Avoiding overdiagnosis in lung cancer screening: the volume doubling time strategy

Revel, Marie‐Pierre

doi:10.1183/09031936.00157713

Cited by 22 publications

(17 citation statements)

References 42 publications

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“…al. [56], and the corresponding editorial by REVEL [57], the slow-growing lung cancer is extensively discussed. A high VDT value of more than 400 days is one of the methods used to …”

Section: Screening Biasesmentioning

confidence: 99%

Screening for lung cancer: time for large-scale screening by chest computed tomography

Shlomi

Ben-Avi

Balmor³

et al. 2014

Eur Respir J

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Lung cancer is the leading cause of cancer death worldwide. Age and smoking are the primary risk factors for lung cancer. Treatment based on surgical removal in the early stages of the disease results in better survival. Screening programmes for early detection that used chest radiography and sputum cytology failed to attain reduction of lung cancer mortality. Screening by low-dose computed tomography (CT) demonstrated high rates of early-stage lung cancer detection in a high-risk population. Nevertheless, no mortality advantage was manifested in small randomised control trials. A large randomised control trial in the USA, the National Lung Screening Trial (NLST), showed a significant relative reduction of 20% in lung cancer mortality and 6.7% reduction in total mortality, yet no reduction was evidenced in the late-stage prevalence. Screening for lung cancer by low-dose CT reveals a high level of false-positive lesions, which necessitates further noninvasive and invasive evaluations. Based primarily on the NLST eligible criteria, new guidelines have recently been developed by major relevant organisations. The overall recommendation coming out of this collective work calls for lung cancer screening by low-dose CT to be performed in medical centres manned by specialised multidisciplinary teams, as well as for a mandatory, pre-screening, comprehensive discussion with the patient about the risks and advantages involved in the process. Lung cancer screening is on the threshold of a new era, with ever more questions still left open to challenge future studies. @ERSpublications Lung cancer screening is on the threshold of a new era, with wider application of CT screening now recommended

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“…al. [56], and the corresponding editorial by REVEL [57], the slow-growing lung cancer is extensively discussed. A high VDT value of more than 400 days is one of the methods used to …”

Section: Screening Biasesmentioning

confidence: 99%

Screening for lung cancer: time for large-scale screening by chest computed tomography

Shlomi

Ben-Avi

Balmor³

et al. 2014

Eur Respir J

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“…A further limitation of the study is that data on VDTs are not available to confirm the results of others suggesting many of these "excess cancers" are indeed indolent and not lifethreatening (11,13). Data from the NELSON trial suggest that volumetric-based determination of VDT may reduce both false positive rates (46) and overdiagnosis (47). Last, we have not assessed the presence of emphysema in those with and without airflow limitation or lung cancer, and it remains a hotly debated issue as to whether airflow limitation or emphysema is the more important manifestation of COPD linked to an increased risk of lung cancer (33,39,48).…”

Section: Discussionmentioning

confidence: 85%

Airflow Limitation and Histology Shift in the National Lung Screening Trial. The NLST-ACRIN Cohort Substudy

Young

Duan

Chiles

et al. 2015

Am J Respir Crit Care Med

122

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Rationale: Annual computed tomography (CT) is now widely recommended for lung cancer screening in the United States, although concerns remain regarding the potential harms, including those from overdiagnosis.Objectives: To examine the effect of airflow limitation on overdiagnosis by comparing lung cancer incidence, histology, and stage shift in a subgroup of the National Lung Screening Trial (NLST). Methods:In an NLST subgroup (n = 18,714), screening participants were randomized to annual computed tomography (CT, n = 9,357) or chest radiograph (n = 9,357) screening and monitored for a mean of 6.1 years. After baseline prebronchodilator spirometry, to identify the presence of airflow limitation, 18,475 subjects (99%) were assigned as having chronic obstructive pulmonary disease (COPD) or no COPD. Lung cancer prevalence, incidence, histology, and stage shift were compared after stratification by COPD.Measurements and Main Results: For screening participants with spirometric COPD (n = 6,436), there was a twofold increase in lung cancer incidence (incident rate ratio, 2.15; P , 0.001) and, when compared according to screening arm, no excess lung cancers and comparable histology. Compared with chest radiography, there was also a trend favoring reduced late-stage and increased early-stage cancers in the CT arm (P = 0.054). For those with normal baseline spirometry (n = 12,039), we found an excess of lung cancers during screening in the CT arm, almost exclusively early-stage adenocarcinomarelated cancers (histology shift and overdiagnosis). After correction for these excess cancers, stage shift was marginal (P = 0.077).Conclusions: In the CT arm of the NLST-ACRIN (American College of Radiology Imaging Network) cohort, COPD status was associated with a doubling of lung cancer incidence, no apparent overdiagnosis, and a more favorable stage shift.

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“…Tumor doubling time has been proposed as a marker for malignancy [8][9][10], and the current standard for measuring tumor response, Response Evaluation Criteria in Solid Tumors (RECIST) [11], is based on uni-dimensional, linear measurements of tumor diameter. Measurements are made manually, and significant inter-observer variability exists [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Lung Nodule Segmentation Algorithms: Methods and Results from a Multi-institutional Study

et al. 2016

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Tumor volume estimation, as well as accurate and reproducible borders segmentation in medical images, are important in the diagnosis, staging, and assessment of response to cancer therapy. The goal of this study was to demonstrate the feasibility of a multi-institutional effort to assess the repeatability and reproducibility of nodule borders and volume estimate bias of computerized segmentation algorithms in CT images of lung cancer, and to provide results from such a study. The dataset used for this evaluation consisted of 52 tumors in 41 CT volumes (40 patient datasets and 1 dataset containing scans of 12 phantom nodules of known volume) from five collections available in The Cancer Imaging Archive. Three academic institutions developing lung nodule segmentation algorithms submitted results for three repeat runs for each of the nodules. We compared the performance of lung nodule segmentation algorithms by assessing several measurements of spatial overlap and volume measurement. Nodule sizes varied from 29 μl to 66 ml and demonstrated a diversity of shapes. Agreement in spatial overlap of segmentations was significantly higher for multiple runs of the same algorithm than between segmentations generated by different algorithms (p < 0.05) and was significantly higher on the phantom dataset compared to the other datasets (p < 0.05). Algorithms differed significantly in the bias of the measured volumes of the phantom nodules (p < 0.05) underscoring the need for assessing performance on clinical data in addition to phantoms. Algorithms that most accurately estimated nodule volumes were not the most repeatable, emphasizing the need to evaluate both their accuracy and precision. There were considerable differences between algorithms, especially in a subset of heterogeneous nodules, underscoring the recommendation that the same software be used at all time points in longitudinal studies.

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Avoiding overdiagnosis in lung cancer screening: the volume doubling time strategy

Cited by 22 publications

References 42 publications

Screening for lung cancer: time for large-scale screening by chest computed tomography

Screening for lung cancer: time for large-scale screening by chest computed tomography

Airflow Limitation and Histology Shift in the National Lung Screening Trial. The NLST-ACRIN Cohort Substudy

A Comparison of Lung Nodule Segmentation Algorithms: Methods and Results from a Multi-institutional Study

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