European and North American lung cancer screening experience and implications for pulmonary nodule management

Abstract

The potential for low dose computed tomography (LDCT) to act as an effective tool in screening for lung cancer is currently the subject of several randomised control trials. It has recently been given prominence by interim results released by the North American National Lung Screening Trial (NLST). Several other trials assessing LDCT as a screening tool are currently underway in Europe, and are due to report their final results in the next few years. These include the NELSON, DLSCT, DANTE, ITALUNG, MILD and LUSI trials. Although slow to instigate a trial of its own, the UK Lung Screen (UKLS) trial will shortly commence. The knowledge gained from the newer trials has mostly reinforced and refined previous concepts that have formed the basis of existing nodule management guidelines. This article takes the opportunity to summarise the main aspects and initial results of the trials presently underway, assess the status of current collaborative efforts and the scope for future collaboration, and analyse observations from these studies that may usefully inform the management of the indeterminate pulmonary nodule. Key Points • Low dose CT screening for lung cancer is promising. • The effect of LDCT screening on mortality is still uncertain. • Several European randomised controlled trials for LDCT are underway. • The trials vary in methodology but most compare LDCT to no screening. • Preliminary results have reinforced existing nodule management concepts.

Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging

“…Other large multicentre studies such as the European randomised lung cancer CT screening trial (EUCT) or the Dutch-Belgian randomised lung cancer multi-slice CT screening trial (NELSON) are currently ongoing [5,6]. Now many associations recommend lung cancer screening [7][8][9][10].…”

Inter- and intrascanner variability of pulmonary nodule volumetry on low-dose 64-row CT: an anthropomorphic phantom study

“…Also, inconsistent results were reported about dependency of volumetry variability on nodule size. Rampinelli et al [19] found that volumetry for larger nodules was more reproducible, based on 83 nodules with a mean volume of 2206241 mm 3 , yet Marchianò et al [28] observed that variability was not affected by nodule volume based on 233 nodules of 996127 mm 3 . In those in vivo studies, different volume ranges of included nodules have likely caused these inconsistent results.…”

“…Moreover, we used five commercially available artificial spherical pulmonary nodules with a smooth surface in five diameters (3, 5, 8, 10 and 12 mm, corresponding to a volume of 14, 65, 268, 524 and 905 mm 3 ), made of polyurethane resin ( Figure 2). CT density was 1100 Hounsfield units (HU) at 120 kV.…”

“…Many lung cancers are found at a relatively late stage, resulting in a 5-year survival of only 15% or less [2]. Low-dose CT is a promising screening method for early detection of lung cancer [3][4][5][6][7]. The first result indicates that CT lung cancer screening can reduce lung cancer-specific mortality [8].…”

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

“…Imaging plays a key role in patient care during all stages of the disease including diagnosis, staging, management, and assessing response to therapy [2,3]. More recently, a number of trials [4] including the National Lung Screening Trial (NLST) [5] have provided compelling evidence that in some populations, the mortality associated with lung cancer can be reduced by screening using low-dose CT (LDCT) [6], thus adding screening to the list of imaging roles.…”