CT Screening for Lung Cancer

Henschke, Claudia I.; Yankelevitz, David F.; Mirtcheva, Rosna; McGuinness, Georgeann; McCauley, Dorothy I.; Miettinen, Olli S.

doi:10.2214/ajr.178.5.1781053

Cited by 823 publications

(211 citation statements)

References 13 publications

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“…This markedly reduces follow-up requirements. To fully document all interim diagnoses occurring between the annual rounds of screening, the protocol requires that each person who has not returned for repeat screening be followed up to 18 months after their prior screening [9,18]. If no cancer has been identified by either a symptom-prompted workup or any other reason, then the person is considered to have stopped participation in the screening program and no further follow-up is required.…”

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confidence: 99%

CT Screening for Lung Cancer: Update 2007

Henschke

Yankelevitz

2008

The Oncologist

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Screening is the pursuit of the early diagnosis of cancer before symptoms occur. The purpose of early diagnosis is to provide early treatment, which potentially prevents death from the cancer. The usefulness of screening depends on how early the cancer can be diagnosed and how many deaths can be prevented by early treatment as compared with later symptom-prompted diagnosis and treatment.The goal of the Early Lung Cancer Action Project investigators was to develop an efficient methodology that would provide an ever-accumulating, continually updated body of evidence for evaluation of emerging new technologies for screening for cancer. This methodology recognizes that screening is a sequential process that starts with the pursuit of the early diagnosis of cancer followed by early treatment. It also recognizes that diagnostic research is fundamentally different from treatment research. To fully understand the current discussions on the evidence for lung cancer screening, key definitions are provided, including the differentiation between the first, baseline round of screening and all subsequent rounds of repeat screening and baseline and repeat cancers and their distribution by cell type. These definitions are critical in analyzing the results of various screening reports as they are not used by all.To provide optimal screening, a regimen for the diagnostic workup must be specified starting with the definition of the initial test, its positive result, and the workup for a positive result leading to a diagnosis of cancer. Assessment of diagnostic performance does not require a control group, but does require confirmation of the diagnosis.For assessment of the effectiveness of early treatment, a comparison group is needed. The comparison group may be formed by randomly assigning people with screen-diagnosed lung cancer to immediate or delayed treatment, as has been done for prostate cancer. This provides a direct assessment of any potential overdiagnosis of the cancer resulting from screening. Alternatively, a quasiexperimental control group can be used KEY CONCEPTS AND DEFINITIONSScreening has been defined as the pursuit of the early diagnosis of cancer before symptoms occur. The purpose of early diagnosis is to provide early treatment, which potentially prevents death from the cancer. The usefulness of screening depends on how early the cancer can be diagnosed and how many deaths can be prevented by early treatment as compared with later symptom-prompted diagnosis and treatment. To fully understand current discussions on the evidence for lung cancer screening, key concepts of screening and definitions are needed.Screening for a cancer should be considered when the cancer is significant in terms of incidence and mortality, treatment of early-stage disease is better than treatment of late-stage disease, and there is a test that provides an earlier diagnosis-lead time-rather than a later, symptomprompted diagnosis [1,2].Lung cancer kills more people than any other cancer worldwide. In the U.S. it kills more pe...

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confidence: 99%

CT Screening for Lung Cancer: Update 2007

Henschke

Yankelevitz

2008

The Oncologist

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“…Furthermore, we only assessed pure GGOs in this study and did not consider part‐solid GGOs, which have a higher incidence of malignancy than either pure GGOs or solid nodules (16) . Although we did not examine part‐solid GGOs, pure GGOs tend to have an intrinsically lower attenuation and, therefore, lower conspicuity, making them more difficult to detect than GGOs with a solid component; thus, we assume that our analysis of pure GGOs would also apply to part‐solid GGOs.…”

Section: Discussionmentioning

confidence: 99%

Radiation dose reduction for CT lung cancer screening using ASIR and MBIR: a phantom study

Mathieu

Fox

et al. 2014

J Applied Clin Med Phys

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The purpose of this study was to reduce the radiation dosage associated with computed tomography (CT) lung cancer screening while maintaining overall diagnostic image quality and definition of ground‐glass opacities (GGOs). A lung screening phantom and a multipurpose chest phantom were used to quantitatively assess the performance of two iterative image reconstruction algorithms (adaptive statistical iterative reconstruction (ASIR) and model‐based iterative reconstruction (MBIR)) used in conjunction with reduced tube currents relative to a standard clinical lung cancer screening protocol (51 effective mAs (3.9 mGy) and filtered back‐projection (FBP) reconstruction). To further assess the algorithms' performances, qualitative image analysis was conducted (in the form of a reader study) using the multipurpose chest phantom, which was implanted with GGOs of two densities. Our quantitative image analysis indicated that tube current, and thus radiation dose, could be reduced by 40% or 80% from ASIR or MBIR, respectively, compared with conventional FBP, while maintaining similar image noise magnitude and contrast‐to‐noise ratio. The qualitative portion of our study, which assessed reader preference, yielded similar results, indicating that dose could be reduced by 60% (to 20 effective mAs (1.6 mGy)) with either ASIR or MBIR, while maintaining GGO definition. Additionally, the readers' preferences (as indicated by their ratings) regarding overall image quality were equal or better (for a given dose) when using ASIR or MBIR, compared with FBP. In conclusion, combining ASIR or MBIR with reduced tube current may allow for lower doses while maintaining overall diagnostic image quality, as well as GGO definition, during CT lung cancer screening.PACS numbers: 87.57.Q‐, 87.57.nf

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“…The malignancy rate of nodular ground glass opacity with solid component within it was also found to be 93% [29]. Henschke et al (2002) found malignancy rates among findings of nodular ground-glass opacity for lesions with and without a solid component as 63% and 18% respectively [19]. Persistent finding of nodular ground glass opacity in CT is highly suggestive of neplastic condition.…”

Section: Appearance Of Ground Glass Opacity (Ggo) Nodules In Ctmentioning

confidence: 92%

“…The ground-glass component represents lepidic growth or mucin production. Aoki et al (2000) showed that increasing solid components within a ground-glass nodule correlated with more aggressive behavior [18] a screening study by Henschke et al showed a higher rate of malignancy among mixed SPNs (63%) compared with nonsolid (18%) and solid SPNs (7%) [19].…”

Section: Attenuationmentioning

confidence: 99%

Differentiation of Benign and Malignant Solitary Pulmonary Nodule: Literature Review

Tripathi¹,

Zhen²

2015

ALC

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The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT), usually the identification is accidental. The overall prevalence of malignancy is relatively low but identification of malignancy of nodule is of prime importance. There are different characters of nodules indicating malignancy, and also the exposure of person to risk factors increases the chances of malignancy of nodule. Chances of malignancy rise with increasing size, the irregular, lobulated border of the nodules is highly associated with higher probability of malignancy and nodules with pure ground grass appearance have higher probability of malignancy, irregularly marginated nodule displaying a corona radiata sign indicating neoplastic infiltration with distortion of neighbouring tissue is almost certainly a malignant nodule. Stippled, punctuate, and eccentric calcifications are suggestive of malignancy. There are 20% -75% of chances of malignancy if nodule is appeared with ground-glass opacity. Malignant nodules have higher growth rate as compared with benign nodules, malignant nodules usually have doubling time (DT) of 30 -400 days while DT of more than 450 days is sign of benignity whereas doubling time less than 30 days is usually acute infectious process. The presence of fat within nodule is sign of benignity. Increasing density of the nodule is suggestive of malignancy and requires shorter follow up. Besides the nodule evaluation the chances of malignancy can also be evaluated through the exposure of patient to risk factors like age, current and past smoking status and history of extra thoracic malignancy. The management depends upon various factors mainly three strategies are applied for management including careful observation of nodule, use of diagnostic techniques like CT FNA, PET, and broncoscopy and surgery.

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CT Screening for Lung Cancer

Abstract: In CT screening for lung cancer, the detected nodule commonly is either only part-solid or nonsolid, but such a nodule is more likely to be malignant than a solid one, even when nodule size is taken into account.

Cited by 823 publications

References 13 publications

CT Screening for Lung Cancer: Update 2007

CT Screening for Lung Cancer: Update 2007

Radiation dose reduction for CT lung cancer screening using ASIR and MBIR: a phantom study

Differentiation of Benign and Malignant Solitary Pulmonary Nodule: Literature Review

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