Does lung cancer screening with low-dose computerized tomography improve survival?

Abstract

Summary A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was ‘Does lung cancer screening with low-dose computerised tomography (LDCT) improve survival?’ More than 963 papers were found, of which 8 randomized control trials and 1 meta-analysis represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. The majority of studies trended towards greater incidence of early lung cancer detection, and subsequent curative treatment, in the LDCT screening populations with appropriately powered randomized control trials (NELSON and NLST) demonstrating survival benefits of >20% in lung cancer-specific mortality. However, this reduction must be evaluated against the potential harms associated with screening, including complications from diagnostic procedures, and costs of overdiagnosis, as evidenced in several studies. We conclude that in high-risk populations, lung cancer screening with LDCT results in earlier detection of low-stage cancers and improved survival when compared to usual clinical care or screening with a chest X-ray.

Laterocervical lymph node metastases from suspected thyroidal primary site that turned out to be metastases of lung cancer: A case report

“…The pooled analysis shows that CTLS screening is associated with a significant increase in the surgical resection rate and, therefore, a reduction in LC‐related mortality of about 20% 20 . CTLS in this selected population allows obtaining a significant increase of early stage tumors diagnosis (stage IA) 22,23 . Finally, the U.S. Preventive Services Task Force (USPSTF) recommends annual screening for LC with LDCT in adults aged 50–80 years who have a history of 20 packs of cigarettes and currently smoke or have quit within the last 15 years.…”

“…22 In fact, FNAB accurately diagnosed metastatic disease 58% of cases, while it identified a malignancy in approximately 90% of cases. 23 Fine-needle aspiration (FNA) cytology coupled with needle-wash thyroglobulin (FNA-Tg) testing is recommended for detection of cervical lymph node metastasis in patients with papillary thyroid carcinoma, but this test has some limitations. For example, patients with high FNA-Tg level have no positive lymph node specimens and this is likely due to contamination in case of intact thyroid.…”

“…Thyroglobulin differentiates primary thyroid tumor from lung one but, in case of poor differentiation, differentiating metastatic lesion in thyroid gland is not easy 22 . In fact, FNAB accurately diagnosed metastatic disease in 58% of cases, while it identified a thyroid malignancy in approximately 90% of cases 23 …”

“… 20 CTLS in this selected population allows obtaining a significant increase of early stage tumors diagnosis (stage IA). 22 , 23 Finally, the U.S. Preventive Services Task Force (USPSTF) recommends annual screening for LC with LDCT in adults aged 50–80 years who have a history of 20 packs of cigarettes and currently smoke or have quit within the last 15 years. The same guidelines recommend stopping screening when a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to undergo curative lung surgery.…”

“… 22 In fact, FNAB accurately diagnosed metastatic disease in 58% of cases, while it identified a thyroid malignancy in approximately 90% of cases. 23 …”