Diagnostic procedures after a positive spiral computed tomography lung carcinoma screen

Abstract

BACKGROUNDLow‐radiation dose spiral computed tomography (LDCT) currently is being evaluated as a screening modality for lung carcinoma in a randomized trial. Although several diagnostic algorithms for the workup of positive LDCT screens have been proposed, to the authors' knowledge there is no widely accepted standard to date and there are few nationwide data concerning how such diagnostic workups are actually being performed outside a research protocol setting.METHODSThe Lung Screening Study (LSS) was a multicenter feasibility trial that randomized 1660 subjects to undergo LDCT and an equivalent number to undergo chest X‐ray. Subjects with positive screens were referred to their own health care providers for diagnostic follow‐up; LSS did not specify a diagnostic algorithm. LSS collected and abstracted medical records regarding procedures employed in the diagnostic workup of positive screens.RESULTSOf the 522 subjects with a positive LDCT screen at baseline or at Year One, 12% underwent biopsy. Biopsy was less likely to be performed in subjects with 4–9‐mm nodules (5%) than in subjects with nodules measuring 10+ mm (25%) or in subjects with no nodules but other suspicious findings (15%). Among 63% of the subjects who underwent chest CT on follow‐up, the median time between screening and first follow‐up chest CT was 82 days. Only a minority of subjects received diagnostic workups that were consistent with published algorithms.CONCLUSIONSThe data from the current study represent the experience of subjects followed by their health care providers in five different U.S. metropolitan areas and one rural area. As such, they provide some indication of practices in the U.S. with regard to the diagnostic workup of patients with positive spiral CT screens. Cancer 2005. Published 2004 by the American Cancer Society.

Lung cancer screening with spiral CT

“…Fifteen percent of the subjects had at least one abnormality in their baseline spiral CT, 10.1% of the spiral CT patients have had at least one extra diagnostic procedure, 4.2% an invasive procedure, and 18.7% of the thoracotomies in the spiral CT arm were done for a benign pulmonary lesion. However, on the whole our data compare favourably with those from most other study groups [10,13,14,30,37,38]. For instance, in the Mayo Clinic study, the reported percentage of thoracotomies carried out for benign pulmonary lesions was 18.1% [38].…”

The Pittsburgh Lung Screening Study (PLuSS)

“…Therefore, our results show a high frequency of thoracotomy or VATS without cancer and an apparent community bias toward aggressive intervention with biopsy for persons with indeterminate lung nodule. Observing 12% of 522 subjects having a biopsy within 1 year of a positive screening CT, Pinsky and colleagues also describe an apparent community bias toward biopsy (17). These results argue for strict adherence to diagnostic guidelines, in combination with informed decision making, when managing persons with nodules detected on screening CT.…”

“…In contrast, comparing outcomes observed in three large studies of CT screening to predictions from two validated risk models, the second analysis concluded that CT screening increases lung cancer diagnosis and lung cancer resection without decreasing advanced lung cancer or lung cancer death (14). In addition to over-diagnosis (screen-detection and treatment of clinically insignificant or indolent lung cancer), CT screening frequently detects benign abnormalities (generally, nonmalignant noncalcified lung nodules) that can lead to anxiety, costs, and unnecessary procedures (16,17).…”

Unlocking Biomarker Discovery: Large Scale Application of Aptamer Proteomic Technology for Early Detection of Lung Cancer

“…Definitive conclusions about CT screening and lung cancer mortality await results from randomized trials in the US [8] and Europe [10]–[13]. CT can detect small, early-stage lung tumors, but distinguishing rare cancers from common benign conditions is difficult and has led to unnecessary procedures, radiation exposure, anxiety, and cost [6], [14]–[16]. We (J.M.S., J.L.W., and colleagues) recently reported such conclusions for the Pittsburgh Lung Screening Study (PLuSS), the largest single-institution CT screening study reported to date [5].…”