Results of Initial Low-Dose Computed Tomographic Screening for Lung Cancer

Abstract

BACKGROUND Lung cancer is the largest contributor to mortality from cancer. The National Lung Screening Trial (NLST) showed that screening with low-dose helical computed tomography (CT) rather than with chest radiography reduced mortality from lung cancer. We describe the screening, diagnosis, and limited treatment results from the initial round of screening in the NLST to inform and improve lung-cancer– screening programs. METHODS At 33 U.S. centers, from August 2002 through April 2004, we enrolled asymptomatic participants, 55 to 74 years of age, with a history of at least 30 pack-years of smoking. The participants were randomly assigned to undergo annual screening, with the use of either low-dose CT or chest radiography, for 3 years. Nodules or other suspicious findings were classified as positive results. This article reports findings from the initial screening examination. RESULTS A total of 53,439 eligible participants were randomly assigned to a study group (26,715 to low-dose CT and 26,724 to chest radiography); 26,309 participants (98.5%) and 26,035 (97.4%), respectively, underwent screening. A total of 7191 participants (27.3%) in the low-dose CT group and 2387 (9.2%) in the radiography group had a positive screening result; in the respective groups, 6369 participants (90.4%) and 2176 (92.7%) had at least one follow-up diagnostic procedure, including imaging in 5717 (81.1%) and 2010 (85.6%) and surgery in 297 (4.2%) and 121 (5.2%). Lung cancer was diagnosed in 292 participants (1.1%) in the low-dose CT group versus 190 (0.7%) in the radiography group (stage 1 in 158 vs. 70 participants and stage IIB to IV in 120 vs. 112). Sensitivity and specificity were 93.8% and 73.4% for low-dose CT and 73.5% and 91.3% for chest radiography, respectively. CONCLUSION The NLST initial screening results are consistent with the existing literature on screening by means of low-dose CT and chest radiography, suggesting that a reduction in mortality from lung cancer is achievable at U.S. screening centers that have staff experienced in chest CT. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.)

HIV-Associated Lung Cancer

“…To overcome these limitations, a large multicenter study compared LC survival benefit using low-dose computed tomography (LDCT) screening with conventional radiography in over 54,000 persons with a high risk profile (55-74 years of age and at least 30 pack-years). LC-related survival was 20% higher in the LDCT group (7% total survival benefit) [59,60]. In view of the high risk profile of smoking HIV-positive individuals, 2 studies tested the survival benefit using routine LDCT scans in PLWHIV.…”

LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective

“…[17][18][19] Approximately 20% of all patients with NSCLC Stage I are medically inoperable because of poor general condition or coexisting morbidities such as chronic obstructive pulmonary disease and/or heart disease, 20 and ,50% of all patients with early stage NSCLC older than 75 years undergo surgery. 21 It is expected that as the global population ages and lung cancer screening of high-risk populations is implemented, 22 the proportion of inoperable patients with lung cancer with comorbidities will increase. [23][24][25] In Stage I patients with NSCLC who refuse surgery and do not receive other treatments such as radiotherapy, 5-year overall survival (OS) and cancer-specific survival (CSS) are low, 6% and 16%, respectively.…”

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.…”