 for colorectal cancer and 4.5 for cervical cancer. These figures were higher with the NELSON criteria. CONCLUSION At least 250 000 women in Spain have a high risk of lung cancer and are participating in a cancer screening programme. These programmes might be an opportunity for implementing specific interventions aiming to reduce this risk.
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Affiliation(s)
- Juan C Martín-Sánchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Adrián González-Marrón
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Cristina Lidón-Moyano
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Nuria Matilla-Santander
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Programme, Catalan Institute of Oncology (ICO), 08908 L'Hospitalet de Llobregat, Spain.,Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute-IDIBELL, 08908 L'Hospitalet de Llobregat, Spain
| | - Carmen Vidal
- Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute-IDIBELL, 08908 L'Hospitalet de Llobregat, Spain.,Cancer Screening Unit, Cancer Prevention and Control Programme, Catalan Institute of Oncology (ICO), 08908 L'Hospitalet de Llobregat, Spain
| | - Montse Garcia
- Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute-IDIBELL, 08908 L'Hospitalet de Llobregat, Spain.,Cancer Screening Unit, Cancer Prevention and Control Programme, Catalan Institute of Oncology (ICO), 08908 L'Hospitalet de Llobregat, Spain
| | - Jose M Martinez-Sanchez
- Group of Evaluation of Health Determinants and Health Policies, Department of Basic Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallès, Spain.,Tobacco Control Unit, Cancer Prevention and Control Programme, Catalan Institute of Oncology (ICO), 08908 L'Hospitalet de Llobregat, Spain.,Cancer Control and Prevention Group, Bellvitge Biomedical Research Institute-IDIBELL, 08908 L'Hospitalet de Llobregat, Spain
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35
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Nardi Agmon I, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Respir J 2020; 55:13993003.00506-2019. [PMID: 32051182 DOI: 10.1183/13993003.00506-2019] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Dept of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, CH Lyon Sud, Pierre Bénite, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Dept of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Dept of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Dept of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Dept of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital Sotiria, Athens, Greece
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36
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Kauczor HU, Baird AM, Blum TG, Bonomo L, Bostantzoglou C, Burghuber O, Čepická B, Comanescu A, Couraud S, Devaraj A, Jespersen V, Morozov S, Agmon IN, Peled N, Powell P, Prosch H, Ravara S, Rawlinson J, Revel MP, Silva M, Snoeckx A, van Ginneken B, van Meerbeeck JP, Vardavas C, von Stackelberg O, Gaga M. ESR/ERS statement paper on lung cancer screening. Eur Radiol 2020; 30:3277-3294. [PMID: 32052170 DOI: 10.1007/s00330-020-06727-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022]
Abstract
In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.
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Affiliation(s)
- Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany.
| | - Anne-Marie Baird
- Central Pathology Laboratory, Trinity College Dublin, St. James's Hospital, Dublin, Ireland
| | | | - Lorenzo Bonomo
- Department of Radiology, Policlinico Universitario Agostino Gemelli, Rome, Italy
| | | | | | | | | | - Sébastien Couraud
- Service de Pneumologie et Oncologie Thoracique, Hospices Civils de Lyon, Sud, Pierre Bénite, Lyon, CH, France.,Faculté de Médecine et de Maïeutique Lyon Sud - Charles Mérieux, Université Claude Bernard Lyon I, Oullins, France
| | | | | | - Sergey Morozov
- Department of Health Care of Moscow, Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Moscow, Russian Federation
| | | | - Nir Peled
- Thoracic Cancer Unit, Rabin Medical Center, Petach Tiqwa, Israel
| | | | - Helmut Prosch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sofia Ravara
- Medical Sciences, Faculty of Health Sciences, University of Beira Interior, Covilha, Portugal.,Tobacco Cessation Unit, CHCB University Hospital, Covilha, Portugal
| | | | | | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Bram van Ginneken
- Image Sciences Institute, University Medical Centre, Utrecht, The Netherlands.,Department of Radiology, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Constantine Vardavas
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece.,Center for Global Tobacco Control, Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Oyunbileg von Stackelberg
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, German Center of Lung Research, INF 110, 69120, Heidelberg, Germany
| | - Mina Gaga
- 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
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37
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Advani S, Braithwaite D. Optimizing selection of candidates for lung cancer screening: role of comorbidity, frailty and life expectancy. Transl Lung Cancer Res 2019; 8:S454-S459. [PMID: 32038937 PMCID: PMC6987350 DOI: 10.21037/tlcr.2019.10.03] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 09/23/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Shailesh Advani
- Cancer Prevention and Control Program, Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
- Social Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Dejana Braithwaite
- Cancer Prevention and Control Program, Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
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38
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Liao F, Liang M, Li Z, Hu X, Song S. Evaluate the Malignancy of Pulmonary Nodules Using the 3-D Deep Leaky Noisy-OR Network. IEEE TRANSACTIONS ON NEURAL NETWORKS AND LEARNING SYSTEMS 2019; 30:3484-3495. [PMID: 30794190 DOI: 10.1109/tnnls.2019.2892409] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Automatic diagnosing lung cancer from computed tomography scans involves two steps: detect all suspicious lesions (pulmonary nodules) and evaluate the whole-lung/pulmonary malignancy. Currently, there are many studies about the first step, but few about the second step. Since the existence of nodule does not definitely indicate cancer, and the morphology of nodule has a complicated relationship with cancer, the diagnosis of lung cancer demands careful investigations on every suspicious nodule and integration of information of all nodules. We propose a 3-D deep neural network to solve this problem. The model consists of two modules. The first one is a 3-D region proposal network for nodule detection, which outputs all suspicious nodules for a subject. The second one selects the top five nodules based on the detection confidence, evaluates their cancer probabilities, and combines them with a leaky noisy-OR gate to obtain the probability of lung cancer for the subject. The two modules share the same backbone network, a modified U-net. The overfitting caused by the shortage of the training data is alleviated by training the two modules alternately. The proposed model won the first place in the Data Science Bowl 2017 competition.
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39
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Li X, Shen L, Xie X, Huang S, Xie Z, Hong X, Yu J. Multi-resolution convolutional networks for chest X-ray radiograph based lung nodule detection. Artif Intell Med 2019; 103:101744. [PMID: 31732411 DOI: 10.1016/j.artmed.2019.101744] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
Lung cancer is the leading cause of cancer death worldwide. Early detection of lung cancer is helpful to provide the best possible clinical treatment for patients. Due to the limited number of radiologist and the huge number of chest x-ray radiographs (CXR) available for observation, a computer-aided detection scheme should be developed to assist radiologists in decision-making. While deep learning showed state-of-the-art performance in several computer vision applications, it has not been used for lung nodule detection on CXR. In this paper, a deep learning-based lung nodule detection method was proposed. We employed patch-based multi-resolution convolutional networks to extract the features and employed four different fusion methods for classification. The proposed method shows much better performance and is much more robust than those previously reported researches. For publicly available Japanese Society of Radiological Technology (JSRT) database, more than 99% of lung nodules can be detected when the false positives per image (FPs/image) was 0.2. The FAUC and R-CPM of the proposed method were 0.982 and 0.987, respectively. The proposed approach has the potential of applications in clinical practice.
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Affiliation(s)
- Xuechen Li
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, Guangdong province, PR China; Shenzhen Institute of Artificial Intelligence and Robotics for Society, PR China; Guangdong Key Laboratory of Itelligent Information Processing, Guangdong Laboratory of Artificial Intelligence and Digital Economy (SZ), Shenzhen University, PR China
| | - Linlin Shen
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, Guangdong province, PR China; Shenzhen Institute of Artificial Intelligence and Robotics for Society, PR China; Guangdong Key Laboratory of Itelligent Information Processing, Guangdong Laboratory of Artificial Intelligence and Digital Economy (SZ), Shenzhen University, PR China.
| | - Xinpeng Xie
- College of Computer Science and Software Engineering, Shenzhen University, Shenzhen, Guangdong province, PR China
| | - Shiyun Huang
- Sun Yat-Sen University Public Health Insititue, Guangzhou, Guangdong province, PR China.
| | - Zhien Xie
- GuangzhHou Thoracic Hospital, Guangzhou, Guangdong province, PR China.
| | - Xian Hong
- GuangzhHou Thoracic Hospital, Guangzhou, Guangdong province, PR China
| | - Juan Yu
- Imaging Department of Shenzhen University Health Science Center, Shenzhen University School of Medicine, Shenzhen Second People's Hospital, First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, PR China.
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40
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Wood DE, Kazerooni EA, Baum SL, Eapen GA, Ettinger DS, Hou L, Jackman DM, Klippenstein D, Kumar R, Lackner RP, Leard LE, Lennes IT, Leung ANC, Makani SS, Massion PP, Mazzone P, Merritt RE, Meyers BF, Midthun DE, Pipavath S, Pratt C, Reddy C, Reid ME, Rotter AJ, Sachs PB, Schabath MB, Schiebler ML, Tong BC, Travis WD, Wei B, Yang SC, Gregory KM, Hughes M. Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2019; 16:412-441. [PMID: 29632061 DOI: 10.6004/jnccn.2018.0020] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.
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41
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[Lung cancer screening]. Radiologe 2019; 59:19-22. [PMID: 30542924 DOI: 10.1007/s00117-018-0478-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CLINICAL/METHODICAL ISSUE The National Lung Screening Trial (NLST) in 2011 was able to prove for the first time that screening with a low-dose CT can reduce lung carcinoma mortality by 20%. Despite the positive outcome of the NLST, there is-unlike in the USA-currently no systematic lung cancer screening in Europe. This is partly because several significantly smaller screening studies in Europe failed to show any improvement in lung cancer mortality. STANDARD RADIOLOGICAL METHODS On the other hand, Europe's healthcare systems differ substantially from those in the United States, so that a direct transfer of US experience to Europe is not possible. For this reason, guidelines for lung cancer screening must be developed in the individual European countries to ensure that lung cancer mortality can be reduced by means of a quality-assured and cost-effective lung cancer screening. PRACTICAL RECOMMENDATIONS The experience and the expected results of the European screening studies can provide valuable help for these purposes.
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42
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Huang KL, Wang SY, Lu WC, Chang YH, Su J, Lu YT. Effects of low-dose computed tomography on lung cancer screening: a systematic review, meta-analysis, and trial sequential analysis. BMC Pulm Med 2019; 19:126. [PMID: 31296196 PMCID: PMC6625016 DOI: 10.1186/s12890-019-0883-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/21/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Nelson mortality results were presented in September 2018. Four other randomized control trials (RCTs) were also reported the latest mortality outcomes in 2018 and 2019. We therefore conducted a meta-analysis to update the evidence and investigate the benefits and harms of low-dose computed tomography (LDCT) in lung cancer screening. METHODS Detailed electronic database searches were performed to identify reports of RCTs that comparing LDCT to any other type of lung cancer screening. Pooled risk ratios (RRs) were calculated using random effects models. RESULTS We identified nine RCTs (n = 97,244 participants). In pooled analyses LDCT reduced lung cancer mortality (RR 0.83, 95% CI 0.76-0.90, I2 = 1%) but had no effect on all-cause mortality (RR 0.95, 95% CI 0.90-1.00). Trial sequential analysis (TSA) confirmed the results of our meta-analysis. Subgroup defined by high quality trials benefitted from LDCT screening in reducing lung cancer mortality (RR 0.82, 95% CI 0.73-0.91, I2 = 7%), whereas no benefit observed in other low quality RCTs. LDCT was associated with detection of a significantly higher number of early stage lung cancers than the control. No significant difference (RR 0.64, 95% CI 0.30-1.33) was found in mortality after invasive procedures between two groups. CONCLUSIONS In meta-analysis based on sufficient evidence demonstrated by TSA suggests that LDCT screening is superiority over usual care in lung cancer survival. The benefit of LDCT is expected to be heavily influenced by the risk of lung cancer in the different target group (smoking status, Asian) being screened.
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Affiliation(s)
- Kai-Lin Huang
- Department of Pharmacy, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449 Taiwan
- Mackay Junior College of Medicine, Nursing, and Management, No. 92, Shengjing Road, Beitou District, Taipei, 11272 Taiwan
| | - Shih-Yuan Wang
- Department of Pharmacy, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449 Taiwan
| | - Wan-Chen Lu
- Department of Pharmacy, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449 Taiwan
| | - Ya-Hui Chang
- Department of Pharmacy, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449 Taiwan
| | - Jian Su
- Department of Chest Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449 Taiwan
- Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252 Taiwan
| | - Yen-Ta Lu
- Department of Chest Medicine, MacKay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449 Taiwan
- Department of Medicine, Mackay Medical College, No. 46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252 Taiwan
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Crosbie PA, Balata H, Evison M, Atack M, Bayliss-Brideaux V, Colligan D, Duerden R, Eaglesfield J, Edwards T, Elton P, Foster J, Greaves M, Hayler G, Higgins C, Howells J, Irion K, Karunaratne D, Kelly J, King Z, Lyons J, Manson S, Mellor S, Miller D, Myerscough A, Newton T, O'Leary M, Pearson R, Pickford J, Sawyer R, Screaton NJ, Sharman A, Simmons M, Smith E, Taylor B, Taylor S, Walsham A, Watts A, Whittaker J, Yarnell L, Threlfall A, Barber PV, Tonge J, Booton R. Second round results from the Manchester 'Lung Health Check' community-based targeted lung cancer screening pilot. Thorax 2019; 74:700-704. [PMID: 30420406 PMCID: PMC6585285 DOI: 10.1136/thoraxjnl-2018-212547] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 10/12/2018] [Accepted: 10/22/2018] [Indexed: 12/02/2022]
Abstract
We report results from the second annual screening round (T1) of Manchester's 'Lung Health Check' pilot of community-based lung cancer screening in deprived areas (undertaken June to August 2017). Screening adherence was 90% (n=1194/1323): 92% of CT scans were classified negative, 6% indeterminate and 2.5% positive; there were no interval cancers. Lung cancer incidence was 1.6% (n=19), 79% stage I, treatments included surgery (42%, n=9), stereotactic ablative radiotherapy (26%, n=5) and radical radiotherapy (5%, n=1). False-positive rate was 34.5% (n=10/29), representing 0.8% of T1 participants (n=10/1194). Targeted community-based lung cancer screening promotes high screening adherence and detects high rates of early stage lung cancer.
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Affiliation(s)
- Phil A Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Molecular and Clinical Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Haval Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Melanie Atack
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Val Bayliss-Brideaux
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Denis Colligan
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Rebecca Duerden
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Josephine Eaglesfield
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Timothy Edwards
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Peter Elton
- Greater Manchester, Lancashire, South Cumbria Strategic Clinical Network, Manchester, UK
| | | | - Melanie Greaves
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Graham Hayler
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Coral Higgins
- Manchester Health and Care Commissioning, Manchester, UK
| | - John Howells
- Department of Radiology, Royal Preston Hospital, Preston, UK
| | - Klaus Irion
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Devinda Karunaratne
- Department of Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jodie Kelly
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Zoe King
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Judith Lyons
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sarah Manson
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stuart Mellor
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Amanda Myerscough
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Tom Newton
- Department of Radiology, Royal Blackburn Hospital, Blackburn, UK
| | | | - Rachel Pearson
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | | | - Richard Sawyer
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Anna Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Maggi Simmons
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Elaine Smith
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ben Taylor
- Department of Radiology, Christie NHS Foundation Trust, Manchester, UK
| | - Sarah Taylor
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anna Walsham
- Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Angela Watts
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - James Whittaker
- Department of Radiology, Stockport NHS Foundation Trust, Stockport, UK
| | - Laura Yarnell
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Anthony Threlfall
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
| | - Phil V Barber
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Janet Tonge
- Manchester Clinical Commissioning Group, Macmillan Cancer Improvement Partnership, Manchester, UK
- Manchester Health and Care Commissioning, Manchester, UK
| | - Richard Booton
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Becker N, Motsch E, Trotter A, Heussel CP, Dienemann H, Schnabel PA, Kauczor HU, Maldonado SG, Miller AB, Kaaks R, Delorme S. Lung cancer mortality reduction by LDCT screening-Results from the randomized German LUSI trial. Int J Cancer 2019; 146:1503-1513. [PMID: 31162856 DOI: 10.1002/ijc.32486] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/09/2019] [Indexed: 11/08/2022]
Abstract
In 2011, the U.S. National Lung Cancer Screening Trial (NLST) reported a 20% reduction of lung cancer mortality after regular screening by low-dose computed tomography (LDCT), as compared to X-ray screening. The introduction of lung cancer screening programs in Europe awaits confirmation of these first findings from European trials that started in parallel with the NLST. The German Lung cancer Screening Intervention (LUSI) is a randomized trial among 4,052 long-term smokers, 50-69 years of age, recruited from the general population, comparing five annual rounds of LDCT screening (screening arm; n = 2,029 participants) with a control arm (n = 2,023) followed by annual postal questionnaire inquiries. Data on lung cancer incidence and mortality and vital status were collected from hospitals or office-based physicians, cancer registries, population registers and health offices. Over an average observation time of 8.8 years after randomization, the hazard ratio for lung cancer mortality was 0.74 (95% CI: 0.46-1.19; p = 0.21) among men and women combined. Modeling by sex, however showed a statistically significant reduction in lung cancer mortality among women (HR = 0.31 [95% CI: 0.10-0.96], p = 0.04), but not among men (HR = 0.94 [95% CI: 0.54-1.61], p = 0.81) screened by LDCT (pheterogeneity = 0.09). Findings from LUSI are in line with those from other trials, including NLST, that suggest a stronger reduction of lung cancer mortality after LDCT screening among women as compared to men. This heterogeneity could be the result of different relative counts of lung tumor subtypes occurring in men and women.
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Affiliation(s)
- Nikolaus Becker
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Erna Motsch
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anke Trotter
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Claus P Heussel
- Department of Radiology, Thoraxklinik Heidelberg, Heidelberg University, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, Heidelberg University Clinic, Heidelberg, Germany.,Member of the German Center for Lung Research (DZL), Translational Lung Research Center (TLRC), Heidelberg, Germany
| | - Hendrik Dienemann
- Member of the German Center for Lung Research (DZL), Translational Lung Research Center (TLRC), Heidelberg, Germany.,Department of Surgery, Thoraxklinik Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Philipp A Schnabel
- Member of the German Center for Lung Research (DZL), Translational Lung Research Center (TLRC), Heidelberg, Germany.,Institute of Pathology, University of Saarland, Homburg (Saar), Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Clinic, Heidelberg, Germany.,Member of the German Center for Lung Research (DZL), Translational Lung Research Center (TLRC), Heidelberg, Germany
| | - Sandra González Maldonado
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Member of the German Center for Lung Research (DZL), Translational Lung Research Center (TLRC), Heidelberg, Germany
| | - Anthony B Miller
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Member of the German Center for Lung Research (DZL), Translational Lung Research Center (TLRC), Heidelberg, Germany
| | - Stefan Delorme
- Member of the German Center for Lung Research (DZL), Translational Lung Research Center (TLRC), Heidelberg, Germany.,Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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45
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Yoon HY, Bae JY, Kim Y, Shim SS, Park S, Park SY, Kim SJ, Ryu YJ, Chang JH, Lee JH. Risk factors associated with an increase in the size of ground-glass lung nodules on chest computed tomography. Thorac Cancer 2019; 10:1544-1551. [PMID: 31155851 PMCID: PMC6610277 DOI: 10.1111/1759-7714.13098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/02/2019] [Accepted: 05/03/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The detection rate of ground-glass nodules (GGNs) in the lung has increased with the increased use of low-dose computed tomography (CT) of the chest for cancer screening; however, limited data is available on the natural history, follow-up, and treatment of GGNs. The aim of this study was to identify factors associated with an increase in the size of GGNs. METHODS A total of 338 patients (mean ages, 59.8 years; males, 35.5%) with 689 nodules who underwent chest CT at our institute between June 2004 and February 2014 were included in this study. The cut-off date of follow-up was August 2018. We analyzed the size, solidity, number, and margins of the nodules compared with their appearance on previous chest CT images. The Cox proportional hazard model was used to identify risk factors associated with nodule growth. RESULTS The median follow-up period was 21.8 months. Of the 338 patients, 38.5% had a history of malignancy, including lung cancer (8.9%). Among the 689 nodules, the median size of the lesions was 6.0 mm (IQR, 5-8 mm), and the proportion of nodules with size ≥10 mm and multiplicity was 17.1% and 66.3%, respectively. Compared to the nodules without an increase in size, the 79 nodules with an increase in size during the follow-up period were initially larger (growth group, 7.0 mm vs. non-growth group, 6.0 mm; P = 0.027), more likely to have a size ≥10 mm (26.6% vs. 15.9%; P = 0.018), and had less frequent multiplicity (54.4% vs. 67.9%, P = 0.028). In the multivariate analysis, nodule size ≥10 mm (hazard ratio [HR], 2.044; P = 0.005), a patient history of lung cancer (HR: 2.190, P = 0.006), and solitary nodule (HR: 2.499, P < 0.001) were independent risk factors for nodule growth. CONCLUSION Careful follow-up of GGNs is warranted in patients with a history of malignancy, a large , or a solitary nodule.
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Affiliation(s)
- Hee-Young Yoon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Ji-Yun Bae
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yookyung Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sung Shin Shim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Sojung Park
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - So-Young Park
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Soo Jung Kim
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Yon Ju Ryu
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jung Hyun Chang
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea
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46
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Sharma A, Kasza K, Hyland A, Cummings KM, Bansal-Travers M, Fong GT, O'Connor RJ. Awareness and interest in lung cancer screening among current and former smokers: findings from the ITC United States Survey. Cancer Causes Control 2019; 30:733-745. [PMID: 31123842 DOI: 10.1007/s10552-019-01186-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 05/16/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE To examine the awareness of low-dose computed tomography (LDCT) lung cancer screening among a population of current and former smokers using a nationally representative sample from the United States. METHODS Data for this study come from Wave 9 of the International Tobacco Control (ITC) United States Survey, conducted between 2013 and 2015. Among respondents age ≥ 40 (n = 1145), a 50% random sample were asked a series of questions pertaining to lung cancer screening. This study examines awareness and screening behaviors in relationship to demographic characteristics of respondents, health beliefs, psychosocial behaviors, and smoking behaviors. Descriptive tables and χ2 tests were used to examine the association between those who were aware and unaware. Logistic regression analyses were conducted, stratified on respondents' smoking status. Data were weighed to be representative of the current smoking population in the US. RESULTS Overall, 52% of current and former smokers reported being aware of lung cancer screening. Among the group with no prior screening, 80.6% said they would take a lung cancer screening exam if recommended by their physician. In the multivariate models, former smokers had significantly greater awareness of lung cancer screening compared to current smokers [odds ratio 1.42 (95% confidence interval 1.03, 1.97)]. CONCLUSIONS Awareness of LDCT lung cancer screening was lower among current smokers compared to former smokers. Most smokers who had not ever been screened said they would have lung cancer screening if it were recommended by their physician, demonstrating the need for healthcare providers to encourage those eligible for screening to take the test.
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Affiliation(s)
- Anushree Sharma
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karin Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14263, USA. Richard.O'
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47
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Snowsill T, Yang H, Griffin E, Long L, Varley-Campbell J, Coelho H, Robinson S, Hyde C. Low-dose computed tomography for lung cancer screening in high-risk populations: a systematic review and economic evaluation. Health Technol Assess 2019; 22:1-276. [PMID: 30518460 DOI: 10.3310/hta22690] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diagnosis of lung cancer frequently occurs in its later stages. Low-dose computed tomography (LDCT) could detect lung cancer early. OBJECTIVES To estimate the clinical effectiveness and cost-effectiveness of LDCT lung cancer screening in high-risk populations. DATA SOURCES Bibliographic sources included MEDLINE, EMBASE, Web of Science and The Cochrane Library. METHODS Clinical effectiveness - a systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programmes [such as chest X-ray (CXR)] was conducted. Bibliographic sources included MEDLINE, EMBASE, Web of Science and The Cochrane Library. Meta-analyses, including network meta-analyses, were performed. Cost-effectiveness - an independent economic model employing discrete event simulation and using a natural history model calibrated to results from a large RCT was developed. There were 12 different population eligibility criteria and four intervention frequencies [(1) single screen, (2) triple screen, (3) annual screening and (4) biennial screening] and a no-screening control arm. RESULTS Clinical effectiveness - 12 RCTs were included, four of which currently contribute evidence on mortality. Meta-analysis of these demonstrated that LDCT, with ≤ 9.80 years of follow-up, was associated with a non-statistically significant decrease in lung cancer mortality (pooled relative risk 0.94, 95% confidence interval 0.74 to 1.19). The findings also showed that LDCT screening demonstrated a non-statistically significant increase in all-cause mortality. Given the considerable heterogeneity detected between studies for both outcomes, the results should be treated with caution. Network meta-analysis, including six RCTs, was performed to assess the relative clinical effectiveness of LDCT, CXR and usual care. The results showed that LDCT was ranked as the best screening strategy in terms of lung cancer mortality reduction. CXR had a 99.7% probability of being the worst intervention and usual care was ranked second. Cost-effectiveness - screening programmes are predicted to be more effective than no screening, reduce lung cancer mortality and result in more lung cancer diagnoses. Screening programmes also increase costs. Screening for lung cancer is unlikely to be cost-effective at a threshold of £20,000/quality-adjusted life-year (QALY), but may be cost-effective at a threshold of £30,000/QALY. The incremental cost-effectiveness ratio for a single screen in smokers aged 60-75 years with at least a 3% risk of lung cancer is £28,169 per QALY. Sensitivity and scenario analyses were conducted. Screening was only cost-effective at a threshold of £20,000/QALY in only a minority of analyses. LIMITATIONS Clinical effectiveness - the largest of the included RCTs compared LDCT with CXR screening rather than no screening. Cost-effectiveness - a representative cost to the NHS of lung cancer has not been recently estimated according to key variables such as stage at diagnosis. Certain costs associated with running a screening programme have not been included. CONCLUSIONS LDCT screening may be clinically effective in reducing lung cancer mortality, but there is considerable uncertainty. There is evidence that a single round of screening could be considered cost-effective at conventional thresholds, but there is significant uncertainty about the effect on costs and the magnitude of benefits. FUTURE WORK Clinical effectiveness and cost-effectiveness estimates should be updated with the anticipated results from several ongoing RCTs [particularly the NEderlands Leuvens Longkanker Screenings ONderzoek (NELSON) screening trial]. STUDY REGISTRATION This study is registered as PROSPERO CRD42016048530. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Tristan Snowsill
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Huiqin Yang
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Ed Griffin
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Linda Long
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Jo Varley-Campbell
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Helen Coelho
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Chris Hyde
- Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK.,Exeter Test Group, University of Exeter Medical School, Exeter, UK
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48
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Donnelly EF, Kazerooni EA, Lee E, Henry TS, Boiselle PM, Crabtree TD, Iannettoni MD, Johnson GB, Laroia AT, Maldonado F, Olsen KM, Shim K, Sirajuddin A, Wu CC, Kanne JP. ACR Appropriateness Criteria ® Lung Cancer Screening. J Am Coll Radiol 2019; 15:S341-S346. [PMID: 30392603 DOI: 10.1016/j.jacr.2018.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/07/2018] [Indexed: 02/04/2023]
Abstract
Lung cancer remains the leading cause of cancer death in both men and women. Smoking is the single greatest risk factor for the development of lung cancer. For patients between the age of 55 and 80 with 30 or more pack years smoking history who currently smoke or who have quit within the last 15 years should undergo lung cancer screening with low-dose CT. In patients who do not meet these criteria but who have additional risk factors for lung cancer, lung cancer screening with low-dose CT is controversial but may be appropriate. Imaging is not recommended for lung cancer screening of patient younger than 50 years of age or patients older than 80 years of age or patients of any age with less than 20 packs per year history of smoking and no additional risk factor (ie, radon exposure, occupational exposure, cancer history, family history of lung cancer, history of COPD, or history of pulmonary fibrosis). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Edwin F Donnelly
- Panel Chair, Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | - Elizabeth Lee
- Research Author, University of Michigan Health System, Ann Arbor, Michigan
| | - Travis S Henry
- Panel Vice-Chair, University of California San Francisco, San Francisco, California
| | - Phillip M Boiselle
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Traves D Crabtree
- Southern Illinois University School of Medicine, Springfield, Illinois; The Society of Thoracic Surgeons
| | - Mark D Iannettoni
- University of Iowa, Iowa City, Iowa; The Society of Thoracic Surgeons
| | | | | | - Fabien Maldonado
- Vanderbilt University Medical Center, Nashville, Tennessee; American College of Chest Physicians
| | | | - Kyungran Shim
- John H. Stroger Jr Hospital of Cook County, Chicago, Illinois; American College of Physicians
| | | | - Carol C Wu
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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49
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Robins M, Solomon J, Koweek LMH, Christensen J, Samei E. Validation of lesion simulations in clinical CT data for anonymized chest and abdominal CT databases. Med Phys 2019; 46:1931-1937. [PMID: 30703259 DOI: 10.1002/mp.13412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 12/04/2018] [Accepted: 01/18/2019] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To make available to the medical imaging community a computed tomography (CT) image database composed of hybrid datasets (patient CT images with digitally inserted anthropomorphic lesions) where lesion ground truth is known a priori. It is envisioned that such a dataset could be a resource for the assessment of CT image quality, machine learning, and imaging technologies [e.g., computer aided detection (CAD) and segmentation algorithms]. ACQUISITION AND VALIDATION METHODS This HIPPA compliant, IRB waiver of approval study consisted of utilizing 120 chest and 100 abdominal clinically acquired adult CT exams. One image series per patient exam was utilized based on coverage of the anatomical region of interest (either the thorax or abdomen). All image series were de-identified. Simulated lesions were derived from a library of anatomically informed digital lesions (93 lung and 50 liver lesions) where six and four digital lesions with nominal diameters ranging from 4 to 20 mm were inserted into lung and liver image series, respectively. Locations for lesion insertion were randomly chosen. A previously validated lesion simulation and virtual insertion technique were utilized. The resulting hybrid images were reviewed by three experienced radiologists to assure similarity with routine clinical imaging in a diverse adult population. DATA FORMAT AND USAGE NOTES The database is composed of four datasets that contain 100 patient cases each, for a total of 400 image series accompanied by Matlab.mat tables that provide descriptive information about the virtually inserted lesions (i.e., size, shape, opacity, and insertion location in physical (world) coordinates and voxel indices). All image and metadata are stored in DICOM format on the Quantitative Imaging Data Warehouse (https://qidw.rsna.org/#collection/57d463471cac0a4ec8ff8f46/folder/5b23dceb1cac0a4ec800a770?dialog=login), in two sets: (a) QIBA CT Hybrid Dataset I which contains Lung I and Liver I datasets, and (b) QIBA CT Hybrid Dataset II which contains Lung II and Liver II datasets. The QIDW is supported by the Radiological Society of North America (RSNA). Registration is required upon initial log in. POTENTIAL APPLICATIONS By simulating lesion opacity (full solid, part solid and ground glass), size, and texture, the relationship between lesion morphology and segmentation or CAD algorithm performance can be investigated without the need for repetitive patient exams. This database can also serve as a reference standard for device and reader performance studies.
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Affiliation(s)
- Marthony Robins
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Medical Physics Graduate Program, Duke University Medical Center, Durham, NC, 27705, USA
| | - Justin Solomon
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Medical Physics Graduate Program, Duke University Medical Center, Durham, NC, 27705, USA
| | - Lynne M Hurwitz Koweek
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Medical Physics Graduate Program, Duke University Medical Center, Durham, NC, 27705, USA
| | - Jared Christensen
- Department of Radiology, Duke University Medical Center, Durham, NC, 27705, USA
| | - Ehsan Samei
- Carl E. Ravin Advanced Imaging Laboratories, Department of Radiology, Medical Physics Graduate Program, Duke University Medical Center, Durham, NC, 27705, USA.,Departments of Biomedical Engineering, Electrical and Computer Engineering, and Physics, Duke University Medical Center, Durham, NC, 27705, USA
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50
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Yang H, Varley-Campbell J, Coelho H, Long L, Robinson S, Snowsill T, Griffin E, Peters J, Hyde C. Do we know enough about the effect of low-dose computed tomography screening for lung cancer on survival to act? A systematic review, meta-analysis and network meta-analysis of randomised controlled trials. Diagn Progn Res 2019; 3:23. [PMID: 31890897 PMCID: PMC6933743 DOI: 10.1186/s41512-019-0067-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 10/18/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Diagnosis of lung cancer frequently occurs in its later stages. Low-dose computed tomography (LDCT) could detect lung cancer early. METHODS Our objective was to estimate the effect of LDCT lung cancer screening on mortality in high-risk populations. A systematic review of randomised controlled trials (RCTs) comparing LDCT screening programmes with usual care (no screening) or other imaging screening programme (such as chest X-ray (CXR)) was conducted. RCTs of CXR screening were additionally included in the network meta-analysis. Bibliographic sources including MEDLINE, Embase, Web of Science and the Cochrane Library were searched to January 2017. All key review steps were done by two persons. Quality assessment used the Cochrane Risk of Bias tool. Meta-analyses were performed. RESULTS Four RCTs were included. More will provide data in the future. Meta-analysis demonstrated that LDCT screening with up to 9.80 years of follow-up was associated with a statistically non-significant decrease in lung cancer mortality (pooled relative risk (RR) 0.94, 95% confidence interval (CI) 0.74 to 1.19; p = 0.62). There was a statistically non-significant increase in all-cause mortality. Given the considerable heterogeneity for both outcomes, the results should be treated with caution.Network meta-analysis including the four original RCTs plus two further RCTs assessed the relative effectiveness of LDCT, CXR and usual care. The results showed that in terms of lung cancer mortality reduction LDCT was ranked as the best screening strategy, CXR screening as the worst strategy and usual care intermediate. CONCLUSIONS LDCT screening may be effective in reducing lung cancer mortality but there is considerable uncertainty: the largest of the RCTs compared LDCT with CXR screening rather than no screening; there is imprecision of the estimates; and there is important heterogeneity between the included study results. The uncertainty about the effect on all-cause mortality is even greater. Maturing trials may resolve the uncertainty.
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Affiliation(s)
- Huiqin Yang
- 0000 0004 1936 8024grid.8391.3Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Jo Varley-Campbell
- 0000 0004 1936 8024grid.8391.3Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Helen Coelho
- 0000 0004 1936 8024grid.8391.3Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Linda Long
- 0000 0004 1936 8024grid.8391.3Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- 0000 0004 1936 8024grid.8391.3Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Tristan Snowsill
- 0000 0004 1936 8024grid.8391.3Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Ed Griffin
- 0000 0004 1936 8024grid.8391.3Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
| | - Jaime Peters
- 0000 0004 1936 8024grid.8391.3Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
- 0000 0004 1936 8024grid.8391.3Exeter Test Group, University of Exeter Medical School, Exeter, UK
| | - Chris Hyde
- 0000 0004 1936 8024grid.8391.3Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
- 0000 0004 1936 8024grid.8391.3Exeter Test Group, University of Exeter Medical School, Exeter, UK
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