Lung cancer screening with spiral CT

Infante, Maurizio; Lutman, Fabio Romano; Cavuto, Silvio; Brambilla, Giorgio; Chiesa, G.; Passera, Eliseo; Angeli, Enzo; Chiarenza, Maurizio; Aranzulla, Giuseppe; Cariboni, Umberto; Alloisio, Marco; Incarbone, Matteo; Testori, Alberto; Destro, Annarita; Cappuzzo, Federico; Roncalli, Massimo; Santoro, Armando; Ravasi, Gianni

doi:10.1016/j.lungcan.2007.08.040

Cited by 177 publications

(35 citation statements)

References 37 publications

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“…A number of small trials have been initiated, in anticipation of combination with partner studies, or a future meta-analysis. These include the Danish Lung Cancer Screening Trial (DLCST), Multi-centric Italian Lung Detection Trial (MILD), 38,39 Italian Lung cancer Computed Tomography screening trial (ITALUNG), 40,41 Detection and screening of early lung cancer by Novel imaging Technology and molecular assays trials in Italy 42 and the French randomised pilot study, Depiscan. 43 ITALUNG, 41 MILD 38 and DLCST 44 have all reported on their mortality data, which showed no difference in the CT-screened arm; however, none of the studies was powered to provide such a result.…”

Section: European Lung Cancer Screening Trialsmentioning

confidence: 99%

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Field

Duffy

Baldwin

et al. 2016

Health Technol Assess

235

231

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BackgroundLung cancer kills more people than any other cancer in the UK (5-year survival < 13%). Early diagnosis can save lives. The USA-based National Lung Cancer Screening Trial reported a 20% relative reduction in lung cancer mortality and 6.7% all-cause mortality in low-dose computed tomography (LDCT)-screened subjects.ObjectivesTo (1) analyse LDCT lung cancer screening in a high-risk UK population, determine optimum recruitment, screening, reading and care pathway strategies; and (2) assess the psychological consequences and the health-economic implications of screening.DesignA pilot randomised controlled trial comparing intervention with usual care. A population-based risk questionnaire identified individuals who were at high risk of developing lung cancer (≥ 5% over 5 years).SettingThoracic centres with expertise in lung cancer imaging, respiratory medicine, pathology and surgery: Liverpool Heart & Chest Hospital, Merseyside, and Papworth Hospital, Cambridgeshire.ParticipantsIndividuals aged 50–75 years, at high risk of lung cancer, in the primary care trusts adjacent to the centres.InterventionsA thoracic LDCT scan. Follow-up computed tomography (CT) scans as per protocol. Referral to multidisciplinary team clinics was determined by nodule size criteria.Main outcome measuresPopulation-based recruitment based on risk stratification; management of the trial through web-based database; optimal characteristics of CT scan readers (radiologists vs. radiographers); characterisation of CT-detected nodules utilising volumetric analysis; prevalence of lung cancer at baseline; sociodemographic factors affecting participation; psychosocial measures (cancer distress, anxiety, depression, decision satisfaction); and cost-effectiveness modelling.ResultsA total of 247,354 individuals were approached to take part in the trial; 30.7% responded positively to the screening invitation. Recruitment of participants resulted in 2028 in the CT arm and 2027 in the control arm. A total of 1994 participants underwent CT scanning: 42 participants (2.1%) were diagnosed with lung cancer; 36 out of 42 (85.7%) of the screen-detected cancers were identified as stage 1 or 2, and 35 (83.3%) underwent surgical resection as their primary treatment. Lung cancer was more common in the lowest socioeconomic group. Short-term adverse psychosocial consequences were observed in participants who were randomised to the intervention arm and in those who had a major lung abnormality detected, but these differences were modest and temporary. Rollout of screening as a service or design of a full trial would need to address issues of outreach. The health-economic analysis suggests that the intervention could be cost-effective but this needs to be confirmed using data on actual lung cancer mortality.ConclusionsThe UK Lung Cancer Screening (UKLS) pilot was successfully undertaken with 4055 randomised individuals. The data from the UKLS provide evidence that adds to existing data to suggest that lung cancer screening in the UK could potentially be implemented in the 60–75 years age group, selected via the Liverpool Lung Project risk model version 2 and using CT volumetry-based management protocols.Future workThe UKLS data will be pooled with the NELSON (Nederlands Leuvens Longkanker Screenings Onderzoek: Dutch–Belgian Randomised Lung Cancer Screening Trial) and other European Union trials in 2017 which will provide European mortality and cost-effectiveness data. For now, there is a clear need for mortality results from other trials and further research to identify optimal methods of implementation and delivery. Strategies for increasing uptake and providing support for underserved groups will be key to implementation.Trial registrationCurrent Controlled Trials ISRCTN78513845.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 40. See the NIHR Journals Library website for further project information.

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Section: European Lung Cancer Screening Trialsmentioning

confidence: 99%

The UK Lung Cancer Screening Trial: a pilot randomised controlled trial of low-dose computed tomography screening for the early detection of lung cancer

Field

Duffy

Baldwin

et al. 2016

Health Technol Assess

235

231

View full text Add to dashboard Cite

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“…In addition, many screening programs have adopted a 5 mm diameter nodule size as the cutoff between positive and negative nodules on CT 1 , 2 , 3 , 4 , 5 , 6 , 7 . Therefore, we used 6 mm HGGOs and analyzed the relationship between the visibility, SNR M 2 and CTDI vol .…”

Section: Methodsmentioning

confidence: 99%

“…Low‐dose computed tomography (CT) for lung cancer screening has been well established as a more effective method of detecting nodules and lung cancers, including early‐stage cancers, than plain chest radiography 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 . In low‐dose CT for lung cancer screening (LDCT), the detection task is typically the observation of focal lung opacities or nodules.…”

Section: Introductionmentioning

confidence: 99%

A phantom study investigating the relationship between ground‐glass opacity visibility and physical detectability index in low‐dose chest computed tomography

Ichikawa

Kobayashi

Sagawa

et al. 2015

J Applied Clin Med Phys

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In this study, the relationship between ground‐glass opacity (GGO) visibility and physical detectability index in low‐dose computed tomography (LDCT) for lung cancer screening was investigated. An anthropomorphic chest phantom that included synthetic GGOs with CT numbers of ‐630 Hounsfield units (HU; high attenuation GGO: HGGO) and ‐800 HU (low attenuation GGO: LGGO), and three phantoms for physical measurements were employed. The phantoms were scanned using 12 CT systems located in 11 screening centers in Japan. The slice thicknesses and CT dose indices (CTDIvol) varied over 1.0–5.0 mm and 0.85–3.30 mGy, respectively, and several reconstruction kernels were used. Physical detectability index values were calculated from measurements of resolution, noise, and slice thickness properties for all image sets. Five radiologists and one thoracic surgeon, blind to one another's observations, evaluated GGO visibility using a five‐point scoring system. The physical detectability index correlated reasonably well with the GGO visibility (R2=0.709,p<0.01 for 6 mm HGGO and R2=0.646,p<0.01 for 10 mm LGGO), and was nearly proportional to the CTDIvol. Consequently, the CTDIvol also correlated reasonably well with the GGO visibility (R2=0.701,p<0.01 for 6 mm HGGO and R2=0.680,p<0.01 for 10 mm LGGO). As a result, the CTDIvol was nearly dominant in the GGO visibility for image sets with different reconstruction kernels and slice thicknesses, used in this study.PACS numbers: 81.70.Tx, 87.57.Q‐

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“…Outside the United States (US), three European randomized controlled screening studies have so far yielded results based on a screening and a control group [21,22,23,24]. These trials were generally smaller by a factor of 10 as compared to the NLST.…”

Section: Lung Cancer Screening: Promentioning

confidence: 99%

“…A total of 1,276 participants were randomized. In this study, screening was also shown to be advantageous in terms of lung cancer-specific mortality and overall mortality [21,22]. The Danish Lung Cancer Screening Trial (DLCST) was a single center study that also compared LDCT screening with observation.…”

Section: Lung Cancer Screening: Promentioning

confidence: 99%