Different efficacy of CT screening for lung cancer according to histological type: Analysis of Japanese-smoker cases detected using a low-dose CT screen

Yoshida, Kazuo; Kawakami, Satoshi; Shiina, Takayuki; Kurai, Makoto; Takasuna, Keiichiro; Yamamoto, Hiroshi; Koizumi, Tomonori; Honda, Takayuki; Kubo, Keishi

doi:10.1016/j.lungcan.2011.05.007

Cited by 15 publications

(15 citation statements)

References 40 publications

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“…This provides further evidence that LDCT screening in NLST was not effective for squamous cell carcinoma. In contrast to the survival findings here, a Japanese study demonstrated that both adenocarcinomas and squamous cell carcinomas had significantly greater survival when detected by CT than CXR 5 . Note this study did not adjust for lead time bias; however, in our analysis, even when analyzed from time of diagnosis, squamous cell survival was no better in the LDCT than the CXR arm.…”

Section: Discussioncontrasting

confidence: 99%

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The National Lung Screening Trial: Results stratified by demographics, smoking history, and lung cancer histology

Pinsky

Church

Izmirlian

et al. 2013

Cancer

238

177

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Background The National Lung Screening Trial (NLST), which compared lung cancer screening with low-dose CT (LDCT) versus chest radiograph (CXR), demonstrated a statistically significant mortality benefit of LDCT screening. We performed a post-hoc analysis to examine whether the benefit was affected by various baseline factors, including age, gender and smoking status, and whether it differed by histology. Methods Lung cancer death rates were computed as events over person years of observation; the mortality risk ratio (RR) was defined as the lung cancer death rate in the LDCT versus CXR arm. Poisson regression was used to test for interactions of gender, age (<65 versus 65+) and smoking status (current versus former) with trial arm. Mortality risk ratios were also computed for specific lung cancer histologies. Results The overall mortality RR was 0.92 in men and 0.73 in women, with a p-value for interaction of 0.08. RRs were similar for subjects under age 65 (0.82) versus 65+ (0.87), and for current (0.81) versus former smokers (0.91). By histology, mortality RRs were 0.75 for adenocarcinoma, 0.71 for all non small cell lung cancer (NSCLC) except squamous, 1.23 for squamous cell carcinoma, and 0.90 for small cell carcinoma. RRs were similar for men and women for non-squamous NSCLC, 0.71 and 0.70, respectively; women had lower RRs for small cell and squamous cell carcinoma. Conclusions LDCT benefit did not vary substantially by age or smoking status; there was weak evidence of differential benefit by gender. Differential benefit across lung cancer histologies may exist.

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Section: Discussioncontrasting

confidence: 99%

“…It has generally been assumed that small cell carcinoma is not amenable to LDCT screening, due to its aggressive natural history and early metastases 5–6 . Here the data were consistent with this assumption, with an RR not significantly different from 1 (RR=0.9, 95% CI 0.69–1.18) and no survival advantage for LDCT versus CXR arm cases.…”

Section: Discussionmentioning

confidence: 99%

The National Lung Screening Trial: Results stratified by demographics, smoking history, and lung cancer histology

Pinsky

Church

Izmirlian

et al. 2013

Cancer

238

177

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“…We have previously evaluated the usefulness of computed tomography (CT) as a screening tool for lung cancer [1], [2]. With the increased use of CT screening, cases of lung cancer appearing as pure ground-glass nodules (GGNs), which are radiologically nonsolid nodules, are being detected with increasing frequency [3].…”

Section: Introductionmentioning

confidence: 99%

Tumor Size and Computed Tomography Attenuation of Pulmonary Pure Ground-Glass Nodules Are Useful for Predicting Pathological Invasiveness

et al. 2014

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ObjectivesPulmonary ground-glass nodules (GGNs) are occasionally diagnosed as invasive adenocarcinomas. This study aimed to evaluate the clinicopathological features of patients with pulmonary GGNs to identify factors predictive of pathological invasion.MethodsWe retrospectively evaluated 101 pulmonary GGNs resected between July 2006 and November 2013 and pathologically classified them as adenocarcinoma in situ (AIS; n = 47), minimally invasive adenocarcinoma (MIA; n = 30), or invasive adenocarcinoma (I-ADC; n = 24). The age, sex, smoking history, tumor size, and computed tomography (CT) attenuation of the 3 groups were compared. Receiver operating characteristic (ROC) curve analyses were performed to identify factors that could predict the presence of pathologically invasive adenocarcinomas.ResultsTumor size was significantly larger in the MIA and I-ADC groups than in the AIS group. CT attenuation was significantly greater in the I-ADC group than in the AIS and MIA groups. In ROC curve analyses, the sensitivity and specificity of tumor size (cutoff, 11 mm) were 95.8% and 46.8%, respectively, and those for CT attenuation (cutoff, −680 HU) were 95.8% and 35.1%, respectively; the areas under the curve (AUC) were 0.75 and 0.77, respectively. A combination of tumor size and CT attenuation (cutoffs of 11 mm and −680 HU for tumor size and CT attenuation, respectively) yielded in a sensitivity and specificity of 91.7% and 71.4%, respectively, with an AUC of 0.82.ConclusionsTumor size and CT attenuation were predictive factors of pathological invasiveness for pulmonary GGNs. Use of a combination of tumor size and CT attenuation facilitated more accurate prediction of invasive adenocarcinoma than the use of these factors independently.

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“…In addition, there have been many reports that CT can detect more of these lesions at an earlier stage than chest radiography [12][13][14][15]. Recently, Austin et al [16] presented a summary of 48 subjects with SCLC detected by the International Early Lung Cancer Action Program (I-ELCAP) [17] and reported that CT screening identified a shift toward early stage and away from late stage disease.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, Austin et al [16] presented a summary of 48 subjects with SCLC detected by the International Early Lung Cancer Action Program (I-ELCAP) [17] and reported that CT screening identified a shift toward early stage and away from late stage disease. We initially began a low-dose CT screening trial using a mobile CT unit in Japan [13,14,18], and CT screening for lung cancer has now been extended in Nagano Prefecture, Japan. Previously, we reported 12 cases of SCLC detected by CT screening in Nagano Prefecture http://dx.doi.org/10.1016/j.lungcan.2015.01.025 0169-5002/© 2015 Elsevier Ireland Ltd. All rights reserved.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes in patients with small cell lung cancer in a single institute: Comparative analysis of radiographic screening with symptom-prompted patients

et al. 2015

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Different efficacy of CT screening for lung cancer according to histological type: Analysis of Japanese-smoker cases detected using a low-dose CT screen

Cited by 15 publications

References 40 publications

The National Lung Screening Trial: Results stratified by demographics, smoking history, and lung cancer histology

The National Lung Screening Trial: Results stratified by demographics, smoking history, and lung cancer histology

Tumor Size and Computed Tomography Attenuation of Pulmonary Pure Ground-Glass Nodules Are Useful for Predicting Pathological Invasiveness

Clinical outcomes in patients with small cell lung cancer in a single institute: Comparative analysis of radiographic screening with symptom-prompted patients

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