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Zhu Y, Yip R, Jirapatnakul AC, Huang M, Cai Q, Dayan E, Liu L, Reeves AP, Henschke CI, Yankelevitz DF. Visual scoring of osteoporosis on low-dose CT in lung cancer screening population. Clin Imaging 2024; 109:110115. [PMID: 38547669 DOI: 10.1016/j.clinimag.2024.110115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVES The risk factors for lung cancer screening eligibility, age as well as smoking history, are also present for osteoporosis. This study aims to develop a visual scoring system to identify osteoporosis that can be applied to low-dose CT scans obtained for lung cancer screening. MATERIALS AND METHODS We retrospectively reviewed 1000 prospectively enrolled participants in the lung cancer screening program at the Mount Sinai Hospital. Optimal window width and level settings for the visual assessment were chosen based on a previously described approach. Visual scoring of osteoporosis and automated measurement using dedicated software were compared. Inter-reader agreement was conducted using six readers with different levels of experience who independently visually assessed 30 CT scans. RESULTS Based on previously validated formulas for choosing window and level settings, we chose osteoporosis settings of Width = 230 and Level = 80. Of the 1000 participants, automated measurement was successfully performed on 774 (77.4 %). Among these, 138 (17.8 %) had osteoporosis. There was a significant correlation between the automated measurement and the visual score categories for osteoporosis (Kendall's Tau = -0.64, p < 0.0001; Spearman's rho = -0.77, p < 0.0001). We also found substantial to excellent inter-reader agreement on the osteoporosis classification among the 6 radiologists (Fleiss κ = 0.91). CONCLUSIONS Our study shows that a simple approach of applying specific window width and level settings to already reconstructed sagittal images obtained in the context of low-dose CT screening for lung cancer is highly feasible and useful in identifying osteoporosis.
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Affiliation(s)
- Yeqing Zhu
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy L. Place, New York, NY 10029, United States of America
| | - Rowena Yip
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy L. Place, New York, NY 10029, United States of America
| | - Artit C Jirapatnakul
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy L. Place, New York, NY 10029, United States of America
| | - Mingqian Huang
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy L. Place, New York, NY 10029, United States of America
| | - Qiang Cai
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy L. Place, New York, NY 10029, United States of America; Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, China
| | - Etan Dayan
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy L. Place, New York, NY 10029, United States of America
| | - Li Liu
- Department of Diagnostic Radiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Anthony P Reeves
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, United States of America
| | - Claudia I Henschke
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy L. Place, New York, NY 10029, United States of America
| | - David F Yankelevitz
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave Levy L. Place, New York, NY 10029, United States of America.
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Henschke CI, Yip R, Sun Q, Li P, Kaufman A, Samstein R, Connery C, Kohman L, Lee P, Tannous H, Yankelevitz DF, Taioli E, Rosenzweig K, Flores RM. Prospective Cohort Study to Compare Long-Term Lung Cancer-Specific and All-Cause Survival of Clinical Early Stage (T1a-b; ≤20 mm) NSCLC Treated by Stereotactic Body Radiation Therapy and Surgery. J Thorac Oncol 2024; 19:476-490. [PMID: 37806384 DOI: 10.1016/j.jtho.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION We aimed to compare outcomes of patients with first primary clinical T1a-bN0M0 NSCLC treated with surgery or stereotactic body radiation therapy (SBRT). METHODS We identified patients with first primary clinical T1a-bN0M0 NSCLCs on last pretreatment computed tomography treated by surgery or SBRT in the following two prospective cohorts: International Early Lung Cancer Action Program (I-ELCAP) and Initiative for Early Lung Cancer Research on Treatment (IELCART). Lung cancer-specific survival and all-cause survival after diagnosis were compared using Kaplan-Meier analysis. Propensity score matching was used to balance baseline demographics and comorbidities and analyzed using Cox proportional hazards regression. RESULTS Of 1115 patients with NSCLC, 1003 had surgery and 112 had SBRT; 525 in I-ELCAP in 1992 to 2021 and 590 in IELCART in 2016 to 2021. Median follow-up was 57.6 months. Ten-year lung cancer-specific survival was not significantly different: 90% (95% confidence interval: 87%-92%) for surgery versus 88% (95% confidence interval: 77%-99%) for SBRT, p = 0.55. Cox regression revealed no significant difference in lung cancer-specific survival for the combined cohorts (p = 0.48) or separately for I-ELCAP (p = 1.00) and IELCART (p = 1.00). Although 10-year all-cause survival was significantly different (75% versus 45%, p < 0.0001), after propensity score matching, all-cause survival using Cox regression was no longer different for the combined cohorts (p = 0.74) or separately for I-ELCAP (p = 1.00) and IELCART (p = 0.62). CONCLUSIONS This first prospectively collected cohort analysis of long-term survival of small, early NSCLCs revealed that lung cancer-specific survival was high for both treatments and not significantly different (p = 0.48) and that all-cause survival after propensity matching was not significantly different (p = 0.74). This supports SBRT as an alternative treatment option for small, early NSCLCs which is especially important with their increasing frequency owing to low-dose computed tomography screening. Furthermore, treatment decisions are influenced by many different factors and should be personalized on the basis of the unique circumstances of each patient.
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Affiliation(s)
- Claudia I Henschke
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Arizona.
| | - Rowena Yip
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Qi Sun
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China
| | - Pengfei Li
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China
| | - Andrew Kaufman
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Samstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cliff Connery
- Department of Thoracic Surgery, Vassar Brothers, Poughkeepsie, New York
| | - Leslie Kohman
- Department of Thoracic Surgery, State University of New York, Syracuse, New York
| | - Paul Lee
- Department of Thoracic Surgery, Northwell Health, New Hyde Park, New York
| | - Henry Tannous
- Department of Thoracic Surgery, State University of Stonybrook, Stonybrook, New York
| | - David F Yankelevitz
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emanuela Taioli
- Department of Thoracic Surgery, Tisch Cancer Center, and Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenneth Rosenzweig
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Zhang J, Yip R, Taioli E, Flores RM, Henschke CI, Yankelevitz DF, Schwartz RM. Change in quality of life of stage IA non-small cell lung cancer after surgery or radiation therapy. J Thorac Dis 2024; 16:147-160. [PMID: 38410593 PMCID: PMC10894411 DOI: 10.21037/jtd-23-1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
Background Few studies have examined the differential impact of stereotactic body radiotherapy (SBRT) and surgery for early-stage non-small cell lung cancer (NSCLC) on quality of life (QoL) during the first post-treatment year. Methods A prospective cohort of stage IA NSCLC patients undergoing surgery or SBRT at Mount Sinai Health System had QoL measured before treatment, and 2, 6, and 12 months post-treatment using: 12-item Short Form Health Survey version 2 (SF-12v2) [physical component summary (PCS) and mental component summary (MCS)], Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS), and the Patient Health Questionnaire-4 (PHQ-4) measuring depression and anxiety. Locally weighted scatterplot smoothing (LOWESS) was fitted to identify the best interval knot for the change in the QoL trends post-treatment, adjusted piecewise linear mixed effects model was developed to estimate differences in baseline, 2- and 12-month scores, and rates of change. Results In total, 503 (88.6%) patients received surgery and 65 (11.4%) SBRT. LOWESS plots suggested QoL changed at 2 months post-surgery. Worsening in PCS was observed for both surgery and SBRT within 2 months after treatment but was only significant for surgical patients (-2.11, P<0.001). Two months later, improvements were observed for surgical but not SBRT patients (0.63 vs. -0.30, P<0.001). Surgical patients had significantly better PCS (P<0.001) and FACT-LCS (P<0.001) scores 1-year post-treatment compared to baseline, but not SBRT patients. Both surgical and SBRT patients reported significantly less anxiety 1-year post-treatment compared to baseline (P<0.001 and P=0.03). Decrease in depression from baseline to 1-year post-treatment was only significant for surgical patients (P<0.001). Conclusions Post-treatment, surgical patients exhibited improvements in physical health and reductions in lung cancer symptoms following initial deterioration within the first two months; in contrast, SBRT patients showed persistent decline in these areas throughout the year. Nonetheless, improved mental health was noted across both patient categories post-treatment. Targeted interventions and continuous monitoring are recommended during the initial 2 months post-surgery and throughout the year post-SBRT to alleviate physical and mental distress in patients.
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Affiliation(s)
- Jiafang Zhang
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rowena Yip
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raja M. Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia I. Henschke
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - David F. Yankelevitz
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rebecca M. Schwartz
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Occupational Medicine, Epidemiology and Prevention (OMEP), Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
| | - the IELCART Investigators*
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Thoracic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
- Department of Occupational Medicine, Epidemiology and Prevention (OMEP), Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
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Lam S, Wynes MW, Connolly C, Ashizawa K, Atkar-Khattra S, Belani CP, DiNatale D, Henschke CI, Hochhegger B, Jacomelli C, Jelitto M, Jirapatnakul A, Kelly KL, Krishnan K, Kobayashi T, Logan J, Mattos J, Mayo J, McWilliams A, Mitsudomi T, Pastorino U, Polańska J, Rzyman W, Sales Dos Santos R, Scagliotti GV, Wakelee H, Yankelevitz DF, Field JK, Mulshine JL, Avila R. The International Association for the Study of Lung Cancer Early Lung Imaging Confederation Open-Source Deep Learning and Quantitative Measurement Initiative. J Thorac Oncol 2024; 19:94-105. [PMID: 37595684 DOI: 10.1016/j.jtho.2023.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION With global adoption of computed tomography (CT) lung cancer screening, there is increasing interest to use artificial intelligence (AI) deep learning methods to improve the clinical management process. To enable AI research using an open-source, cloud-based, globally distributed, screening CT imaging data set and computational environment that are compliant with the most stringent international privacy regulations that also protect the intellectual properties of researchers, the International Association for the Study of Lung Cancer sponsored development of the Early Lung Imaging Confederation (ELIC) resource in 2018. The objective of this report is to describe the updated capabilities of ELIC and illustrate how this resource can be used for clinically relevant AI research. METHODS In this second phase of the initiative, metadata and screening CT scans from two time points were collected from 100 screening participants in seven countries. An automated deep learning AI lung segmentation algorithm, automated quantitative emphysema metrics, and a quantitative lung nodule volume measurement algorithm were run on these scans. RESULTS A total of 1394 CTs were collected from 697 participants. The LAV950 quantitative emphysema metric was found to be potentially useful in distinguishing lung cancer from benign cases using a combined slice thickness more than or equal to 2.5 mm. Lung nodule volume change measurements had better sensitivity and specificity for classifying malignant from benign lung nodules when applied to solid lung nodules from high-quality CT scans. CONCLUSIONS These initial experiments revealed that ELIC can support deep learning AI and quantitative imaging analyses on diverse and globally distributed cloud-based data sets.
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Affiliation(s)
- Stephen Lam
- Department of Integrative Oncology, The British Columbia Cancer Research Institute and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Murry W Wynes
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Casey Connolly
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Kazuto Ashizawa
- Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sukhinder Atkar-Khattra
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Chandra P Belani
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruno Hochhegger
- Department of Radiology, University of Florida, Gainesville, Florida
| | | | | | - Artit Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen L Kelly
- International Association for the Study of Lung Cancer, Denver, Colorado
| | | | - Takeshi Kobayashi
- Department of Diagnostic and Interventional Radiology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | | | - Juliane Mattos
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - John Mayo
- Department of Radiology, Vancouver General Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Annette McWilliams
- Fiona Stanley Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Tetsuya Mitsudomi
- Department of Surgery, Division of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Ugo Pastorino
- Department of Surgery, Section of Thoracic Surgery, National Cancer Institute of Milan, Milan, Italy
| | - Joanna Polańska
- Department of Data Science and Engineering, Silesian University of Technology, Gliwice, Poland
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | - Heather Wakelee
- Stanford Cancer Institute, Stanford University, Stanford, California
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John K Field
- Roy Castle Lung Cancer Research Programme, The University of Liverpool, Department of Molecular and Clinical Cancer Medicine, Liverpool, United Kingdom
| | - James L Mulshine
- Internal Medicine, Graduate College, Rush University Medical Center, Chicago, Illinois
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Sun Q, Li P, Zhang J, Yip R, Zhu Y, Yankelevitz DF, Henschke CI. CT Predictors of Visceral Pleural Invasion in Patients with Non-Small Cell Lung Cancers 30 mm or Smaller. Radiology 2024; 310:e231611. [PMID: 38193838 DOI: 10.1148/radiol.231611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
Background CT-defined visceral pleural invasion (VPI) is an important indicator of prognosis for non-small cell lung cancer (NSCLC). However, there is a lack of studies focused on small subpleural NSCLCs (≤30 mm). Purpose To identify CT features predictive of VPI in patients with subpleural NSCLCs 30 mm or smaller. Materials and Methods This study is a retrospective review of patients enrolled in the Initiative for Early Lung Cancer Research on Treatment (IELCART) at Mount Sinai Hospital between July 2014 and February 2023. Subpleural nodules 30 mm or smaller were classified into two groups: a pleural-attached group and a pleural-tag group. Preoperative CT features suggestive of VPI were evaluated for each group separately. Multivariable logistic regression analysis adjusted for sex, age, nodule size, and smoking status was used to determine predictive factors for VPI. Model performance was analyzed with the area under the receiver operating characteristic curve (AUC), and models were compared using Akaike information criterion (AIC). Results Of 379 patients with NSCLC with subpleural nodules, 37 had subsolid nodules and 342 had solid nodules. Eighty-eight patients (22%) had documented VPI, all in solid nodules. Of the 342 solid nodules (46% in male patients, 54% in female patients; median age, 71 years; IQR: 66, 76), 226 were pleural-attached nodules and 116 were pleural-tag nodules. VPI was more frequent for pleural-attached nodules than for pleural-tag nodules (31% [69 of 226] vs 16% [19 of 116], P = .005). For pleural-attached nodules, jellyfish sign (odds ratio [OR], 21.60; P < .001), pleural thickening (OR, 6.57; P < .001), and contact surface area (OR, 1.05; P = .01) independently predicted VPI. The jellyfish sign led to a better VPI prediction (AUC, 0.84; 95% CI: 0.78, 0.90). For pleural-tag nodules, multiple tags to different pleura surfaces enabled independent prediction of VPI (OR, 9.30; P = .001). Conclusions For patients with solid NSCLC (≤30 mm), CT predictors of VPI were the jellyfish sign, pleural thickening, contact surface area (pleural-attached nodules), and multiple tags to different pleura surfaces (pleural-tag nodules). © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Nishino in this issue.
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Affiliation(s)
- Qi Sun
- From the Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029 (Q.S., P.L., J.Z., R.Y., Y.Z., D.F.Y., C.I.H.)
| | - Pengfei Li
- From the Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029 (Q.S., P.L., J.Z., R.Y., Y.Z., D.F.Y., C.I.H.)
| | - Jiafang Zhang
- From the Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029 (Q.S., P.L., J.Z., R.Y., Y.Z., D.F.Y., C.I.H.)
| | - Rowena Yip
- From the Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029 (Q.S., P.L., J.Z., R.Y., Y.Z., D.F.Y., C.I.H.)
| | - Yeqing Zhu
- From the Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029 (Q.S., P.L., J.Z., R.Y., Y.Z., D.F.Y., C.I.H.)
| | - David F Yankelevitz
- From the Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029 (Q.S., P.L., J.Z., R.Y., Y.Z., D.F.Y., C.I.H.)
| | - Claudia I Henschke
- From the Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029 (Q.S., P.L., J.Z., R.Y., Y.Z., D.F.Y., C.I.H.)
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Zhu Y, Yip R, Zhang J, Cai Q, Sun Q, Li P, Paksashvili N, Triphuridet N, Henschke CI, Yankelevitz DF. Radiologic Features of Nodules Attached to the Mediastinal or Diaphragmatic Pleura at Low-Dose CT for Lung Cancer Screening. Radiology 2024; 310:e231219. [PMID: 38165250 PMCID: PMC10831475 DOI: 10.1148/radiol.231219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 01/03/2024]
Abstract
Background Pulmonary noncalcified nodules (NCNs) attached to the fissural or costal pleura with smooth margins and triangular or lentiform, oval, or semicircular (LOS) shapes at low-dose CT are recommended for annual follow-up instead of immediate workup. Purpose To determine whether management of mediastinal or diaphragmatic pleura-attached NCNs (M/DP-NCNs) with the same features as fissural or costal pleura-attached NCNs at low-dose CT can follow the same recommendations. Materials and Methods This retrospective study reviewed chest CT examinations in participants from two databases. Group A included 1451 participants who had lung cancer that was first present as a solid nodule with an average diameter of 3.0-30.0 mm. Group B included 345 consecutive participants from a lung cancer screening program who had at least one solid nodule with a diameter of 3.0-30.0 mm at baseline CT and underwent at least three follow-up CT examinations. Radiologists reviewed CT images to identify solid M/DP-NCNs, defined as nodules 0 mm in distance from the mediastinal or diaphragmatic pleura, and recorded average diameter, margin, and shape. General descriptive statistics were used. Results Among the 1451 participants with lung cancer in group A, 163 participants (median age, 68 years [IQR, 61.5-75.0 years]; 92 male participants) had 164 malignant M/DP-NCNs 3.0-30.0 mm in average diameter. None of the 164 malignant M/DP-NCNs had smooth margins and triangular or LOS shapes (upper limit of 95% CI of proportion, 0.02). Among the 345 consecutive screening participants in group B, 146 participants (median age, 65 years [IQR, 59-71 years]; 81 female participants) had 240 M/DP-NCNs with average diameter 3.0-30.0 mm. None of the M/DP-NCNs with smooth margins and triangular or LOS shapes were malignant after a median follow-up of 57.8 months (IQR, 46.3-68.1 months). Conclusion For solid M/DP-NCNs with smooth margins and triangular or LOS shapes at low-dose CT, the risk of lung cancer is extremely low, which supports the recommendation of Lung Imaging Reporting and Data System version 2022 for annual follow-up instead of immediate workup. © RSNA, 2024 See also the editorial by Goodman and Baruah in this issue.
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Affiliation(s)
- Yeqing Zhu
- From the Department of Radiology, Icahn School of Medicine at Mount
Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., J.Z., Q.C., Q.S.,
P.L., N.P., N.T., C.I.H., D.F.Y.); Department of Radiology, Shanxi Provincial
People’s Hospital, Taiyuan, China (Q.C.); Department of Radiology, Harbin
Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department
of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess
Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok,
Thailand (N.T.)
| | - Rowena Yip
- From the Department of Radiology, Icahn School of Medicine at Mount
Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., J.Z., Q.C., Q.S.,
P.L., N.P., N.T., C.I.H., D.F.Y.); Department of Radiology, Shanxi Provincial
People’s Hospital, Taiyuan, China (Q.C.); Department of Radiology, Harbin
Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department
of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess
Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok,
Thailand (N.T.)
| | - Jiafang Zhang
- From the Department of Radiology, Icahn School of Medicine at Mount
Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., J.Z., Q.C., Q.S.,
P.L., N.P., N.T., C.I.H., D.F.Y.); Department of Radiology, Shanxi Provincial
People’s Hospital, Taiyuan, China (Q.C.); Department of Radiology, Harbin
Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department
of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess
Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok,
Thailand (N.T.)
| | - Qiang Cai
- From the Department of Radiology, Icahn School of Medicine at Mount
Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., J.Z., Q.C., Q.S.,
P.L., N.P., N.T., C.I.H., D.F.Y.); Department of Radiology, Shanxi Provincial
People’s Hospital, Taiyuan, China (Q.C.); Department of Radiology, Harbin
Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department
of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess
Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok,
Thailand (N.T.)
| | - Qi Sun
- From the Department of Radiology, Icahn School of Medicine at Mount
Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., J.Z., Q.C., Q.S.,
P.L., N.P., N.T., C.I.H., D.F.Y.); Department of Radiology, Shanxi Provincial
People’s Hospital, Taiyuan, China (Q.C.); Department of Radiology, Harbin
Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department
of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess
Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok,
Thailand (N.T.)
| | - Pengfei Li
- From the Department of Radiology, Icahn School of Medicine at Mount
Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., J.Z., Q.C., Q.S.,
P.L., N.P., N.T., C.I.H., D.F.Y.); Department of Radiology, Shanxi Provincial
People’s Hospital, Taiyuan, China (Q.C.); Department of Radiology, Harbin
Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department
of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess
Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok,
Thailand (N.T.)
| | - Natela Paksashvili
- From the Department of Radiology, Icahn School of Medicine at Mount
Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., J.Z., Q.C., Q.S.,
P.L., N.P., N.T., C.I.H., D.F.Y.); Department of Radiology, Shanxi Provincial
People’s Hospital, Taiyuan, China (Q.C.); Department of Radiology, Harbin
Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department
of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess
Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok,
Thailand (N.T.)
| | - Natthaya Triphuridet
- From the Department of Radiology, Icahn School of Medicine at Mount
Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., J.Z., Q.C., Q.S.,
P.L., N.P., N.T., C.I.H., D.F.Y.); Department of Radiology, Shanxi Provincial
People’s Hospital, Taiyuan, China (Q.C.); Department of Radiology, Harbin
Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department
of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess
Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok,
Thailand (N.T.)
| | - Claudia I. Henschke
- From the Department of Radiology, Icahn School of Medicine at Mount
Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., J.Z., Q.C., Q.S.,
P.L., N.P., N.T., C.I.H., D.F.Y.); Department of Radiology, Shanxi Provincial
People’s Hospital, Taiyuan, China (Q.C.); Department of Radiology, Harbin
Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department
of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess
Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok,
Thailand (N.T.)
| | - David F. Yankelevitz
- From the Department of Radiology, Icahn School of Medicine at Mount
Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., J.Z., Q.C., Q.S.,
P.L., N.P., N.T., C.I.H., D.F.Y.); Department of Radiology, Shanxi Provincial
People’s Hospital, Taiyuan, China (Q.C.); Department of Radiology, Harbin
Medical University Cancer Hospital, Harbin, China (Q.S., P.L.); and Department
of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess
Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok,
Thailand (N.T.)
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Yankelevitz DF, Yip R, Henschke CI. Considerations for Incorporating Family History Into Low-dose Computed Tomography Screening Recommendations. J Thorac Oncol 2023; 18:1426-1427. [PMID: 37879761 DOI: 10.1016/j.jtho.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 10/27/2023]
Affiliation(s)
- David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Lewis JA, Samuels LR, Weems J, Park D, Winter R, Lindsell CJ, Callaway-Lane C, Audet C, Slatore CG, Wiener RS, Dittus RS, Kripalani S, Yankelevitz DF, Henschke CI, Moghanaki D, Matheny ME, Vogus TJ, Roumie CL, Spalluto LB. The Association of Organizational Readiness With Lung Cancer Screening Utilization. Am J Prev Med 2023; 65:844-853. [PMID: 37224985 PMCID: PMC10592591 DOI: 10.1016/j.amepre.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Lung cancer screening is widely underutilized. Organizational factors, such as readiness for change and belief in the value of change (change valence), may contribute to underutilization. The aim of this study was to evaluate the association between healthcare organizations' preparedness and lung cancer screening utilization. METHODS Investigators cross-sectionally surveyed clinicians, staff, and leaders at10 Veterans Affairs from November 2018 to February 2021 to assess organizational readiness to implement change. In 2022, investigators used simple and multivariable linear regression to evaluate the associations between facility-level organizational readiness to implement change and change valence with lung cancer screening utilization. Organizational readiness to implement change and change valence were calculated from individual surveys. The primary outcome was the proportion of eligible Veterans screened using low-dose computed tomography. Secondary analyses assessed scores by healthcare role. RESULTS The overall response rate was 27.4% (n=1,049), with 956 complete surveys analyzed: median age of 49 years, 70.3% female, 67.6% White, 34.6% clinicians, 61.1% staff, and 4.3% leaders. For each 1-point increase in median organizational readiness to implement change and change valence, there was an associated 8.4-percentage point (95% CI=0.2, 16.6) and a 6.3-percentage point increase in utilization (95% CI= -3.9, 16.5), respectively. Higher clinician and staff median scores were associated with increased utilization, whereas leader scores were associated with decreased utilization after adjusting for other roles. CONCLUSIONS Healthcare organizations with higher readiness and change valence utilized more lung cancer screening. These results are hypothesis generating. Future interventions to increase organizations' preparedness, especially among clinicians and staff, may increase lung cancer screening utilization.
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Affiliation(s)
- Jennifer A Lewis
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Medical Service, VA Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, Tennessee; Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
| | - Lauren R Samuels
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jacy Weems
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel Park
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Winter
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carol Callaway-Lane
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Medical Service, VA Tennessee Valley Healthcare System, Veterans Health Administration, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carolyn Audet
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care (CIVIC), Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon; Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, Oregon; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; VA National Center for Lung Cancer Screening (NCLCS), Veterans Health Administration, Washington, District of Columbia
| | - Renda Soylemez Wiener
- VA National Center for Lung Cancer Screening (NCLCS), Veterans Health Administration, Washington, District of Columbia; Center for Healthcare Organization & Implementation Research, VA Boston Healthcare System, Boston, Massachusetts; The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Robert S Dittus
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Yankelevitz
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; VA Phoenix Health Care System, Phoenix, Arizona
| | - Drew Moghanaki
- Radiation Oncology Service, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Michael E Matheny
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee
| | - Christianne L Roumie
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Health Policy, Vanderbilt University, Nashville, Tennessee
| | - Lucy B Spalluto
- VA Tennessee Valley Health Care System Geriatric Research Education and Clinical Center (GRECC), Veterans Health Administration, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
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Henschke CI, Yip R, Shaham D, Markowitz S, Cervera Deval J, Zulueta JJ, Seijo LM, Aylesworth C, Klingler K, Andaz S, Chin C, Smith JP, Taioli E, Altorki N, Flores RM, Yankelevitz DF. A 20-year Follow-up of the International Early Lung Cancer Action Program (I-ELCAP). Radiology 2023; 309:e231988. [PMID: 37934099 DOI: 10.1148/radiol.231988] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Background The low-dose CT (≤3 mGy) screening report of 1000 Early Lung Cancer Action Program (ELCAP) participants in 1999 led to the International ELCAP (I-ELCAP) collaboration, which enrolled 31 567 participants in annual low-dose CT screening between 1992 and 2005. In 2006, I-ELCAP investigators reported the 10-year lung cancer-specific survival of 80% for 484 participants diagnosed with a first primary lung cancer through annual screening, with a high frequency of clinical stage I lung cancer (85%). Purpose To update the cure rate by determining the 20-year lung cancer-specific survival of participants diagnosed with first primary lung cancer through annual low-dose CT screening in the expanded I-ELCAP cohort. Materials and Methods For participants enrolled in the HIPAA-compliant prospective I-ELCAP cohort between 1992 and 2022 and observed until December 30, 2022, Kaplan-Meier survival analysis was used to determine the 10- and 20-year lung cancer-specific survival of participants diagnosed with first primary lung cancer through annual low-dose CT screening. Eligible participants were aged at least 40 years and had current or former cigarette use or had never smoked but had been exposed to secondhand tobacco smoke. Results Among 89 404 I-ELCAP participants, 1257 (1.4%) were diagnosed with a first primary lung cancer (684 male, 573 female; median age, 66 years; IQR, 61-72), with a median smoking history of 43.0 pack-years (IQR, 29.0-60.0). Median follow-up duration was 105 months (IQR, 41-182). The frequency of clinical stage I at pretreatment CT was 81% (1017 of 1257). The 10-year lung cancer-specific survival of 1257 participants was 81% (95% CI: 79, 84) and the 20-year lung cancer-specific survival was 81% (95% CI: 78, 83), and it was 95% (95% CI: 91, 98) for 181 participants with pathologic T1aN0M0 lung cancer. Conclusion The 10-year lung cancer-specific survival of 80% reported in 2006 for I-ELCAP participants enrolled in annual low-dose CT screening and diagnosed with a first primary lung cancer has persisted, as shown by the updated 20-year lung cancer-specific survival for the expanded I-ELCAP cohort. © RSNA, 2023 See also the editorials by Grenier and by Sequist and Olazagasti in this issue.
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Affiliation(s)
- Claudia I Henschke
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Rowena Yip
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Dorith Shaham
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Steven Markowitz
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - José Cervera Deval
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Javier J Zulueta
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Luis M Seijo
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Cheryl Aylesworth
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Karl Klingler
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Shahriyour Andaz
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Cynthia Chin
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - James P Smith
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Emanuela Taioli
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Nasser Altorki
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - Raja M Flores
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
| | - David F Yankelevitz
- From the Department of Diagnostic, Molecular, and Interventional Radiology (C.I.H., R.Y., D.F.Y.), Institute of Translational Epidemiology (E.T.), and Department of Thoracic Surgery (R.M.F.), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029; Department of Radiology, Phoenix Veterans Affairs Health Care System, Phoenix, Ariz (C.I.H.); Department of Radiology, Hadassah Medical Center, Jerusalem, Israel (D.S.); Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel (D.S.); Barry Commoner Center for Health and the Environment, Queens College City University of New York, Queens, NY (S.M.); Department of Radiology, Fundación Instituto Valenciano de Oncología, Valencia, Spain (J.C.D.); Department of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai West, New York, NY (J.J.Z.); Department of Pulmonology, Clínica Universidad de Navarra, Pamplona, Spain (J.J.Z., L.M.S.); Department of Hematology and Oncology, Holy Cross Hospital Cancer Institute, Silver Spring, Md (C.A.); Department of Pulmonology and Sleep Medicine Clinic Hirslanden, LungenZentrum Hirslanden, Zurich, Switzerland (K.K.); Department of Thoracic Surgery, Mount Sinai South Nassau, Oceanside, NY (S.A.); Department of Thoracic Surgery, Montefiore St Luke's Cornwall, Cornwall, NY (C.C.); Departments of Pulmonology (J.P.S.) and Surgery (N.A.), Weill Cornell Medical College, New York, NY; and Department of Thoracic Surgery, Tisch Cancer Center, New York, NY (E.T.)
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10
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Lewis JA, Bonnet K, Schlundt DG, Byerly S, Lindsell CJ, Henschke CI, Yankelevitz DF, York SJ, Hendler F, Dittus RS, Vogus TJ, Kripalani S, Moghanaki D, Audet CM, Roumie CL, Spalluto LB. Rural barriers and facilitators of lung cancer screening program implementation in the veterans health administration: a qualitative study. Front Health Serv 2023; 3:1209720. [PMID: 37674596 PMCID: PMC10477991 DOI: 10.3389/frhs.2023.1209720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/04/2023] [Indexed: 09/08/2023]
Abstract
Introduction To assess healthcare professionals' perceptions of rural barriers and facilitators of lung cancer screening program implementation in a Veterans Health Administration (VHA) setting through a series of one-on-one interviews with healthcare team members. Methods Based on measures developed using Reach Effectiveness Adoption Implementation Maintenance (RE-AIM), we conducted a cross-sectional qualitative study consisting of one-on-one semi-structured telephone interviews with VHA healthcare team members at 10 Veterans Affairs medical centers (VAMCs) between December 2020 and September 2021. An iterative inductive and deductive approach was used for qualitative analysis of interview data, resulting in the development of a conceptual model to depict rural barriers and facilitators of lung cancer screening program implementation. Results A total of 30 interviews were completed among staff, providers, and lung cancer screening program directors and a conceptual model of rural barriers and facilitators of lung cancer screening program implementation was developed. Major themes were categorized within institutional and patient environments. Within the institutional environment, participants identified systems-level (patient communication, resource availability, workload), provider-level (attitudes and beliefs, knowledge, skills and capabilities), and external (regional and national networks, incentives) barriers to and facilitators of lung cancer screening program implementation. Within the patient environment, participants revealed patient-level (modifiable vulnerabilities) barriers and facilitators as well as ecological modifiers (community) that influence screening behavior. Discussion Understanding rural barriers to and facilitators of lung cancer screening program implementation as perceived by healthcare team members points to opportunities and approaches for improving lung cancer screening reach, implementation and effectiveness in VHA rural settings.
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Affiliation(s)
- Jennifer A. Lewis
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Nashville, TN, United States
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt-Ingram Cancer Center, Nashville, TN, United States
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
- Qualitative Research Core, Vanderbilt University Medical Center, Nashville, TN, United States
| | - David G. Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
- Qualitative Research Core, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Susan Byerly
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Christopher J. Lindsell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, New York, United States
- Veterans Health Administration—Phoenix VA Health Care System, Radiology Service, Phoenix, AZ, United States
| | - David F. Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, New York, United States
| | - Sally J. York
- Veterans Health Administration-Tennessee Valley Healthcare System, Medicine Service, Nashville, TN, United States
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt-Ingram Cancer Center, Nashville, TN, United States
| | - Fred Hendler
- Rex Robley VA Medical Center, Medicine Service, Louisville, KY, United States
| | - Robert S. Dittus
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Timothy J. Vogus
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN, United States
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Drew Moghanaki
- Veterans Health Administration—Greater Los Angeles Veterans Affairs Medical Center, Radiation Oncology Service, Los Angeles, CA, United States
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Carolyn M. Audet
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Christianne L. Roumie
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Lucy B. Spalluto
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, United States
- Vanderbilt-Ingram Cancer Center, Nashville, TN, United States
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
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11
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Tahvilian S, Kuban JD, Yankelevitz DF, Leventon D, Henschke CI, Zhu J, Baden L, Yip R, Hirsch FR, Reed R, Brown A, Muldoon A, Trejo M, Katchman BA, Donovan MJ, Pagano PC. The presence of circulating genetically abnormal cells in blood predicts risk of lung cancer in individuals with indeterminate pulmonary nodules. BMC Pulm Med 2023; 23:193. [PMID: 37277788 DOI: 10.1186/s12890-023-02433-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/13/2023] [Indexed: 06/07/2023] Open
Abstract
PURPOSE Computed tomography is the standard method by which pulmonary nodules are detected. Greater than 40% of pulmonary biopsies are not lung cancer and therefore not necessary, suggesting that improved diagnostic tools are needed. The LungLB™ blood test was developed to aid the clinical assessment of indeterminate nodules suspicious for lung cancer. LungLB™ identifies circulating genetically abnormal cells (CGACs) that are present early in lung cancer pathogenesis. METHODS LungLB™ is a 4-color fluorescence in-situ hybridization assay for detecting CGACs from peripheral blood. A prospective correlational study was performed on 151 participants scheduled for a pulmonary nodule biopsy. Mann-Whitney, Fisher's Exact and Chi-Square tests were used to assess participant demographics and correlation of LungLB™ with biopsy results, and sensitivity and specificity were also evaluated. RESULTS Participants from Mount Sinai Hospital (n = 83) and MD Anderson (n = 68), scheduled for a pulmonary biopsy were enrolled to have a LungLB™ test. Additional clinical variables including smoking history, previous cancer, lesion size, and nodule appearance were also collected. LungLB™ achieved 77% sensitivity and 72% specificity with an AUC of 0.78 for predicting lung cancer in the associated needle biopsy. Multivariate analysis found that clinical and radiological factors commonly used in malignancy prediction models did not impact the test performance. High test performance was observed across all participant characteristics, including clinical categories where other tests perform poorly (Mayo Clinic Model, AUC = 0.52). CONCLUSION Early clinical performance of the LungLB™ test supports a role in the discrimination of benign from malignant pulmonary nodules. Extended studies are underway.
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Affiliation(s)
- Shahram Tahvilian
- LungLife AI, Inc, 2545 W. Hillcrest Drive, Suite 140, Thousand Oaks, CA, USA
| | - Joshua D Kuban
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Leventon
- LungLife AI, Inc, 2545 W. Hillcrest Drive, Suite 140, Thousand Oaks, CA, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Zhu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lara Baden
- LungLife AI, Inc, 2545 W. Hillcrest Drive, Suite 140, Thousand Oaks, CA, USA
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Fred R Hirsch
- Icahn School of Medicine, Center for Thoracic Oncology, Tisch Cancer Institute at Mount Sinai, New York, NY, USA
| | - Rebecca Reed
- LungLife AI, Inc, 2545 W. Hillcrest Drive, Suite 140, Thousand Oaks, CA, USA
| | - Ashley Brown
- LungLife AI, Inc, 2545 W. Hillcrest Drive, Suite 140, Thousand Oaks, CA, USA
| | - Allison Muldoon
- LungLife AI, Inc, 2545 W. Hillcrest Drive, Suite 140, Thousand Oaks, CA, USA
| | - Michael Trejo
- LungLife AI, Inc, 2545 W. Hillcrest Drive, Suite 140, Thousand Oaks, CA, USA
| | - Benjamin A Katchman
- LungLife AI, Inc, 2545 W. Hillcrest Drive, Suite 140, Thousand Oaks, CA, USA
| | - Michael J Donovan
- LungLife AI, Inc, 2545 W. Hillcrest Drive, Suite 140, Thousand Oaks, CA, USA
- Department of Pathology, Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul C Pagano
- LungLife AI, Inc, 2545 W. Hillcrest Drive, Suite 140, Thousand Oaks, CA, USA.
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12
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Fuhrman J, Yip R, Zhu Y, Jirapatnakul AC, Li F, Henschke CI, Yankelevitz DF, Giger ML. Evaluation of emphysema on thoracic low-dose CTs through attention-based multiple instance deep learning. Sci Rep 2023; 13:1187. [PMID: 36681685 PMCID: PMC9867724 DOI: 10.1038/s41598-023-27549-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
In addition to lung cancer, other thoracic abnormalities, such as emphysema, can be visualized within low-dose CT scans that were initially obtained in cancer screening programs, and thus, opportunistic evaluation of these diseases may be highly valuable. However, manual assessment for each scan is tedious and often subjective, thus we have developed an automatic, rapid computer-aided diagnosis system for emphysema using attention-based multiple instance deep learning and 865 LDCTs. In the task of determining if a CT scan presented with emphysema or not, our novel Transfer AMIL approach yielded an area under the ROC curve of 0.94 ± 0.04, which was a statistically significant improvement compared to other methods evaluated in our study following the Delong Test with correction for multiple comparisons. Further, from our novel attention weight curves, we found that the upper lung demonstrated a stronger influence in all scan classes, indicating that the model prioritized upper lobe information. Overall, our novel Transfer AMIL method yielded high performance and provided interpretable information by identifying slices that were most influential to the classification decision, thus demonstrating strong potential for clinical implementation.
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Affiliation(s)
- Jordan Fuhrman
- Committee on Medical Physics, Department of Radiology, The University of Chicago, 5841 S Maryland Avenue, MC2026, Chicago, 60637, USA.
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, 10029, USA
| | - Yeqing Zhu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, 10029, USA
| | - Artit C Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, 10029, USA
| | - Feng Li
- Committee on Medical Physics, Department of Radiology, The University of Chicago, 5841 S Maryland Avenue, MC2026, Chicago, 60637, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, 10029, USA
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, 10029, USA
| | - Maryellen L Giger
- Committee on Medical Physics, Department of Radiology, The University of Chicago, 5841 S Maryland Avenue, MC2026, Chicago, 60637, USA
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13
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Yankelevitz DF, Yip R, Henschke CI. Impact of Duration of Diagnostic Workup on Prognosis for Early Lung Cancer. J Thorac Oncol 2023; 18:527-537. [PMID: 36642158 DOI: 10.1016/j.jtho.2022.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/18/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Growth assessment for pulmonary nodules is an important diagnostic tool; however, the impact on prognosis due to time delay for follow-up diagnostic scans needs to be considered. METHODS Using the data between 2003 and 2019 from the International Early Lung Cancer Action Program, a prospective cohort study, we determined the size-specific, 10-year Kaplan-Meier lung cancer (LC) survival rates as surrogates for cure rates. We estimated the change in LC diameter after delays of 90, 180, and 365 days using three representative LC volume doubling times (VDTs) of 60 (fast), 120 (moderate), and 240 (slow). We then estimated the decrease in the LC cure rate resulting from time between computed tomography scans to assess for growth during the diagnostic workup. RESULTS Using a regression model of the 10-year LC survival rates on LC diameter, the estimated LC cure rate of a 4.0 mm LC with fast (60-d) VDT is 96.0% (95% confidence interval [CI]: 95.2%-96.7%) initially, but it would decrease to 94.3% (95% CI: 93.2%-95.0%), 92.0% (95% CI: 90.5%-93.4%), and 83.6%(95% CI: 80.6%-86.6%) after delays of 90, 180, and 365 days, respectively. A 20.0-mm LC with the same VDTs has a lower LC cure rate of 79.9% (95% CI: 76.2%-83.5%) initially and decreases more rapidly to 71.5% (95% CI: 66.4%-76.7%), 59.8% (95% CI: 52.4%-67.1%), and 17.9% (95% CI: 3.0%-32.8%) after the same delays of 90, 180, and 365 days, respectively. CONCLUSIONS Time between scans required to measure growth of lung nodules affects prognosis with the effect being greater for fast growing and larger cancers. Quantifying the extent of change in prognosis is required to understand efficiencies of different management protocols.
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Affiliation(s)
- David F Yankelevitz
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Rowena Yip
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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14
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Strayer TE, Spalluto LB, Burns A, Lindsell CJ, Henschke CI, Yankelevitz DF, Moghanaki D, Dittus RS, Vogus TJ, Audet C, Kripalani S, Roumie CL, Lewis JA. Using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study. Implement Sci Commun 2023; 4:5. [PMID: 36635719 PMCID: PMC9836333 DOI: 10.1186/s43058-022-00388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Lung cancer screening is a complex clinical process that includes identification of eligible individuals, shared decision-making, tobacco cessation, and management of screening results. Adaptations to the delivery process for lung cancer screening in situ are understudied and underreported, with the potential loss of important considerations for improved implementation. The Framework for Reporting Adaptations and Modifications-Expanded (FRAME) allows for a systematic enumeration of adaptations to implementation of evidence-based practices. We applied FRAME to study adaptations in lung cancer screening delivery processes implemented by lung cancer screening programs in a Veterans Health Administration (VHA) Enterprise-Wide Initiative. METHODS We prospectively conducted semi-structured interviews at baseline and 1-year intervals with lung cancer screening program navigators at 10 Veterans Affairs Medical Centers (VAMCs) between 2019 and 2021. Using this data, we developed baseline (1st) process maps for each program. In subsequent years (year 1 and year 2), each program navigator reviewed the process maps. Adaptations in screening processes were identified, documented, and mapped to FRAME categories. RESULTS We conducted a total of 16 interviews across 10 VHA lung cancer screening programs (n=6 in year 1, n=10 in year 2) to collect adaptations. In year 1 (2020), six programs were operational and eligible. Of these, three reported adaptations to their screening process that were planned or in response to COVID-19. In year 2 (2021), all 10 programs were operational and eligible. Programs reported 14 adaptations in year 2. These adaptations were planned and unplanned and often triggered by increased workload; 57% of year 2 adaptations were related to the identification and eligibility of Veterans and 43% were related to follow-up with Veterans for screening results. Throughout the 2 years, adaptations related to data management and patient tracking occurred in 60% of programs to improve the data collection and tracking of Veterans in the screening process. CONCLUSIONS Using FRAME, we found that adaptations occurred primarily in the areas of patient identification and communication of results due to increased workload. These findings highlight navigator time and resource considerations for sustainability and scalability of existing and future lung cancer screening programs as well as potential areas for future intervention.
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Affiliation(s)
- Thomas E Strayer
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lucy B Spalluto
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA
| | - Abby Burns
- Veterans Health Administration-Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Veterans Health Administration - Phoenix VA Health Care System, Phoenix, AZ, USA
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Drew Moghanaki
- Veterans Health Administration - Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Robert S Dittus
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN, USA
| | - Carolyn Audet
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christianne L Roumie
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jennifer A Lewis
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
- Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC) and Medicine Service, Nashville, TN, USA.
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1200, Nashville, TN, 37203, USA.
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15
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Wolf A, Laskey D, Yip R, Beasley MB, Yankelevitz DF, Henschke CI. Measuring the margin distance in pulmonary wedge resection. J Surg Oncol 2022; 126:1350-1358. [PMID: 35975701 DOI: 10.1002/jso.27053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/25/2022] [Accepted: 07/30/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Margin distance contributes to survival and recurrence during wedge resections for early-stage non-small cell lung cancer. The Initiative for Early Lung Cancer Research on Treatment sought to standardize a surgeon-measured margin intraoperatively. METHODS Lung cancer patients who underwent wedge resection were reviewed. Margins were measured by the surgeon twice as per a standardized protocol. Intraobserver variability as well as surgeon-pathologist variability were compared. RESULTS Forty-five patients underwent wedge resection. Same-surgeon measurement analysis indicated good reliability with a small mean difference and narrow limit of agreement for the two measures. The median surgeon-measured margin was 18.0 mm, median pathologist-measured margin was 16.0 mm and the median difference between the surgeon-pathologist margin was -1.0 mm, ranging from -18.0 to 12.0 mm. Bland-Altman analysis for margin measurements demonstrated a mean difference of 0.65 mm. The limit of agreement for the two approaches were wide, with the difference lying between -16.25 and 14.96 mm. CONCLUSIONS A novel protocol of surgeon-measured margin was evaluated and compared with pathologist-measured margin. High intraobserver agreement for repeat surgeon measurements yet low-to-moderate correlation or directionality between surgeon and pathologic measurements were found. DISCUSSION A standardized protocol may reduce variability in pathologic assessment. These findings have critical implications considering the impact of margin distance on outcomes.
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Affiliation(s)
- Andrea Wolf
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel Laskey
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mary B Beasley
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Center for Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Center for Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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16
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Strayer TE, Spalluto LB, Burns A, Lindsell CJ, Henschke CI, Yankelevitz DF, Moghanaki D, Dittus RS, Vogus TJ, Audet C, Kripalani S, Roumie CL, Lewis JA. Using the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to study lung cancer screening adaptations in the Veterans Health Administration. Res Sq 2022:rs.3.rs-1862731. [PMID: 35982653 PMCID: PMC9387539 DOI: 10.21203/rs.3.rs-1862731/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Lung cancer screening includes identification of eligible individuals, shared decision-making inclusive of tobacco cessation, and management of screening results. Adaptations to the implemented processes for lung cancer screening in situ are understudied and underreported, with potential loss of important considerations for improved implementation. The Framework for Reporting Adaptations and Modifications-Expanded (FRAME) allows for systematic enumeration of adaptations to implementations of evidence-based practices. We used FRAME to study adaptations in lung cancer screening processes that were implemented as part of a Veterans Health Administration (VHA) Enterprise-Wide Initiative. Methods: We conducted semi-structured interviews at baseline and 1-year intervals with lung cancer screening program navigators at 10 Veterans Affairs Medical Centers (VAMC) between 2019-2021. Using this data, we developed baseline (1st) process maps for each program. In subsequent years (year 1 and year 2), each program navigator reviewed the process maps. Adaptations in screening processes were identified, recorded and mapped to FRAME categories. Results: A total of 14 program navigators across 10 VHA lung cancer screening programs participated in 20 interviews. In year 1 (2019-2020), seven programs were operational and of these, three reported adaptations to their screening process that were either planned and in response to COVID-19. In year 2 (2020-2021), all 10 programs were operational. Programs reported 14 adaptations in year 2. These adaptations were both planned and unplanned and often triggered by increased workload; 57% of year 2 adaptations were related to identification and eligibility of Veterans and 43% were related to follow-up with Veterans for screening results. Throughout the 2 years, adaptations related to data management and patient tracking occurred in 6 of 10 programs to improve the data collection and tracking of Veterans in the screening process. Conclusions: Using FRAME, we found that adaptations occurred throughout the lung cancer screening process but primarily in the areas of patient identification and communication of results. These findings highlight considerations for lung cancer screening implementation and potential areas for future intervention.
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Affiliation(s)
| | | | | | | | | | | | - Drew Moghanaki
- UCLA Health System: University of California Los Angeles Health System
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17
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Mack PC, Gomez JE, Rodilla AM, Carreño JM, Hsu CY, Rolfo C, Meshulami N, Moore A, Brody RI, King JC, Treatman J, Lee S, Raskin A, Srivastava K, Gleason CR, de Miguel-Perez D, Tcheou J, Bielak D, Acharya R, Gerber DE, Rohs N, Henschke CI, Yankelevitz DF, Simon V, Minna JD, Bunn PA, García-Sastre A, Krammer F, Shyr Y, Hirsch FR. Longitudinal COVID-19-vaccination-induced antibody responses and Omicron neutralization in patients with lung cancer. Cancer Cell 2022; 40:575-577. [PMID: 35504289 PMCID: PMC9020481 DOI: 10.1016/j.ccell.2022.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Philip C Mack
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jorge E Gomez
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ananda M Rodilla
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Juan Manuel Carreño
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Vaccine Research and Pandemic Preparedness (C-VARPP), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chih-Yuan Hsu
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Christian Rolfo
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noy Meshulami
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amy Moore
- LUNGevity Foundation, Bethesda, MD, USA
| | - Rachel I Brody
- Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jacquelyn Treatman
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sooyun Lee
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ariel Raskin
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Vaccine Research and Pandemic Preparedness (C-VARPP), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Komal Srivastava
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Vaccine Research and Pandemic Preparedness (C-VARPP), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Charles R Gleason
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Vaccine Research and Pandemic Preparedness (C-VARPP), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Diego de Miguel-Perez
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johnstone Tcheou
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Vaccine Research and Pandemic Preparedness (C-VARPP), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dominika Bielak
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Vaccine Research and Pandemic Preparedness (C-VARPP), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - David E Gerber
- Hamon Center for Therapeutic Oncology Research, Departments of Internal Medicine and Pharmacology UT Southwestern Medical Center, Dallas, TX, USA
| | - Nicholas Rohs
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia I Henschke
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, NY, USA
| | - David F Yankelevitz
- Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, NY, USA
| | - Viviana Simon
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Vaccine Research and Pandemic Preparedness (C-VARPP), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John D Minna
- Hamon Center for Therapeutic Oncology Research, Departments of Internal Medicine and Pharmacology UT Southwestern Medical Center, Dallas, TX, USA
| | - Paul A Bunn
- Department of Internal Medicine, University of Colorado Cancer Center, Denver, CO, USA
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Vaccine Research and Pandemic Preparedness (C-VARPP), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University, Nashville, TN, USA
| | - Fred R Hirsch
- Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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18
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Abstract
Background Bronchiectasis is associated with loss of lung function, substantial use of health care resources, and increased morbidity and mortality in people with cardiopulmonary diseases. Purpose To assess the frequency and severity of bronchiectasis and related clinical findings of participants in a low-dose CT (LDCT) screening program. Materials and Methods The Early Lung and Cardiac Action Program (ELCAP) bronchiectasis score (range, 0-42; higher values indicate more severe bronchiectasis) was developed to facilitate bronchiectasis assessment. This quantitative scoring system screened participants based on accumulated knowledge and improved CT imaging capabilities. Secondary review of LDCT studies from smokers aged 40-90 years was performed when they were initially enrolled in the prospective Mount Sinai ELCAP screening study between 2010 and 2019. Medical records were reviewed to identify associated respiratory symptoms and acute respiratory events during the 2 years after LDCT. Logistic regression analysis was performed to examine factors associated with bronchiectasis. Results LDCT studies of 2191 screening participants (mean age, 65 years ± 9; 1140 [52%] women) were obtained, and bronchiectasis was identified in 504 (23%) participants. Median ELCAP bronchiectasis score was 12 (interquartile range, 9-16). Bronchiectasis was most common in the lower lobes for all participants, and lower lobe prevalence was greater with higher ELCAP score (eg, 91% prevalence with an ELCAP score of 16-42). In the fourth quartile, however, midlung involvement was higher compared with lower lung involvement (128 of 131 participants [98%] vs 122 of 131 participants [93%]). Bronchiectasis was more frequent with greater age (odds ratio [OR] = 2.0 per decade; 95% CI: 1.7, 2.4); being a former smoker (OR = 1.33; 95% CI: 1.01, 1.73); and having self-reported chronic obstructive pulmonary disease (OR = 1.38; 95% CI: 1.02, 1.88), an elevated hemidiaphragm (OR = 4; 95% CI: 2, 11), or consolidation (OR = 5; 95% CI: 3, 11). It was less frequent in overweight (OR = 0.7; 95% CI: 0.5, 0.9) or obese (OR = 0.6; 95% CI: 0.4, 0.8) participants. Two years after baseline LDCT, respiratory symptoms, acute respiratory events, and respiratory events that required hospitalization were more frequent with increasing severity of the ELCAP bronchiectasis score (P < .005 for all trends). Conclusion Prevalence of bronchiectasis in smokers undergoing low-dose CT screening was high, and respiratory symptoms and acute events were more frequent with increasing severity of the Early Lung and Cardiac Action Program Bronchiectasis score. © RSNA, 2022 See also the editorial by Verschakelen in this issue.
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Affiliation(s)
- Qiang Cai
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Natthaya Triphuridet
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Yeqing Zhu
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Nan You
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Rowena Yip
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - David F Yankelevitz
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
| | - Claudia I Henschke
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029
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19
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Huber RM, Cavic M, Kerpel-Fronius A, Viola L, Field J, Jiang L, Kazerooni EA, Koegelenberg CF, Mohan A, Sales dos Santos R, Ventura L, Wynes M, Yang D, Zulueta J, Lee CT, Tammemägi MC, Henschke CI, Lam S. Lung Cancer Screening Considerations During Respiratory Infection Outbreaks, Epidemics or Pandemics: An International Association for the Study of Lung Cancer Early Detection and Screening Committee Report. J Thorac Oncol 2022; 17:228-238. [PMID: 34864164 PMCID: PMC8639478 DOI: 10.1016/j.jtho.2021.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 02/02/2023]
Abstract
After the results of two large, randomized trials, the global implementation of lung cancer screening is of utmost importance. However, coronavirus disease 2019 infections occurring at heightened levels during the current global pandemic and also other respiratory infections can influence scan interpretation and screening safety and uptake. Several respiratory infections can lead to lesions that mimic malignant nodules and other imaging changes suggesting malignancy, leading to an increased level of follow-up procedures or even invasive diagnostic procedures. In periods of increased rates of respiratory infections from severe acute respiratory syndrome coronavirus 2 and others, there is also a risk of transmission of these infections to the health care providers, the screenees, and patients. This became evident with the severe acute respiratory syndrome coronavirus 2 pandemic that led to a temporary global stoppage of lung cancer and other cancer screening programs. Data on the optimal management of these situations are not available. The pandemic is still ongoing and further periods of increased respiratory infections will come, in which practical guidance would be helpful. The aims of this report were: (1) to summarize the data available for possible false-positive results owing to respiratory infections; (2) to evaluate the safety concerns for screening during times of increased respiratory infections, especially during a regional outbreak or an epidemic or pandemic event; (3) to provide guidance on these situations; and (4) to stimulate research and discussions about these scenarios.
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Affiliation(s)
- Rudolf M. Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine V, Ludwig-Maximilian-University of Munich, Thoracic Oncology Centre Munich, German Centre for Lung Research (DZL CPC-M), Munich, Germany,Corresponding author. Address for correspondence: Rudolf M. Huber, MD, PhD, Division of Respiratory Medicine and Thoracic Oncology, Department of Medicine V, Ludwig-Maximilians-University of Munich, Thoracic Oncology Centre Munich, German Centre for Lung Research (DZL CPC-M), Ziemssenstrasse 1, Munich, Bavaria D-80336 Germany
| | - Milena Cavic
- Department of Experimental Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Anna Kerpel-Fronius
- Department of Radiology, National Korányi Institute for Pulmonology, Budapest, Hungary
| | - Lucia Viola
- Thoracic Oncology Unit, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - John Field
- Roy Castle Lung Cancer Research Programme, The University of Liverpool, Department of Molecular and Clinical Cancer Medicine, Liverpool, United Kingdom
| | - Long Jiang
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, People’s Republic of China
| | - Ella A. Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Medical School/Michigan Medicine, Ann Arbor, Michigan,Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School/Michigan Medicine, Ann Arbor, Michigan
| | - Coenraad F.N. Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Anant Mohan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Luigi Ventura
- Thoracic Surgery, Department of Medicine and Surgery, University Hospital of Parma, Italy
| | - Murry Wynes
- The International Association for the Study of Lung Cancer, Denver, Colorado
| | - Dawei Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Javier Zulueta
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine, New York, New York
| | - Choon-Taek Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seoul, South Korea
| | - Martin C. Tammemägi
- Prevention and Cancer Control, Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada,Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephen Lam
- Department of Integrative Oncology, BC Cancer and Department of Medicine, University of British Columbia, Vancouver, Canada
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20
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Spalluto LB, Lewis JA, Samuels LR, Callaway-Lane C, Matheny ME, Denton J, Robles JA, Dittus RS, Yankelevitz DF, Henschke CI, Massion PP, Moghanaki D, Roumie CL. Association of Rurality With Annual Repeat Lung Cancer Screening in the Veterans Health Administration. J Am Coll Radiol 2022; 19:131-138. [PMID: 35033300 PMCID: PMC8830608 DOI: 10.1016/j.jacr.2021.08.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE Lung cancer causes the largest number of cancer-related deaths in the United States. Lung cancer incidence rates, mortality rates, and rates of advanced stage disease are higher among those who live in rural areas. Known disparities in lung cancer outcomes between rural and nonrural populations may be in part because of barriers faced by rural populations. The authors tested the hypothesis that among Veterans who receive initial lung cancer screening, rural Veterans would be less likely to complete annual repeat screening than nonrural Veterans. METHODS A retrospective cohort study was conducted of 10 Veterans Affairs medical centers from 2015 to 2019. Rural and nonrural Veterans undergoing lung cancer screening were identified. Rural status was defined using the rural-urban commuting area codes. The primary outcome was annual repeat lung cancer screening in the 9- to 15-month window (primary analysis) and 31-day to 18-month window (sensitivity analysis) after the first documented lung cancer screening. To examine rurality as a predictor of annual repeat lung cancer screening, multivariable logistic regression models were used. RESULTS In the final analytic sample of 11,402 Veterans, annual repeat lung cancer screening occurred in 27.7% of rural Veterans (641 of 2,316) and 31.8% of nonrural Veterans (2,891 of 9,086) (adjusted odds ratio: 0.86; 95% confidence interval: 0.73-1.03). Similar results were seen in the sensitivity analysis, with 41.6% of rural Veterans (963 of 2,316) versus 45.2% of nonrural Veterans (4,110 of 9,086) (adjusted odds ratio: 0.88; 95% confidence interval: 0.73-1.04) having annual repeat screening in the expanded 31-day to 18-month window. CONCLUSIONS Among a national cohort of Veterans, rural residence was associated with numerically lower odds of annual repeat lung cancer screening than nonrural residence. Continued, intentional outreach efforts to increase annual repeat lung cancer screening among rural Veterans may offer an opportunity to decrease deaths from lung cancer.
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Affiliation(s)
- Lucy B. Spalluto
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN,Department of Radiology, Vanderbilt University Medical Center, Nashville, TN,Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Jennifer A. Lewis
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN,Vanderbilt-Ingram Cancer Center, Nashville, TN,Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren R. Samuels
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN,Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Carol Callaway-Lane
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN
| | - Michael E. Matheny
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN,Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Jason Denton
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN,Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Jennifer A. Robles
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN,Veterans Health Administration – Tennessee Valley Healthcare System, Surgery Service, Nashville, TN,Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Robert S. Dittus
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN,Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | | | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY,Phoenix Veterans Health Care System, Phoenix, AZ
| | - Pierre P. Massion
- Vanderbilt-Ingram Cancer Center, Nashville, TN,Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN,Veterans Health Administration – Tennessee Valley Healthcare System, Medical Service, Nashville, TN
| | - Drew Moghanaki
- Radiation Oncology, Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA,Department of Radiation Oncology, University of California at Los Angeles, Los Angeles, CA
| | - Christianne L. Roumie
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN,Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
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21
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Schwartz RM, Yip R, You N, Gillezeau C, Song K, Yankelevitz DF, Taioli E, Henschke CI, Flores RM. Early-Stage Lung Cancer Patients’ Perceptions of Presurgical Discussions. MDM Policy Pract 2022; 7:23814683221085570. [PMID: 35341091 PMCID: PMC8941700 DOI: 10.1177/23814683221085570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
Background Patients with early-stage non–small-cell lung cancer (NSCLC) have high
survival rates, but patients often say they did not anticipate the effect of
the surgery on their postsurgical quality of life (QoL). This study adds to
the literature regarding patient and surgeon interactions and highlights the
areas where the current approach is not providing good communication. Design Since its start in 2016, the Initiative for Early Lung Cancer Research on
Treatment (IELCART), a prospective cohort study, has enrolled 543 patients
who underwent surgery for stage I NSCLC within the Mount Sinai Health
System. Presurgical patient and surgeon surveys were available for 314
patients, postsurgical surveys for 420, and both pre- and postsurgical
surveys for 285. Results Of patients with presurgical surveys, 31.2% said that their surgeon
recommended multiple types of treatment. Of patients with postsurgical
surveys, 85.0% felt very well prepared and 11.4% moderately well prepared
for their postsurgical recovery. The median Functional Assessment of Cancer
Therapy–Lung Cancer score and social support score of the patients who felt
very well prepared was significantly higher than those moderately or not
well prepared (24.0 v. 22.0, P < 0.001) and (5.0
[interquartile range: 4.7–5.0] v. 5.0 [IQR: 4.2–5.0], p =
0.015). Conclusions This study provides insight into the areas where surgeons are communicating
well with their patients as well as the areas where patients still feel
uninformed. Most surgeons feel that they prepare their patients well or very
well for surgical recovery, whereas some patients still feel that their
surgeons did not prepare them well for postsurgical recovery. Surgeons may
want to spend additional time emphasizing postsurgical recovery and QoL with
their patients or provide their patients with additional avenues to get
their questions and concerns addressed. Highlights
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Affiliation(s)
- Rebecca M. Schwartz
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
- Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell
| | - Rowena Yip
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | - Nan You
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | - Christina Gillezeau
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
| | - Kimberly Song
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai
| | - David F. Yankelevitz
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai
| | - Claudia I. Henschke
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | - Raja M. Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai
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22
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Rolfo C, Meshulami N, Russo A, Krammer F, García-Sastre A, Mack PC, Gomez JE, Bhardwaj N, Benyounes A, Sirera R, Moore A, Rohs N, Henschke CI, Yankelevitz D, King J, Shyr Y, Bunn PA, Minna JD, Hirsch FR. Lung Cancer and Severe Acute Respiratory Syndrome Coronavirus 2 Infection: Identifying Important Knowledge Gaps for Investigation. J Thorac Oncol 2021; 17:214-227. [PMID: 34774792 PMCID: PMC8579698 DOI: 10.1016/j.jtho.2021.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/30/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022]
Abstract
Patients with lung cancer are especially vulnerable to coronavirus disease 2019 (COVID-19) with a greater than sevenfold higher rate of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19, a greater than threefold higher hospitalization rate with high complication rates, and an estimated case fatality rate of more than 30%. The reasons for the increased vulnerability are not known. In addition, beyond the direct impact of the pandemic on morbidity and mortality among patients with lung cancer, COVID-19, with its disruption of patient care, has also resulted in substantial impact on lung cancer screening and treatment/management.COVID-19 vaccines are safe and effective in people with lung cancer. On the basis of the available data, patients with lung cancer should continue their course of cancer treatment and get vaccinated against the SARS-CoV-2 virus. For unknown reasons, some patients with lung cancer mount poor antibody responses to vaccination. Thus, boosting vaccination seems urgently indicated in this subgroup of vulnerable patients with lung cancer. Nevertheless, many unanswered questions regarding vaccination in this population remain, including the magnitude, quality, and duration of antibody response and the role of innate and acquired cellular immunities for clinical protection. Additional important knowledge gaps also remain, including the following: how can we best protect patients with lung cancer from developing COVID-19, including managing care in patient with lung cancer and the home environment of patients with lung cancer; are there clinical/treatment demographics and tumor molecular demographics that affect severity of COVID-19 disease in patients with lung cancer; does anticancer treatment affect antibody production and protection; does SARS-CoV-2 infection affect the development/progression of lung cancer; and are special measures and vaccine strategies needed for patients with lung cancer as viral variants of concern emerge.
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Affiliation(s)
- Christian Rolfo
- Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine, at Mount Sinai, New York, New York
| | - Noy Meshulami
- Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine, at Mount Sinai, New York, New York
| | - Alessandro Russo
- Medical Oncology Unit, Azienda Ospedaliera Papardo (A.O. Papardo), Messina, Italy
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Philip C Mack
- Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine, at Mount Sinai, New York, New York
| | - Jorge E Gomez
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nina Bhardwaj
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amin Benyounes
- Thoracic Oncology, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Rafael Sirera
- Unidad Mixta TRIAL, Centro Investigación Príncipe Felipe-Fundación Investigación, Hospital General Universitario de Valencia, Valencia, Spain; Centro de Investigación Biomédica en Red Cáncer, CIBERONC, Madrid, Spain; Department of Biotechnology, Universitat Politècnica de València, Valencia, Spain
| | - Amy Moore
- LUNGevity Foundation, Bethesda, Maryland
| | - Nicholas Rohs
- Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine, at Mount Sinai, New York, New York
| | | | - David Yankelevitz
- Department of Radiology, Mount Sinai Health System, New York, New York
| | - Jennifer King
- GO(2) Foundation for Lung Cancer, Washington, District of Columbia
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Paul A Bunn
- Division of Medical Oncology, University of Colorado Cancer Center, Aurora, Colorado
| | - John D Minna
- Division of Hematology and Oncology, Department of Internal Medicine, The Hamon Center for Therapeutic Oncology Research, University of Texas Southwestern Medical Center, Dallas, Texas; Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fred R Hirsch
- Center of Excellence for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine, at Mount Sinai, New York, New York.
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23
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Zhu Y, Cai Q, Wang Y, You N, Yip R, Lee DS, Taioli E, Flores R, Henschke CI, Yankelevitz DF. Pre-surgical assessment of mediastinal lymph node metastases in patients having ≥ 30 mm non-small-cell lung cancers. Lung Cancer 2021; 161:189-196. [PMID: 34624614 DOI: 10.1016/j.lungcan.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Computed tomography (CT) and fluorodeoxyglucose-positron-emission-tomography (FDG-PET) measurements of mediastinal lymph nodes (MLNs) of patients with non-small-cell-lung-cancers (NSCLCs) ≤ 30 mm in maximum diameter are recommended for pre-surgical prediction of MLN metastases. METHODS We reviewed all patients at Mount Sinai Health System enrolled in the Initiative for Early Lung Cancer Research on Treatment (IELCART), prospective cohort between 2016 and 2020, who had pre-surgical FDG-PET and underwent surgery with MLN resection and/or pre-operative endobronchial ultrasound (EBUS) for a first primary NSCLC ≤ 30 mm in maximum diameter on pre-surgical CT. RESULTS Among 470 patients, none with part-solid (n = 63) or nonsolid (n = 23) NSCLCs had MLN metastases. Solid NSCLCs were identified in 384 patients, none in typical carcinoid (n = 48) or NSCLC ≤ 10 mm in maximum diameter (n = 47, including 8 typical carcinoids) had MLN metastases. Among the remaining 297 patients with solid NSCLCs 10.1-30.0 mm, 7 (2.4%) had MLN metastases. Area-under-the-curve (AUC) for predicting MLN metastases in solid NSCLCs 10.1-30.0 mm, using the CT maximum short-axis MLN diameter was 0.62 (95% CI:0.44-0.81, p = 0.18) and using the highest SUVmax of any MLN, AUC was 0.58 (95% CI:0.39-0.78,p = 0.41). Neither AUCs were significantly different from chance alone. Optimal cutoff for prediction of MLN metastases was ≥ 18.9 mm for CT maximum short-axis diameter [sensitivity 14.3% (95%CI:0.0%-57.9%); specificity 100.0% (95%CI:98.9%-100.0%)] and for highest SUVmax was ≥ 11.7 [sensitivity 14.3% (95%CI:0.0%-57.9%) and specificity 99.7% (95%CI:98.3%-100.0%)]. CONCLUSIONS CT and SUVmax had low sensitivity but high specificity for predicting MLN metastases in solid NSCLCs 10.1-30.0 mm. Clinical Stage IA NSCLCs ≤ 30 mm should be based on CT maximum tumor diameter and MLN maximum short-axis diameter ≤ 20 mm.
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Affiliation(s)
- Yeqing Zhu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Qiang Cai
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012 China
| | - Yong Wang
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Nan You
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dong-Seok Lee
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emanuela Taioli
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Tisch Center Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Center for Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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24
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Jirapatnakul A, Yip R, Branch AD, Lewis S, Crane M, Yankelevitz DF, Henschke CI. Dose-response relationship between World Trade Center dust exposure and hepatic steatosis. Am J Ind Med 2021; 64:837-844. [PMID: 34328231 DOI: 10.1002/ajim.23269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/04/2021] [Accepted: 05/17/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND The World Trade Center (WTC) attack exposed thousands of workers to toxic chemicals that have been linked to liver diseases and cancers. This study examined the relationship between the intensity of WTC dust exposure and the risk of hepatic steatosis in the WTC General Responders Cohort (GRC). METHODS All low-dose computed tomography (CT) scans of the chest performed on the WTC GRC between September 11, 2001 and December 31, 2018, collected as part of the World Trade Center Health Program, were reviewed. WTC dust exposure was categorized into five groups based on WTC arrival time. CT liver density was estimated using an automated algorithm, statistics-based liver density estimation from imaging. The relationship between the intensity of WTC dust exposure and the risk of hepatic steatosis was examined using univariate and multivariable regression analyses. RESULTS Of the 1788 WTC responders, 258 (14.4%) had liver attenuation less than 40 Hounsfield units (HU < 40) on their earliest CT. Median time after September 11, 2001 and the earliest available CT was 11.3 years (interquartile range: 8.0-14.9 years). Prevalence of liver attenuation less than 40 HU was 17.0% for arrivals on September 11, 2001, 16.0% for arrivals on (September 12, 2001 or September 13, 2001), 10.9% for arrivals on September 14-30, 2001, and 9.0% for arrivals on January 10, 2001 or later (p = 0.0015). A statistically significant trend of increasing liver steatosis was observed with earlier arrival times (p < 0.0001). WTC arrival time remained a significant independent factor for decreased liver attenuation after controlling for other covariates. CONCLUSIONS Early arrival at the WTC site was significantly associated with increasing hepatic steatosis.
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Affiliation(s)
- Artit Jirapatnakul
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Rowena Yip
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Andrea D. Branch
- Division of Liver Diseases, Department of Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Sara Lewis
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Michael Crane
- Department of Environmental Medicine and Public Health Icahn School of Medicine at Mount Sinai New York New York USA
| | - David F. Yankelevitz
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
| | - Claudia I. Henschke
- Department of Radiology Icahn School of Medicine at Mount Sinai New York New York USA
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25
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Zhu Y, Yip R, You N, Cai Q, Henschke CI, Yankelevitz DF. Characterization of Newly Detected Costal Pleura-attached Noncalcified Nodules at Annual Low-Dose CT Screenings. Radiology 2021; 301:724-731. [PMID: 34546130 DOI: 10.1148/radiol.2021210807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Solid costal pleura-attached noncalcified nodules (CP-NCNs) less than 10.0 mm with lentiform, oval, or semicircular (LOS) or triangular shapes and smooth margins on baseline low-dose CT scans from the Mount Sinai Early Lung and Cardiac Action Program (MS-ELCAP) were reviewed, and it was determined that they can be followed up at the first annual screening rather than having a shorter-term work-up. Purpose To determine whether the same criteria could be used for solid CP-NCNs newly identified at annual screening examinations. Materials and Methods With use of the same MS-ELCAP database, all new solid CP-NCNs measuring 30.0 mm or less were identified at 4425 annual screening examinations between 2010 and 2019. In addition, to ensure that no malignant CP-NCNs met the criteria, all solid malignant CP-NCNs of 30.0 mm or less in the International Early Lung Cancer Action Program, or I-ELCAP, database of 111 102 annual screening examinations from the 76 participating institutions between 1992 and 2019 were identified; Mount Sinai is one of these institutions. All identified solid CP-NCNs were reviewed-with the radiologists blinded to diagnosis-for shape (triangular, LOS, polygonal, round, or irregular), margin (smooth or nonsmooth), pleural attachment (broad or narrow), and the presence of emphysema and/or fibrosis within 10.0 mm of each CP-NCN. Intra- and interreader readings were performed, and agreements were determined by using the B-statistic. Results Of the 76 new solid CP-NCNs, 21 were lung cancers. Benign CP-NCNs were smaller than malignant ones (median diameter, 4.2 mm vs 11 mm; P < .001), had a different shape distributions, more frequently had smooth margins (67% vs 14%; P < .001), and less frequently had emphysema (38% vs 81%; P = .003) or fibrosis (3.6% vs 19%; P = .045) within a 10.0 mm radius. All 22 solid CP-NCNs less than 10.0 mm in average diameter with triangular or LOS shapes and smooth margins were benign, and none of the 21 solid malignant CP-NCNs had these characteristics. Intra- and interobserver agreement for triangular or LOS-shaped CP-NCNs with smooth margins was almost perfect (0.77 and 0.69, respectively). Conclusion The same follow-up recommendation developed for baseline costal pleura-attached noncalcified nodules (CP-NCNs) can be used for CP-NCNs newly identified at annual screening rounds. © RSNA, 2021.
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Affiliation(s)
- Yeqing Zhu
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | - Rowena Yip
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | - Nan You
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | - Qiang Cai
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | - Claudia I Henschke
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
| | - David F Yankelevitz
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
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- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029 (Y.Z., R.Y., N.Y., Q.C., C.I.H., D.F.Y.); and Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China (Q.C.)
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26
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Zhu Y, Triphuridet N, Yip R, Becker BJ, Wang Y, Yankelevitz DF, Henschke CI. Opportunistic CT screening of osteoporosis on thoracic and lumbar spine: a meta-analysis. Clin Imaging 2021; 80:382-390. [PMID: 34530357 DOI: 10.1016/j.clinimag.2021.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Osteoporotic fractures are a major contributor to late life morbidity and mortality, and impose a substantial societal cost, yet osteoporosis remains substantially underdiagnosed and undertreated. The purpose of this meta-analysis was to assess the pooled diagnostic sensitivity and specificity of computed tomography (CT) images for diagnosing osteoporosis in patients who meet WHO dual X-ray absorptiometry (DXA) osteoporosis criteria using specific Hounsfield unit (HU) values as a threshold. METHODS Systematic literature searches in PubMed, Embase, Web of Science and Google Scholar were performed from the earliest available date through 1 July 2018, restricted to publications in English. Participants in all studies underwent CT scans that included the lumbar and/or thoracic spine for different indications and HU measurements were used to identify osteoporosis. DXA scans served as the reference standard. RESULTS Ten eligible studies were identified. The mean area under the hierarchical summary receiver operating characteristic (ROC) curve for diagnosis osteoporosis was 0.84 (95% CI: 0.81, 0.87). The pooled diagnostic sensitivity and specificity of CT images to identify osteoporosis were 0.83 (95% CI: 0.73, 0.90) and 0.74 (95% CI: 0.69, 0.79). The positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio were 3.4 (95% CI: 2.7, 4.5), 0.21 (95% CI: 0.12, 0.36), and 16.4 (95% CI: 7.8, 34.3), respectively. The bias-adjusted sensitivity and specificity of CT were 0.73 and 0.71. Meta-regression demonstrated that country of study, DXA criteria and scanner manufacturer were significant factors associated with the sensitivity of CT in detecting osteoporosis while scanner manufacturer was the only factor associated with specificity of CT. CONCLUSIONS This meta-analysis showed reasonable pooled sensitivity and specificity for using threshold values measured on CT scans to identify osteoporosis opportunistically.
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Affiliation(s)
- Yeqing Zhu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Natthaya Triphuridet
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pulmonary Medicine, Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Betsy J Becker
- Department of Educational Psychology and Learning Systems, College of Education, Florida State University, Tallahassee, FL, USA
| | - Yong Wang
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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27
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Spalluto LB, Lewis JA, Stolldorf D, Yeh VM, Callaway-Lane C, Wiener RS, Slatore CG, Yankelevitz DF, Henschke CI, Vogus TJ, Massion PP, Moghanaki D, Roumie CL. Organizational Readiness for Lung Cancer Screening: A Cross-Sectional Evaluation at a Veterans Affairs Medical Center. J Am Coll Radiol 2021; 18:809-819. [PMID: 33421372 PMCID: PMC8180484 DOI: 10.1016/j.jacr.2020.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Lung cancer has the highest cancer-related mortality in the United States and among Veterans. Screening of high-risk individuals with low-dose CT (LDCT) can improve survival through detection of early-stage lung cancer. Organizational factors that aid or impede implementation of this evidence-based practice in diverse populations are not well described. We evaluated organizational readiness for change and change valence (belief that change is beneficial and valuable) for implementation of LDCT screening. METHODS We performed a cross-sectional survey of providers, staff, and administrators in radiology and primary care at a single Veterans Affairs Medical Center. Survey measures included Shea's validated Organizational Readiness for Implementing Change (ORIC) scale and Shea's 10 items to assess change valence. ORIC and change valence were scored on a scale from 1 to 7 (higher scores representing higher readiness for change or valence). Multivariable linear regressions were conducted to determine predictors of ORIC and change valence. RESULTS Of 523 employees contacted, 282 completed survey items (53.9% overall response rate). Higher ORIC scores were associated with radiology versus primary care (mean 5.48, SD 1.42 versus 5.07, SD 1.22, β = 0.37, P = .039). Self-identified leaders in lung cancer screening had both higher ORIC (5.56, SD 1.39 versus 5.11, SD 1.26, β = 0.43, P = .050) and change valence scores (5.89, SD 1.21 versus 5.36, SD 1.19, β = 0.51, P = .012). DISCUSSION Radiology health professionals have higher levels of readiness for change for implementation of LDCT screening than those in primary care. Understanding health professionals' behavioral determinants for change can inform future lung cancer screening implementation strategies.
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Affiliation(s)
- Lucy B Spalluto
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Vice Chair of Health Equity, Associate Director, Diversity and Inclusion Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt-Ingram Cancer Center, Nashville, Tennessee.
| | - Jennifer A Lewis
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Co-Director, Veterans Administration Tennessee Valley Healthcare System Lung Cancer Screening Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Deonni Stolldorf
- Chair, Vanderbilt University School of Nursing PhD Program Evaluation Committee, Chair, Vanderbilt University Competency Exam Committee, School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Vivian M Yeh
- Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Carol Callaway-Lane
- Co-Director, Veterans Administration Tennessee Valley Healthcare System Lung Cancer Screening Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Associate Director, Tennessee Valley Healthcare System Veterans Administration Quality Scholars Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Renda Soylemez Wiener
- Associate Director, Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, Co-Chair, VISN1 Lung Cancer Screening Council, Deputy Chair, Pulmonary Field Advisory Committee, Veterans Health Administration, Boston Massachusetts; The Pulmonary Center, Boston University Medical Center, Boston, Massachusetts
| | - Christopher G Slatore
- Medical Director, Portland VA Medical Center Unsuspected Radiologic Findings System, Health Services Research and Development, Portland Veterans Affairs Medical Center, Portland, Oregon; Co-Director, Portland VA Medical Center Lung Cancer Screening Program, Section of Pulmonary and Critical Care Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland, Oregon
| | - David F Yankelevitz
- Director, Lung Biopsy Service, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Claudia I Henschke
- Phoenix Veterans Health Care System, Phoenix, Arizona; Director of the Early Lung and Cardiac Action Program, Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Timothy J Vogus
- Deputy Director of Business Innovation, Frist Center for Autism and Innovation, Vanderbilt University, Faculty Director, Leadership Development, Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee
| | - Pierre P Massion
- Director, Cancer Early Detection and Prevention Initiative at Vanderbilt-Ingram Cancer Center, Co-Leader, Cancer Health Outcomes and Control Program, Vanderbilt-Ingram Cancer Center, Nashville, Tennessee; Department of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System, Medical Service, Nashville, Tennessee
| | - Drew Moghanaki
- Section Chief, Department of Radiation Oncology, Atlanta VA Medical Center, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Christianne L Roumie
- Deputy Director, VA Tennessee Valley Healthcare System VA Quality Scholars Program, Veterans Health Administration-Tennessee Valley Health Care System Geriatric Research, Education and Clinical Center (GRECC), Nashville, Tennessee; Director, Vanderbilt Master of Public Health Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Li M, Cai Q, Ma JW, Zhang L, Henschke CI. The 100 most cited articles on lung cancer screening: a bibliometric analysis. Ann Transl Med 2021; 9:787. [PMID: 34268400 PMCID: PMC8246190 DOI: 10.21037/atm-20-3199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 11/15/2020] [Indexed: 12/21/2022]
Abstract
Background The number of citations of an article reflects its impact on the scientific community. The aim of this study was to identify and characterize the 100 most cited articles on lung cancer screening. Methods The 100 most cited articles on lung cancer screening published in all scientific journals were identified using the Web of Science database. Relevant data, including the number of citations, publication year, publishing journal and impact factor (IF), authorship and country of origin, article type and study design, screening modality, and main topic, were collected and analyzed. Results The 100 most cited articles were all English and published between 1973 and 2017, with 81 published after 2000. The mean number of citations was 292.90 (range 100–3,910). Sixty articles originated from the United States. These articles were published in 32 journals; there was a statistically significant positive correlation between journal IF and the number of citations (r=0.238, P=0.018). Seventy-nine articles were original research of which 37.9% were about results from randomized controlled trials (RCTs). The most common screening modalities in these articles were low-dose computed tomography (LDCT) (n=78), followed by chest X-ray radiography (CXR) and sputum cytology (n=11). The most common topic in these articles was screening test effectiveness. Conclusions Our study presents a detailed list and analysis of the 100 most cited articles published about lung cancer screening which provides insight into the historical developments and key contributions in this field.
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Affiliation(s)
- Meng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Radiology, Mount Sinai Health System, New York, NY, USA
| | - Qiang Cai
- Department of Radiology, Mount Sinai Health System, New York, NY, USA.,Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Jing-Wen Ma
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Radiology, Mount Sinai Health System, New York, NY, USA
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Lewis JA, Spalluto LB, Henschke CI, Yankelevitz DF, Aguayo SM, Morales P, Avila R, Audet CM, Prusaczyk B, Lindsell CJ, Callaway-Lane C, Dittus RS, Vogus TJ, Massion PP, Limper HM, Kripalani S, Moghanaki D, Roumie CL. Protocol to evaluate an enterprise-wide initiative to increase access to lung cancer screening in the Veterans Health Administration. Clin Imaging 2021; 73:151-161. [PMID: 33422974 PMCID: PMC8479827 DOI: 10.1016/j.clinimag.2020.11.059] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The Veterans Affairs Partnership to increase Access to Lung Screening (VA-PALS) is an enterprise-wide initiative to implement lung cancer screening programs at VA medical centers (VAMCs). VA-PALS will be using implementation strategies that include program navigators to coordinate screening activities, trainings for navigators and radiologists, an open-source software management system, tools to standardize low-dose computed tomography image quality, and access to a support network. VAMCs can utilize strategies according to their local needs. In this protocol, we describe the planned program evaluation for the initial 10 VAMCs participating in VA-PALS. MATERIALS AND METHODS The implementation of programs will be evaluated using the Consolidated Framework for Implementation Research to ensure broad contextual guidance. Program evaluation measures have been developed using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. Adaptations of screening processes will be assessed using the Framework for Reporting Adaptations and Modifications to Evidence Based Interventions. Measures collected will reflect the inner settings, estimate and describe the population reached, adoption by providers, implementation of the programs, report clinical outcomes and maintenance of programs. Analyses will include descriptive statistics and regression to evaluate predictors and assess implementation over time. DISCUSSION This theory-based protocol will evaluate the implementation of lung cancer screening programs across the Veterans Health Administration using scientific frameworks. The findings will inform plans to expand the VA-PALS initiative beyond the original sites and can guide implementation of lung cancer screening programs more broadly.
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Affiliation(s)
- Jennifer A Lewis
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America; Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America; Vanderbilt Ingram Cancer Center, Nashville, TN, United States of America.
| | - Lucy B Spalluto
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America; Vanderbilt Ingram Cancer Center, Nashville, TN, United States of America; Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America; Phoenix VA Health Care System, Phoenix, AZ, United States of America
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, NY, New York, United States of America; Phoenix VA Health Care System, Phoenix, AZ, United States of America
| | - Samuel M Aguayo
- Phoenix VA Health Care System, Phoenix, AZ, United States of America
| | | | - Rick Avila
- Paraxial LLC, Halfmoon, NY, United States of America
| | - Carolyn M Audet
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Beth Prusaczyk
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Christopher J Lindsell
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Carol Callaway-Lane
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America; VA Tennessee Valley Healthcare System, Medicine Service, Nashville, TN, United States of America
| | - Robert S Dittus
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Timothy J Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN, United States of America
| | - Pierre P Massion
- Vanderbilt Ingram Cancer Center, Nashville, TN, United States of America; VA Tennessee Valley Healthcare System, Medicine Service, Nashville, TN, United States of America; Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Heather M Limper
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Sunil Kripalani
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Drew Moghanaki
- Radiation Oncology, Atlanta VA Medical Center, Atlanta, Georgia; Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Christianne L Roumie
- VA Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States of America; Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
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Steiger D, Siddiqi MF, Yip R, Yankelevitz DF, Henschke CI. The importance of low-dose CT screening to identify emphysema in asymptomatic participants with and without a prior diagnosis of COPD. Clin Imaging 2021; 78:136-141. [PMID: 33799061 DOI: 10.1016/j.clinimag.2021.03.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Chronic Obstructive Pulmonary Disease (COPD) includes chronic bronchitis, small airways disease, and emphysema. Diagnosis of COPD requires spirometric evidence and may be normal even when small airways disease or emphysema is present. Emphysema increases the risk of exacerbations, and is associated with all-cause mortality and increased risk of lung cancer. We evaluated the prevalence of emphysema in participants with and without a prior history of COPD. METHODS We reviewed a prospective cohort of 52,726 subjects who underwent baseline low dose CT screening for lung cancer from 2003 to 2016 in the International Early Lung Cancer Action Program. RESULTS Of 52,726 participants, 23.8%(12,542) had CT evidence of emphysema. Of these 12,542 participants with emphysema, 76.5%(9595/12,542) had no prior COPD diagnosis even though 23.6% (2258/9595) had moderate or severe emphysema. Among 12,542 participants, significant predictors of no prior COPD diagnosis were: male (OR = 1.47, p < 0.0001), younger age (ORage10 = 0.72, p < 0.0001), lower pack-years of smoking (OR10pack-years = 0.90, p < 0.0001), completed college or higher (OR = 1.54, p < 0.0001), no family history of lung cancer (OR = 1.12, p = 0.04), no self-reported cardiac disease (OR = 0.76, p = 0.0003) or hypertension (OR = 0.74, p < 0.0001). The severity of emphysema was significantly lower among the 9595 participants with no prior COPD diagnosis, the OR for moderate emphysema was ORmoderate = 0.58(p = 0.0007) and for severe emphysema, it was ORsevere = 0.23(p < 0.0001). CONCLUSION Emphysema was identified in 23.8% participants undergoing LDCT and was unsuspected in 76.5%. LDCT provides an opportunity to identify emphysema, and recommend smoking cessation.
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Affiliation(s)
- David Steiger
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine, Mount Sinai St. Lukes, Mount Sinai West, Mount Sinai Beth Israel, New York, NY, United States of America
| | - M Faisal Siddiqi
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine, Mount Sinai St. Lukes, Mount Sinai West, Mount Sinai Beth Israel, New York, NY, United States of America
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States of America
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States of America
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, United States of America; Phoenix Veterans Health Care System, Phoenix, AZ, United States of America.
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Mulshine JL, Avila RS, Conley E, Devaraj A, Ambrose LF, Flanagan T, Henschke CI, Hirsch FR, Janz R, Kakinuma R, Lam S, McWilliams A, Van Ooijen PMA, Oudkerk M, Pastorino U, Reeves A, Rogalla P, Schmidt H, Sullivan DC, Wind HHJ, Wu N, Wynes M, Xueqian X, Yankelevitz DF, Field JK. The International Association for the Study of Lung Cancer Early Lung Imaging Confederation. JCO Clin Cancer Inform 2021; 4:89-99. [PMID: 32027538 PMCID: PMC7053806 DOI: 10.1200/cci.19.00099] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To improve outcomes for lung cancer through low-dose computed tomography (LDCT) early lung cancer detection. The International Association for the Study of Lung Cancer is developing the Early Lung Imaging Confederation (ELIC) to serve as an open-source, international, universally accessible environment to analyze large collections of quality-controlled LDCT images and associated biomedical data for research and routine screening care. METHODS ELIC is an international confederation that allows access to efficiently analyze large numbers of high-quality computed tomography (CT) images with associated de-identified clinical information without moving primary imaging/clinical or imaging data from its local or regional site of origin. Rather, ELIC uses a cloud-based infrastructure to distribute analysis tools to the local site of the stored imaging and clinical data, thereby allowing for research and quality studies to proceed in a vendor-neutral, collaborative environment. ELIC’s hub-and-spoke architecture will be deployed to permit analysis of CT images and associated data in a secure environment, without any requirement to reveal the data itself (ie, privacy protecting). Identifiable data remain under local control, so the resulting environment complies with national regulations and mitigates against privacy or data disclosure risk. RESULTS The goal of pilot experiments is to connect image collections of LDCT scans that can be accurately analyzed in a fashion to support a global network using methodologies that can be readily scaled to accrued databases of sufficient size to develop and validate robust quantitative imaging tools. CONCLUSION This initiative can rapidly accelerate improvements to the multidisciplinary management of early, curable lung cancer and other major thoracic diseases (eg, coronary artery disease and chronic obstructive pulmonary disease) visualized on a screening LDCT scan. The addition of a facile, quantitative CT scanner image quality conformance process is a unique step toward improving the reliability of clinical decision support with CT screening worldwide.
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Affiliation(s)
| | | | - Ed Conley
- University of Liverpool, Liverpool, United Kingdom
| | | | | | | | | | | | - Robert Janz
- University of Groningen, Groningen, Netherlands
| | | | - Stephen Lam
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Patrick Rogalla
- Toronto Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
| | - Heidi Schmidt
- Toronto Joint Department of Medical Imaging, University of Toronto, Ontario, Canada
| | | | | | - Ning Wu
- National Cancer Center, Peking Union Medical College, Beijing, China
| | - Murry Wynes
- International Association for the Study of Lung Cancer, Denver, CO
| | | | | | - John K Field
- University of Liverpool, Liverpool, United Kingdom
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Li K, Liu X, Yip R, Yankelevitz DF, Henschke CI, Geng Y, Fang Y, Li W, Pan C, Chen X, Qin P, Zhong Y, Liu K, Li S. Early prediction of severity in coronavirus disease (COVID-19) using quantitative CT imaging. Clin Imaging 2021; 78:223-229. [PMID: 34058647 PMCID: PMC7874917 DOI: 10.1016/j.clinimag.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/21/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022]
Abstract
Purpose To evaluate whether the extent of COVID-19 pneumonia on CT scans using quantitative CT imaging obtained early in the illness can predict its future severity. Methods We conducted a retrospective single-center study on confirmed COVID-19 patients between January 18, 2020 and March 5, 2020. A quantitative AI algorithm was used to evaluate each patient's CT scan to determine the proportion of the lungs with pneumonia (VR) and the rate of change (RAR) in VR from scan to scan. Patients were classified as being in the severe or non-severe group based on their final symptoms. Penalized B-splines regression modeling was used to examine the relationship between mean VR and days from onset of symptoms in the two groups, with 95% and 99% confidence intervals. Results Median VR max was 18.6% (IQR 9.1–32.7%) in 21 patients in the severe group, significantly higher (P < 0.0001) than in the 53 patients in non-severe group (1.8% (IQR 0.4–5.7%)). RAR was increasing with a median RAR of 2.1% (IQR 0.4–5.5%) in severe and 0.4% (IQR 0.1–0.9%) in non-severe group, which was significantly different (P < 0.0001). Penalized B-spline analyses showed positive relationships between VR and days from onset of symptom. The 95% confidence limits of the predicted means for the two groups diverged 5 days after the onset of initial symptoms with a threshold of 11.9%. Conclusion Five days after the initial onset of symptoms, CT could predict the patients who later developed severe symptoms with 95% confidence.
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Affiliation(s)
- Kunwei Li
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China; Guangdong Provincial Key Laboratory of Biomedical Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China.
| | - Xueguo Liu
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China; Guangdong Provincial Key Laboratory of Biomedical Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China.
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, United States of America.
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, United States of America.
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029, United States of America.
| | - Yayuan Geng
- Huiying Medical Technology Co., Ltd, Room A206, B2, Dongsheng Science and Technology Park, HaiDian District, Beijing 100192, China.
| | - Yijie Fang
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China.
| | - Wenjuan Li
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China.
| | - Cunxue Pan
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China
| | - Xiaojun Chen
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China.
| | - Peixin Qin
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China
| | - Yinghua Zhong
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China
| | - Kunfeng Liu
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China.
| | - Shaolin Li
- Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China; Guangdong Provincial Key Laboratory of Biomedical Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, Zhuhai 519000, China.
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Yip R, Jirapatnakul A, Hu M, Chen X, Han D, Ma T, Zhu Y, Salvatore MM, Margolies LR, Yankelevitz DF, Henschke CI. Added benefits of early detection of other diseases on low-dose CT screening. Transl Lung Cancer Res 2021; 10:1141-1153. [PMID: 33718052 PMCID: PMC7947380 DOI: 10.21037/tlcr-20-746] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Low-dose CT screening for lung cancer provides images of the entire chest and upper abdomen. While the focus of screening is on finding early lung cancer, radiology leadership has embraced the fact that the information contained in the images presents a new challenge to the radiology profession. Other findings in the chest and upper abdomen were not the reason for obtaining the screening CT scan, nor symptom-prompted, but still need to be reported. Reporting these findings and making recommendations for further workup requires careful consideration to avoid unnecessary workup or interventions while still maximizing the benefit that early identification of these other diseases provided. Other potential findings, such as cardiovascular disease and chronic pulmonary obstructive diseases actually cause more deaths than lung cancer. Existing recommendations for workup of abnormal CT findings are based on symptom-prompted indications for imaging. These recommendations may be different when the abnormalities are identified in asymptomatic people undergoing CT screening for lung cancer. I-ELCAP, a large prospectively collected multi-institutional and multi-national database of screenings, was used to analyze CT findings identified in screening for lung cancer. These analyses and recommendations were made by radiologists in collaboration with clinicians in different medical specialties.
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Affiliation(s)
- Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Artit Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Minxia Hu
- Department of Diagnostic Ultrasound, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiangmeng Chen
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, China
| | - Dan Han
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Teng Ma
- Department of Radiology, Tong Ren Hospital, Capital Medical University, Beijing, China
| | - Yeqing Zhu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mary M Salvatore
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Laurie R Margolies
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Henschke CI, Yankelevitz DF, Jirapatnakul A, Yip R, Reccoppa V, Benjamin C, Llamo T, Williams A, Liu S, Max D, Aguayo SM, Morales P, Igel BJ, Abbaszadegan H, Fredricks PA, Garcia DP, Permana PA, Fawcett J, Sultan S, Murphy LA. Implementation of low-dose CT screening in two different health care systems: Mount Sinai Healthcare System and Phoenix VA Health Care System. Transl Lung Cancer Res 2021; 10:1064-1082. [PMID: 33718045 PMCID: PMC7947390 DOI: 10.21037/tlcr-20-761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Implementation of lung screening (LS) programs is challenging even among health care organizations that have the motivation, the resources, and more importantly, the goal of providing for life-saving early detection, diagnosis, and treatment of lung cancer. We provide a case study of LS implementation in different healthcare systems, at the Mount Sinai Healthcare System (MSHS) in New York City, and at the Phoenix Veterans Affairs Health Care System (PVAHCS) in Phoenix, Arizona. This will illustrate the commonalities and differences of the LS implementation process in two very different health care systems in very different parts of the United States. Underlying the successful implementation of these LS programs was the use of a comprehensive management system, the Early Lung Cancer Action Program (ELCAP) Management SystemTM. The collaboration between MSHS and PVAHCS over the past decade led to the ELCAP Management SystemTM being gifted by the Early Diagnosis and Treatment Research Foundation to the PVAHCS, to develop a “VA-ELCAP” version. While there remain challenges and opportunities to continue improving LS and its implementation, there is an increasing realization that most patients who are diagnosed with lung cancer as a result of annual LS can be cured, and that of all the possible risks associated with LS, the greater risk of all is for heavy cigarette smokers not to be screened. We identified 10 critical components in implementing a LS program. We provided the details of each of these components for the two healthcare systems. Most importantly, is that continual re-evaluation of the screening program is needed based on the ongoing quality assurance program and database of the actual screenings. At minimum, there should be an annual review and updating. As early diagnosis of lung cancer must be followed by optimal treatment to be effective, treatment advances for small, early lung cancers diagnosed as a result of screening also need to be assessed and incorporated into the entire screening and treatment program.
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Affiliation(s)
- Claudia I Henschke
- Mount Sinai Healthcare System, New York, NY, USA.,Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - David F Yankelevitz
- Mount Sinai Healthcare System, New York, NY, USA.,Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Artit Jirapatnakul
- Mount Sinai Healthcare System, New York, NY, USA.,Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Rowena Yip
- Mount Sinai Healthcare System, New York, NY, USA.,Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | | | | | | | | | - Simon Liu
- Mount Sinai Healthcare System, New York, NY, USA
| | - Daniel Max
- Mount Sinai Healthcare System, New York, NY, USA
| | - Samuel M Aguayo
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | | | - Brian J Igel
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | | | | | - Daniel P Garcia
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Paska A Permana
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Janet Fawcett
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Samir Sultan
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
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Abstract
There have been hundreds of publications about overdiagnosis during the past decade describing concern regarding its potential for harms in lung cancer screening. However, the definition and frequency with which it occurs in screening trials remains unclear. This lack of clarity stems from its current definition which is not based on a clinical grounds but instead on an epidemiologic definition that depends on the cause of death. Thus, with the current definition an overdiagnosed cancer can only be diagnosed if the person does not die from the cancer, regardless of whether or not the cancer is aggressive or the treatment successful. Using a definition based on epidemiology rather than the clinical presentation is highly unusual. Furthermore, the frequency of overdiagnosis has also been a cause of great confusion. Prior to the results from the National Lung Screening trial (NLST), concerns were expressed that virtually all CT screen detected cancers would be overdiagnosed, yet the extended follow-up study of the National Lung Screening Trial shows that in essence there were virtually no overdiagnosis. Even more confusing is that it was previously suspected that there was a high rate of overdiagnosis when using chest radiographic screening and therefore as CT is a more sensitive imaging test and finds cancers even earlier, it would be presumed that the overdiagnosis rate for CT would be even be higher. A proposed change in the definition would focus more on the clinical manifestation of the cancer as to its aggressiveness as this can be diagnosed while the patient is alive. Using a definition that is based on clinical features, a cancer that manifests as a nonsolid nodule would be considered overdiagnosed if instead of being recognized as relatively indolent was instead thought to be an aggressive cancer. The concept of overtreatment arises if this nonaggressive cancer were treated aggressively.
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Affiliation(s)
- David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Henschke CI, Yip R, Shaham D, Zulueta JJ, Aguayo SM, Reeves AP, Jirapatnakul A, Avila R, Moghanaki D, Yankelevitz DF. The Regimen of Computed Tomography Screening for Lung Cancer: Lessons Learned Over 25 Years From the International Early Lung Cancer Action Program. J Thorac Imaging 2021; 36:6-23. [PMID: 32520848 PMCID: PMC7771636 DOI: 10.1097/rti.0000000000000538] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We learned many unanticipated and valuable lessons since we started planning our study of low-dose computed tomography (CT) screening for lung cancer in 1991. The publication of the baseline results of the Early Lung Cancer Action Project (ELCAP) in Lancet 1999 showed that CT screening could identify a high proportion of early, curable lung cancers. This stimulated large national screening studies to be quickly started. The ELCAP design, which provided evidence about screening in the context of a clinical program, was able to rapidly expand to a 12-institution study in New York State (NY-ELCAP) and to many international institutions (International-ELCAP), ultimately working with 82 institutions, all using the common I-ELCAP protocol. This expansion was possible because the investigators had developed the ELCAP Management System for screening, capturing data and CT images, and providing for quality assurance. This advanced registry and its rapid accumulation of data and images allowed continual assessment and updating of the regimen of screening as advances in knowledge and new technology emerged. For example, in the initial ELCAP study, introduction of helical CT scanners had allowed imaging of the entire lungs in a single breath, but the images were obtained in 10 mm increments resulting in about 30 images per person. Today, images are obtained in submillimeter slice thickness, resulting in around 700 images per person, which are viewed on high-resolution monitors. The regimen provides the imaging acquisition parameters, imaging interpretation, definition of positive result, and the recommendations for further workup, which now include identification of emphysema and coronary artery calcifications. Continual updating is critical to maximize the benefit of screening and to minimize potential harms. Insights were gained about the natural history of lung cancers, identification and management of nodule subtypes, increased understanding of nodule imaging and pathologic features, and measurement variability inherent in CT scanners. The registry also provides the foundation for assessment of new statistical techniques, including artificial intelligence, and integration of effective genomic and blood-based biomarkers, as they are developed.
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Affiliation(s)
- Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York
- Phoenix Veterans Affairs Health Care System, Phoenix, AZ
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York
| | - Dorith Shaham
- Department of Medical Imaging, Hadassah Medical Center, Jerusalem, Israel
| | - Javier J. Zulueta
- Clinica Universidad de Navarra, University of Navarra School of Medicine, Pamplona, Spain
| | | | - Anthony P. Reeves
- Department of Electrical and Computer Engineering, Cornell University, Ithaca
| | - Artit Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York
| | | | - Drew Moghanaki
- Department of Radiation Oncology, Atlanta VA Medical Center, Decatur, GA
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Siddique M, Yip R, Henschke CI, Yankelevitz DF. PET standardized uptake values of primary lung cancer for comparison with tumor volume doubling times. Clin Imaging 2020; 73:146-150. [PMID: 33418311 DOI: 10.1016/j.clinimag.2020.11.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the relationship between two documented indicators of tumor aggressiveness, SUV and volume doubling time (VDT) for stage I non-small cell lung cancer (NSCLC). METHODS 116 pathology proven solid NSCLC patients with 2 pretreatment CT and 1 PET/CT scan were retrospectively identified. The 2 CT scans were at least 85 days apart. SUV values were collected from PET/CT reports and CT derived VDT's were calculated assuming an exponential growth rate. Corrected SUV values were also obtained for all cases. Median VDT, SUV and corrected SUV values were reported according to cancer histology. Relationships between VDT, SUV and corrected SUV were examined. RESULTS 91 Adenocarcinomas and 25 squamous-cell carcinomas had median VDT values of 150.6 and 110.0 days respectively. Median SUV values were 5.1 and 12.3 for adenocarcinoma and squamous-cell carcinoma, respectively (p = 0.0003); median corrected SUV values were 16.8 and 31.7 respectively (p = 0.003). A statistically significant monotonic relationship was observed between increased SUV uptake and faster VDT (p = 0.05) and corrected SUV and VDT (P = 0.0002). When stratified by cancer histology, the relationship between VDT and either SUV or corrected SUV was statistically significant for adenocarcinomas (p = 0.02 and p = 0.0001, respectively), but not for squamous-cell carcinoma (p = 0.85 and p = 0.37, respectively). CONCLUSION We demonstrated an overall significant relationship between VDT, SUV and corrected SUV. The relationship, however, was stronger for adenocarcinomas than for squamous-cell carcinomas. This implies that the primary determinant for these relationships is histology and within each cell type, there are other factors that have strong influences.
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Affiliation(s)
- Maham Siddique
- Department of Radiology, Columbia University Medical Center, New York Presbyterian Hospital, 622 West 168th Street, PB-1-301, New York, NY 10032, United States of America.
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America.
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America.
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, United States of America.
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Zhu Y, Yip R, You N, Henschke CI, Yankelevitz DF. Management of Nodules Attached to the Costal Pleura at Low-Dose CT Screening for Lung Cancer. Radiology 2020; 297:710-718. [PMID: 33021893 DOI: 10.1148/radiol.2020202388] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Pulmonary nodule features have been used to differentiate benign from malignant nodules. Purpose To determine the frequency of solid noncalcified nodules attached to the costal pleura (CP-NCNs) at baseline low-dose CT and to identify key features of benignity. Materials and Methods A retrospective review was performed of baseline low-dose CT scans obtained in 8730 participants in the Mount Sinai Early Lung and Cardiac Action Program screening cohort between 1992 and 2019. Participants with one or more solid CP-NCNs between 3.0 mm and 30.0 mm in average diameter were included. For each CP-NCN, the size, location, shape (lentiform, oval, or semicircular [LOS]; triangular; polygonal; round; or irregular), margin (smooth or nonsmooth), and attachment to the costal pleura (broad or narrow) were documented. The manifestation of emphysema and fibrosis within a 10-mm radius of the CP-NCN was determined. Multivariable logistic regression analysis, with synthetic minority oversampling techniques, was used. Results The 569 eligible participants (average age, 62 years ± 9 [standard deviation]; 343 women) had 943 solid CP-NCNs, of which 934 (99.0%) were benign and nine (1.0%) were malignant. Multivariable analysis showed that five shapes could be consolidated into three (LOS and/or triangular, round and/or polygonal, and irregular shape); pleural attachment was not a significant independent predictor (odds ratio, 1.24; P = .70); and interaction terms of size with shape (odds ratio, 0.73; P = .005) and margin were significant (odds ratio, 0.80; P = .001). All 603 CP-NCNs less than 10.0 mm with LOS or triangular shapes and smooth margins were benign. Conclusion All baseline noncalcified solid nodules attached to the costal pleura less than 10.0 mm in average diameter with lentiform, oval, semicircular, or triangular shapes and smooth margins were benign; thus, for these nodules, an annual repeat scan in 1 year, rather than a more immediate work-up, is recommended. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Godoy in this issue.
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Affiliation(s)
- Yeqing Zhu
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574
| | - Rowena Yip
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574
| | - Nan You
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574
| | - Claudia I Henschke
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574
| | - David F Yankelevitz
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574
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Zhang L, Yip R, Jirapatnakul A, Li M, Cai Q, Henschke CI, Yankelevitz DF. Lung cancer screening intervals based on cancer risk. Lung Cancer 2020; 149:113-119. [PMID: 33007677 DOI: 10.1016/j.lungcan.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/30/2020] [Accepted: 09/17/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES As low-dose CT screening is gaining acceptance, focus is on increasing the efficiency of screening. One major consideration is to reduce the total number of annual rounds by increasing the interval between screening rounds. It has been suggested that longer intervals could be used for individuals who are at lower risk of lung cancer. In this study, we explored whether eligible participants in a program of LDCT screening who are at lower risk of lung cancer have less aggressive cancers than those at higher risk. METHODS We retrospectively identified 118 participants in I-ELCAP database between 1992-2019 who had been screened using HIPAA-compliant protocols and had solid lung cancers diagnosed on an annual round of screening, 7-18 months after the prior round. Volume doubling time (VDT) for each cancer was calculated. Estimated risk of developing lung cancer was calculated using PLCOM2012 model. The strength of the relationship between VDT and individual PLCOM2012 scores was assessed by Pearson(r) and Spearman (ρ) correlation coefficients. RESULTS VDTs were significantly different by cell-type (p < 0.0001); median VDT for small cell was 34.0 days, followed by other cell-types (61.8 days), squamous-cell (73.3 days), and adenocarcinoma (135.7 days). The median VDT for the 78 (66.1 %) Stage I lung cancers was significantly longer than the 40 Stage II + lung cancers (101.4 days vs. 45.5 days, p < 0.0001). None of the established lung cancer risk indicators (age, pack-years of smoking, or PLCOM2012 scores) were significant predictors of VDT or lung cancer stage. CONCLUSION No significant relationship was demonstrated between risk of developing lung cancer (measured by risk models, age or smoking history) and lung cancer aggressiveness (measured by VDT, cell-type and Stage). This suggests that there is no evidence for determining intervals between repeat screenings using risk-based characteristics. It does not, however, exclude the possibility that future models may establish such a relationship.
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Affiliation(s)
- Li Zhang
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Artit Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Meng Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Qiang Cai
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Radiology, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, 030012, China
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Veterans Administration Health Care System, Phoenix, AZ, United States
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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Février E, Yip R, Becker BJ, Taioli E, Yankelevitz DF, Flores R, Henschke CI, Schwartz RM. Change in quality of life of stage IA lung cancer patients after sublobar resection and lobectomy. J Thorac Dis 2020; 12:3488-3499. [PMID: 32802427 PMCID: PMC7399443 DOI: 10.21037/jtd-20-402] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Few studies have examined the differential impact of sublobar resection (SL) and lobectomy (L) on quality of life (QoL) during the first postoperative year. Methods We used a prospective cohort of Stage IA lung cancer patients undergoing video-assisted thoracoscopic surgery (VATS) from the Initiative for Early Lung Cancer Research on Treatment. QoL was measured before surgery, and within 4, 6, and 12 months post-surgery using three validated instruments: SF-12 [physical (PCS) and mental health (MCS)], FACT-LCS (lung-cancer-symptoms), and the PHQ-4 (anxiety and depression subscales). Locally weighted smoothing curve (LOWESS) was fitted to identify the best interval knot for the change in the QoL trend post-surgery. After adjusting for demographic and clinical variables, an adjusted piecewise linear mixed effects model was developed to estimate differences in baseline and 12-month scores, and rates of change for each QoL measure. Results SL resection was performed in 127 (63.2%) and L in 74 (36.8%) patients. LOWESS plots suggested that the shift of QoL (interval knot) was at 2 months post-surgery. Decreases in PCS scores were less severe for SL than L patients 2 months post-surgery (−0.18 vs. −2.30, P=0.02); while subsequent improvements were observed for both groups (SL: +0.29 vs. L: +0.74, P=0.06). SL patients reported significantly better scores a year post-surgery compared to baseline (P=0.003), while L patients did not. Anxiety decreased at similar rates for both SL and L patients within 2 months post-surgery (P=0.18), then stabilized for the remaining months. MCS and depression scores remained stable in both groups throughout. QoL scores were lower for women than for men, but only significantly worse for the lung-cancer-symptoms (P=0.003) and anxiety (P=0.04). Conclusions SL patients fared better in physical health and lung cancer symptoms than L patients. The first two postoperative months showed the most significant change which suggests targeting postoperative intervention during that time.
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Affiliation(s)
- Esther Février
- Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Rowena Yip
- Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Betsy J Becker
- Department of Educational Psychology and Learning Systems, College of Education, Florida State University, Tallahassee, FL, USA
| | - Emanuela Taioli
- Department of Thoracic Surgery, Mount Sinai School of Medicine, New York, NY, USA.,Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, NY, USA.,Tisch Center Institute, Mount Sinai School of Medicine, New York, NY, USA.,Center for Thoracic Oncology, Mount Sinai School of Medicine, New York, NY, USA
| | - David F Yankelevitz
- Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA.,Tisch Center Institute, Mount Sinai School of Medicine, New York, NY, USA.,Center for Thoracic Oncology, Mount Sinai School of Medicine, New York, NY, USA
| | - Raja Flores
- Department of Thoracic Surgery, Mount Sinai School of Medicine, New York, NY, USA.,Tisch Center Institute, Mount Sinai School of Medicine, New York, NY, USA.,Center for Thoracic Oncology, Mount Sinai School of Medicine, New York, NY, USA
| | - Claudia I Henschke
- Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA.,Tisch Center Institute, Mount Sinai School of Medicine, New York, NY, USA.,Center for Thoracic Oncology, Mount Sinai School of Medicine, New York, NY, USA.,Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
| | - Rebecca M Schwartz
- Institute for Translational Epidemiology, Mount Sinai School of Medicine, New York, NY, USA.,Tisch Center Institute, Mount Sinai School of Medicine, New York, NY, USA.,Department of Occupational Medicine, Epidemiology and Prevention (OMEP), Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY, USA
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Henschke CI. Dual-energy computed tomography for pre-surgical identification of adenocarcinoma subtypes. Transl Lung Cancer Res 2020; 9:432-433. [PMID: 32676305 PMCID: PMC7354120 DOI: 10.21037/tlcr.2020.03.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Veronesi G, Baldwin DR, Henschke CI, Ghislandi S, Iavicoli S, Oudkerk M, De Koning HJ, Shemesh J, Field JK, Zulueta JJ, Horgan D, Fiestas Navarrete L, Infante MV, Novellis P, Murray RL, Peled N, Rampinelli C, Rocco G, Rzyman W, Scagliotti GV, Tammemagi MC, Bertolaccini L, Triphuridet N, Yip R, Rossi A, Senan S, Ferrante G, Brain K, van der Aalst C, Bonomo L, Consonni D, Van Meerbeeck JP, Maisonneuve P, Novello S, Devaraj A, Saghir Z, Pelosi G. Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe. Cancers (Basel) 2020; 12:E1672. [PMID: 32599792 PMCID: PMC7352874 DOI: 10.3390/cancers12061672] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
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Affiliation(s)
- Giulia Veronesi
- Faculty of Medicine and Surgery—Vita-Salute San Raffaele University, 20132 Milan, Italy;
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - David R. Baldwin
- Department of Respiratory Medicine, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK;
| | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
| | - Simone Ghislandi
- Department of Social and Political Sciences, Bocconi University, 20136 Milan, Italy; (S.G.); (L.F.N.)
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority (INAIL), 00078 Rome, Italy;
| | - Matthijs Oudkerk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands;
| | - Harry J. De Koning
- Department of Public Health, Erasmus MC—University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.J.D.K.); (C.v.d.A.)
| | - Joseph Shemesh
- The Grace Ballas Cardiac Research Unit, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, 52621 Tel Aviv-Yafo, Israel;
| | - John K. Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool L69 3BX, UK;
| | - Javier J. Zulueta
- Department of Pulmonology, Clinica Universidad de Navarra, 31008 Pamplona, Spain;
- Visiongate Inc., Phoenix, AZ 85044, USA
| | - Denis Horgan
- European Alliance for Personalised Medicine (EAPM), Avenue de l’Armée Legerlaan 10, 1040 Brussels, Belgium;
| | - Lucia Fiestas Navarrete
- Department of Social and Political Sciences, Bocconi University, 20136 Milan, Italy; (S.G.); (L.F.N.)
| | | | - Pierluigi Novellis
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Rachael L. Murray
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham NG5 1PB, UK;
| | - Nir Peled
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, 84101 Beer-Sheva, Israel;
| | - Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Gaetano Rocco
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | | | - Martin C. Tammemagi
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St Catharines, ON L2S 3A1, Canada;
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Natthaya Triphuridet
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
- Faculty of Medicine and Public Health, Chulabhorn Royal Academy, HRH Princess Chulabhorn College of Medical Science, Bangkok 10210, Thailand
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele (MI), Italy;
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, VU location, De Boelelaan 1117, Postbox 7057, 1007 MB Amsterdam, The Netherlands;
| | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano (MI), Italy;
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS, UK;
| | - Carlijn van der Aalst
- Department of Public Health, Erasmus MC—University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.J.D.K.); (C.v.d.A.)
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University, 00168 Rome, Italy;
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Jan P. Van Meerbeeck
- Thoracic Oncology, Antwerp University Hospital and Ghent University, 2650 Edegem, Belgium;
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Silvia Novello
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.V.S.); (S.N.)
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London SW3 6NP, UK;
| | - Zaigham Saghir
- Department of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark;
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Inter-Hospital Pathology Division, IRCCS MultiMedica, 20138 Milan, Italy
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Wang Y, Zhu Y, Yip R, Lee DS, Flores RM, Kaufman A, Henschke CI, Yankelevitz DF. Pre-surgical assessment of mediastinal lymph node metastases in Stage IA non-small-cell lung cancers. Clin Imaging 2020; 68:61-67. [PMID: 32570011 DOI: 10.1016/j.clinimag.2020.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Evaluation of sensitivity and specificity of CT and fluorodeoxyglucose-positron emission tomography for pre-surgical staging of mediastinal lymph node metastases (N2/N3) of non-small-cell-lung-cancers ≤30 mm. METHODS We reviewed a total of 263 patients from a prospective cohort study, who underwent resection including mediastinal lymph nodes, for first primary non-small-cell-lung-cancer ≤30 mm in maximum diameter on pre-surgical CT. Cutoff criteria for short-axis diameter on CT of the largest N2/N3 node of 10, 15, and 20 mm and positron emission uptake of 2.5, 3.0, and 4.0 were evaluated using Area-Under-the-Curve (AUC) assessment. Accuracy criterion was used to determine the optimal cutoffs. RESULTS Of 263 patients, 9 had nonsolid, 42 part-solid, and 212 solid non-small-cell-lung-cancers. Post-surgically, none of the 51 patients with nonsolid or part-solid cancers had mediastinal lymph node metastases. Among the 212 patients with solid cancers, 23 had N2 node metastases. For the 212 patients with solid cancers, the AUC for CT lymph node measurements was 0.67 (95% CI: 0.57-0.77), significantly higher (p = 0.001) than chance alone, while the AUC for SUVmax measurements, 0.56 (95% CI: 0.48-0.65), was not (p = 0.13). Optimal CT cutoff was >20 mm had low sensitivity of 30.4% (95% CI: 11.6%-49.2%) but high specificity of 99.5% (95% CI: 98.4%-100.0%). CONCLUSION Based on these results, clinical Stage IA for non-small-cell-lung-cancers with nonsolid, part-solid, or solid consistency should be based on pre-surgical CT maximum tumor diameter and lymph node short-axis measurements on CT ≤20 mm. Further prospective evaluation of these clinical Stage IA staging criteria is needed.
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Affiliation(s)
- Yong Wang
- Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA; Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Yeqing Zhu
- Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA; Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Rowena Yip
- Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA
| | - Dong-Seok Lee
- Department of Thoracic Surgery, Mount Sinai School of Medicine, NY, NY, USA
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai School of Medicine, NY, NY, USA; Tisch Center Institute, Mount Sinai School of Medicine, NY, NY, USA; Center for Thoracic Oncology, Mount Sinai School of Medicine, NY, NY, USA
| | - Andrew Kaufman
- Department of Thoracic Surgery, Mount Sinai School of Medicine, NY, NY, USA; Tisch Center Institute, Mount Sinai School of Medicine, NY, NY, USA; Center for Thoracic Oncology, Mount Sinai School of Medicine, NY, NY, USA
| | - Claudia I Henschke
- Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA; Tisch Center Institute, Mount Sinai School of Medicine, NY, NY, USA; Center for Thoracic Oncology, Mount Sinai School of Medicine, NY, NY, USA; Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA.
| | - David F Yankelevitz
- Department of Radiology, Mount Sinai School of Medicine, NY, NY, USA; Phoenix Veterans Affairs Health Care System, Phoenix, AZ, USA
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Bertolini A, Capaccione K, Austin JH, Blum A, Padilla M, DSouza B, Yankelevitz D, Henschke CI, Salvatore MM. Teleradiology: An opportunity to improve outcomes in pulmonary fibrosis. Clin Imaging 2020; 60:263-264. [DOI: 10.1016/j.clinimag.2019.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 11/28/2022]
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Steiger D, Han D, Yip R, Li K, Chen X, Liu L, Liu J, Ma T, Siddiqi F, Yankelevitz DF, Henschke CI. Increased main pulmonary artery diameter and main pulmonary artery to ascending aortic diameter ratio in smokers undergoing lung cancer screening. Clin Imaging 2020; 63:16-23. [PMID: 32120308 DOI: 10.1016/j.clinimag.2019.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Pulmonary hypertension (PH) is a progressive, potentially fatal disease, difficult to diagnose early due to non-specific nature of symptoms. PH is associated with increased morbidity and death in many respiratory and cardiac disorders, and with all-cause mortality, independent of age and cardiopulmonary disease. The main pulmonary artery diameter (MPA), and ratio of MPA to adjacent ascending aorta (AA), MPA:AA, on Chest CT are strong indicators of suspected PH. Our goal was to determine the prevalence of abnormally high values of these indicators of PH in asymptomatic low-dose CT (LDCT) screening participants at risk of lung cancer, and determine the associated risk factors. METHODS We reviewed consecutive baseline LDCT scans of 1949 smokers in an IRB-approved study. We measured the MPA and AA diameter and calculated MPA:AA ratio. We defined abnormally high values as being more than two standard deviations above the average (MPA ≥ 34 mm and MPA:AA ≥ 1.0). Regression analyses were used to identify risk factors and CT findings of participants associated with high values. RESULTS The prevalence of MPA ≥ 34 mm and MPA:AA ≥ 1.0 was 4.2% and 6.9%, respectively. Multivariable regression demonstrated that BMI was a significant risk factor, both for MPA ≥ 34 mm (OR = 1.07, p < 0.0001) and MPA:AA ≥ 1.0 (OR = 1.04, p = 0.003). Emphysema was significant in the univariate but not in the multivariate analysis. CONCLUSIONS We determined that the possible prevalence of PH as defined by abnormally high values of MPA and of MPA:AA was greater than previously described in the general population and that pulmonary consultation be recommended for these participants, in view of the significance of PH.
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Affiliation(s)
- David Steiger
- Division of Pulmonary Medicine, Icahn School of Medicine, New York, NY, United States of America
| | - Dan Han
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Xicheng District, Beijing, China
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Kunwei Li
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xiangmeng Chen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Jiangmen Central Hospital, Jiangmen, China
| | - Li Liu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Diagnostic Radiology, Cancer Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Chaoyang District, Beijing, China
| | - Jiayi Liu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, Beijing, China
| | - Teng Ma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Radiology, Tong Ren Hospital, Capital Medical University, Dongcheng District, Beijing, China
| | - Faisal Siddiqi
- Division of Pulmonary Medicine, Icahn School of Medicine, New York, NY, United States of America
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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Zhu Y, Wang Y, Gioia WE, Yip R, Jirapatnakul AC, Chung MS, Yankelevitz DF, Henschke CI. Visual scoring of aortic valve calcifications on low-dose CT in lung cancer screening. Eur Radiol 2020; 30:2658-2668. [PMID: 32040729 DOI: 10.1007/s00330-019-06614-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/18/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate risk factors for prevalence and progression of aortic valve calcification (AVC) in lung cancer screening participants and also to assess the sensitivity and reliability of visual AVCs on low-dose CT (LDCT) for predicting aortic stenosis (AS) in high-risk smokers. METHODS We reviewed 1225 consecutive participants in annual LDCT screening for lung cancer at the Mount Sinai Hospital between 2010 and 2017. Sensitivity and specificity of moderate/severe AVC score on LDCT to identify AS on echocardiogram were calculated for 126 participants who had both within 12 months. Using regression analyses, risk factors for AVC at baseline, for progression, and for new AVC on annual rounds of screening were identified. Reliability of AVC assessment on LDCT was assessed by comparing visual AVC scores (1) with standard-dose, electrocardiography (ECG)-gated CT for 31 participants who had both within 12 months and (2) with Agatston scores of 1225 participants and by determining (3) the intra-reader agreement of 1225 participants. RESULTS Visual AVC scores on LDCT had substantial agreement with the severity of AS on echocardiography and substantial inter-observer and excellent intra-observer agreement. Sensitivity and specificity of moderate/severe visual AVC scores for moderate/severe AS on echocardiogram were 100% and 94%, respectively. Significant predictors for baseline AVC were male sex (OR = 2.52), age (OR10 years = 2.87), and coronary artery calcification score (OR = 1.18), the significant predictor for AVC progression after baseline was pack-years of smoking (HR10 packyears = 1.14), and significant predictors for new AVC on annual LDCT were male sex (HR = 1.51), age (HR10 years = 2.17), CAC (HR = 1.09) and BMI (HR = 1.06). CONCLUSIONS AVC scores on LDCT should be documented, especially in lung cancer screening program. KEY POINTS • LDCT screening for lung cancer provides an opportunity to identify lung cancer and cardiovascular disease in asymptomatic smokers. • Visual aortic valve calcification scores could be reliably evaluated on LDCT and had substantial agreement with the severity of aortic valve stenosis on echocardiography. • Sensitivity and specificity of moderate/severe visual AVC scores on LDCT for moderate/severe AS on echocardiogram were 100% and 94%, respectively.
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Affiliation(s)
- Yeqing Zhu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA.,Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yong Wang
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA.,Department of Radiology, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - William E Gioia
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Artit C Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Michael S Chung
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA.
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Chen X, Ma T, Yip R, Perumalswami PV, Branch AD, Lewis S, Crane M, Yankelevitz DF, Henschke CI. Elevated prevalence of moderate-to-severe hepatic steatosis in World Trade Center General Responder Cohort in a program of CT lung screening. Clin Imaging 2019; 60:237-243. [PMID: 31945662 DOI: 10.1016/j.clinimag.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 11/19/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS To determine the prevalence of moderate-to-severe hepatic steatosis (HS) and associated risk factors in members of the World Trade Center (WTC) General Responder Cohort (GRC) who qualify for low-dose non-contrast computed tomography for lung cancer screening and compare them to non-WTC participants in the same screening program. METHODS All participants gave written informed consent before participating in this IRB-approved study. Clinical variables and laboratory values were recorded. Hepatic attenuation measurement (Hounsfield unit; HU) was measured on low-dose computed tomography (LDCT) and a threshold attenuation value <40HU indicated moderate-to-severe HS. Bivariate and multivariable linear and logistic regression analyses were performed. Propensity scores (PS) were calculated and inverse probability weighting (IPW) was used to adjust for potential confounders when comparing the WTC with non-WTC participants. RESULTS The prevalence of moderate-to-severe HS was 16.2% among 154 WTC participants compared to 5.3% among 170 non-WTC participants. In WTC members, moderate-to-severe HS was associated with higher BMI, higher laboratory liver function tests, and former smoking status. Using PS analysis and IPW to account for potential confounders, the odds ratio for moderate-to-severe HS was 3.4-fold higher (95% confidence interval: 1.7-6.7) in the WTC participants compared with non-WTC participants. Moderate-to-severe HS was also associated with higher BMI and former smoker status. CONCLUSION Prevalence of moderate-to-severe HS was >3-fold higher in the WTC-GRC group than in other participants.
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Affiliation(s)
- Xiangmeng Chen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Radiology, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China; Department of Radiology, Jiangmen Central Hospital, Jiangmen 529030, China
| | - Teng Ma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States; Department of Radiology, Tong Ren Hospital, Capital Medical University, Beijing 100730, China
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Ponni V Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Michael Crane
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
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Liu B, Dharmarajan K, Henschke CI, Taioli E. State-Level Variations in the Utilization of Lung Cancer Screening Among Medicare Fee-for-Service Beneficiaries: An Analysis of the 2015 to 2017 Physician and Other Supplier Data. Chest 2019; 157:1012-1020. [PMID: 31759960 DOI: 10.1016/j.chest.2019.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/29/2019] [Accepted: 11/02/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Lung cancer screening (LCS) is an important secondary prevention measure to reduce lung cancer mortality. The goal of this study was to assess state-level variations in LCS among the US elderly during the first 3 years since Medicare began its LCS reimbursement policy in 2015. METHODS This ecological study examined the relations between LCS utilization density, defined as the number of low-dose CT (LDCT) or shared decision-making and counseling (SDMC) services per 1,000 Medicare fee-for-service (FFS) beneficiaries derived from the Medicare Provider Utilization and Payment Data: Physician and Other Supplier public use file, and state-level factors from several publicly available data sources. The study included Kruskal-Wallis tests and a cluster analysis. RESULTS In 2017, the median utilization density per 1,000 Medicare FFS beneficiaries was 3.32 for LDCT and 0.46 for SDMC, which was 24 and 13 times the 2015 level, respectively. From 2015 to 2017, the total number of unique providers billed for LCS increased from 222 to 3,444 for LDCT imaging and from 20 to 523 for SDMC. Higher utilizations for both LDCT and SDMC services tended to concentrate in the northeastern and upper Midwest states than in the southwest states. The cluster of states with high utilization density did not include those states with the most lung cancer mortality and/or smoking prevalence. CONCLUSIONS A steady increase was noted in LCS utilization since Medicare began its reimbursement policy. The utilization and its growth varied across the United States and differed between LDCT imaging and SDMC, indicating large growth potentials for LCS and for states with high lung cancer mortality and smoking prevalence.
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Affiliation(s)
- Bian Liu
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Kavita Dharmarajan
- Departments of Radiation Oncology and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Jirapatnakul A, Reeves AP, Lewis S, Chen X, Ma T, Yip R, Chin X, Liu S, Perumalswami PV, Yankelevitz DF, Crane M, Branch AD, Henschke CI. Automated measurement of liver attenuation to identify moderate-to-severe hepatic steatosis from chest CT scans. Eur J Radiol 2019; 122:108723. [PMID: 31778964 DOI: 10.1016/j.ejrad.2019.108723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE Develop and validate an automated method for measuring liver attenuation in non-contrast low-dose chest CT (LDCT) scans and compare it to the standard manual method for identifying moderate-to-severe hepatic steatosis (HS). METHOD The automated method identifies a region below the right lung within the liver and uses statistical sampling techniques to exclude non-liver parenchyma. The method was used to assess moderate-to-severe HS on two IRB-approved cohorts: 1) 24 patients with liver disease examined between 1/2013-1/2017 with non-contrast chest CT and abdominal MRI scans obtained within three months of liver biopsy, and 2) 319 lung screening participants with baseline LDCT performed between 8/2011-1/2017. Agreement between the manual and automated CT methods, the manual MRI method, and pathology for determining moderate-to-severe HS was assessed using Cohen's Kappa by applying a 40 HU threshold to the CT method and 17.4% fat fraction to MRI. Agreement between the manual and automated CT methods was assessed using the intraclass correlation coefficient (ICC). Variability was assessed using Bland-Altman limits of agreement (LoA). RESULTS In the first cohort, the manual and automated CT methods had almost perfect agreement (ICC = 0.97, κ = 1.00) with LoA of -7.6 to 4.7 HU. Both manual and automated CT methods had almost perfect agreement with MRI (κ = 0.90) and substantial agreement with pathology (κ = 0.77). In the second cohort, the manual and automated CT methods had almost perfect agreement (ICC = 0.94, κ = 0.87). LoA were -10.6 to 5.2 HU. CONCLUSION Automated measurements of liver attenuation from LDCT scans can be used to identify moderate-to-severe HS on LDCT.
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Affiliation(s)
- Artit Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Anthony P Reeves
- School of Electrical and Computer Engineering, Cornell University, 392 Rhodes Hall, Ithaca, NY 14853, United States
| | - Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Xiangmeng Chen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States; Department of Radiology, The First Affiliated Hospital of Jinan University, Huangpu West Ave No. 613, Guangzhou, Guangdong, China; Department of Radiology, Jiangmen Central Hospital, No. 18 Zicha Road, Jiangmen, Guangdong, China
| | - Teng Ma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States; Department of Radiology, Jiangmen Central Hospital, No. 18 Zicha Road, Jiangmen, Guangdong, China
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Xing Chin
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Shuang Liu
- School of Electrical and Computer Engineering, Cornell University, 392 Rhodes Hall, Ithaca, NY 14853, United States
| | - Ponni V Perumalswami
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1123, New York, NY 10029, United States
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States
| | - Michael Crane
- Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY 10029, United States
| | - Andrea D Branch
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1123, New York, NY 10029, United States
| | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Pl, Box 1234, New York, NY 10029, United States.
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González J, Henschke CI, Yankelevitz DF, Seijo LM, Reeves AP, Yip R, Xie Y, Chung M, Sánchez-Salcedo P, Alcaide AB, Campo A, Bertó J, del Mar Ocón M, Pueyo J, Bastarrika G, de-Torres JP, Zulueta JJ. Emphysema phenotypes and lung cancer risk. PLoS One 2019; 14:e0219187. [PMID: 31344121 PMCID: PMC6657833 DOI: 10.1371/journal.pone.0219187] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/18/2019] [Indexed: 12/18/2022] Open
Abstract
Background To assess the relationship between lung cancer and emphysema subtypes. Objective Airflow obstruction and emphysema predispose to lung cancer. Little is known, however, about the lung cancer risk associated with different emphysema phenotypes. We assessed the risk of lung cancer based on the presence, type and severity of emphysema, using visual assessment. Methods Seventy-two consecutive lung cancer cases were selected from a prospective cohort of 3,477 participants enrolled in the Clínica Universidad de Navarra’s lung cancer screening program. Each case was matched to three control subjects using age, sex, smoking history and body mass index as key variables. Visual assessment of emphysema and spirometry were performed. Logistic regression and interaction model analysis were used in order to investigate associations between lung cancer and emphysema subtypes. Results Airflow obstruction and visual emphysema were significantly associated with lung cancer (OR = 2.8, 95%CI: 1.6 to 5.2; OR = 5.9, 95%CI: 2.9 to 12.2; respectively). Emphysema severity and centrilobular subtype were associated with greater risk when adjusted for confounders (OR = 12.6, 95%CI: 1.6 to 99.9; OR = 34.3, 95%CI: 25.5 to 99.3, respectively). The risk of lung cancer decreases with the added presence of paraseptal emphysema (OR = 4.0, 95%CI: 3.6 to 34.9), losing this increased risk of lung cancer when it occurs alone (OR = 0.7, 95%CI: 0.5 to 2.6). Conclusions Visual scoring of emphysema predicts lung cancer risk. The centrilobular phenotype is associated with the greatest risk.
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Affiliation(s)
- Jessica González
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Claudia I. Henschke
- Department of Radiology Mount Sinai School of Medicine, NY, United States of America
| | - David F. Yankelevitz
- Department of Radiology Mount Sinai School of Medicine, NY, United States of America
| | - Luis M. Seijo
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Anthony P. Reeves
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, United States of America
- D4Vision, Inc, Ithaca, NY, United States of America
| | - Rowena Yip
- Department of Radiology Mount Sinai School of Medicine, NY, United States of America
| | - Yiting Xie
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, United States of America
| | - Michael Chung
- Department of Radiology Mount Sinai School of Medicine, NY, United States of America
| | | | - Ana B. Alcaide
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Aranzazu Campo
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan Bertó
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
| | | | - Jesus Pueyo
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan P. de-Torres
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra’s Health Research Institute (IDISNA), Pamplona, Spain
| | - Javier J. Zulueta
- Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain
- Navarra’s Health Research Institute (IDISNA), Pamplona, Spain
- CIBERONC, ISCIII, Madrid, Spain
- VisionGate, Inc, Phoenix, Arizona, United States of America
- * E-mail:
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