The British Thoracic Society guidelines on the investigation and management of pulmonary nodules

Baldwin, David R; Callister, Matthew

doi:10.1136/thoraxjnl-2015-207221

Cited by 401 publications

(179 citation statements)

References 10 publications

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“…19 The British Thoracic Society does not recommend nodule follow-up for lung nodules ,5 mm (or 80 mm 3 ). 20 In our study, the performance of ASIR, SafeCT and MBIR images were similar for nodule detection at 0.25, 0.4 and 0.8 mGy. In our study, the tested IRTs (ASIR, MBIR and SafeCT) had lesser effect on diagnosis than in scanning patients with variable sizes using a fixed CT dose, variable kVp and reconstruction kernels.…”

Section: Radiation Dosementioning

confidence: 64%

Assessment of chest CT at CTDIvol less than 1 mGy with iterative reconstruction techniques

Padole

Digumarthy

Flores

et al. 2017

The British Journal of Radiology

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Objective: To assess the image quality of chest CT reconstructed with image-based iterative reconstruction (SafeCT; MedicVision®, Tirat Carmel, Israel), adaptive statistical iterative reconstruction (ASIR; GE Healthcare, Waukesha, WI) and model-based iterative reconstruction (MBIR; GE Healthcare, Waukesha, WI) techniques at CT dose index volume (CTDI vol ) ,1 mGy. Methods: In an institutional review board-approved study, 25 patients gave written informed consent for acquisition of three reduced dose (0.25-, 0.4-and 0.8-mGy) chest CT after standard of care CT (8 mGy) on a 64-channel multidetector CT (MDCT) and reconstructed with SafeCT, ASIR and MBIR. Two board-certified thoracic radiologists evaluated images from the lowest to the highest dose of the reduced dose CT series and subsequently for standard of care CT. INTRODUCTIONThe reduced dose (RD) CT examinations can be associated with higher image noise which may affect the diagnostic confidence, particularly with filtered back projection (FBP) images. [1][2][3] Prior studies have demonstrated improved image quality with iterative reconstruction techniques (IRTs) at RDs. [4][5][6][7][8][9][10][11][12][13] In order to achieve a RD CT, users need to modify the scan parameters and then apply IRTs to improve the image quality. Prior RD studies have assessed CT dose index volume (CTDI vol ) of ,1 mGy with IRTs to demonstrated uncompromised lung nodule detection.

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Section: Radiation Dosementioning

confidence: 64%

Assessment of chest CT at CTDIvol less than 1 mGy with iterative reconstruction techniques

Padole

Digumarthy

Flores

et al. 2017

The British Journal of Radiology

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“…Another positive from the CT screening studies is that they have provided evidence underpinning the rational approach to the investigation of solitary pulmonary nodules, including the very helpful algorithm developed by the BTS [35]. This includes appreciation that minimally invasive adenocarcinomas may be benign in behaviour and may allow a less aggressive approach to management in comorbid or frail patients.…”

Section: Applicability Of Trial Findings To Routine Clinical Practicementioning

confidence: 99%

Low-Dose Computed Tomography Screening for Lung Cancer

Rogers¹

2017

A Global Scientific Vision - Prevention, Diagnosis, and Treatment of Lung Cancer

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In the landmark American National Lung Cancer Screening Trial (NLST), low-dose CT (LDCT) screening produced a relative mortality reduction of 20%. These results have not been replicated in any of the European studies, although these are of limited statistical power. Besides doubt about the general applicability of the NLST findings, if LDCT screening is to be successfully implemented, a number of developments are still required, including better characterisation of entry criteria and refinement of screening and nodule management protocols. The high incidence of false-positive findings increases costs and morbidity. Even when histologically malignant tumours are identified, frequently these would not have manifested as disease, i.e. they are "overdiagnosed". These patients are liable to receive unnecessary treatment. LDCT screening is relatively expensive in comparison with other cancer screening modalities. Whilst cost-effectiveness can be improved by integration with smoking cessation programmes, how this would be done in practice remains unclear. Furthermore, individuals at high-risk of lung cancer are virtually by definition risk prone, raising concerns about how attractive participation in a screening programme would be, especially given the very small reported absolute risk reduction in the NLST.

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“…Nodule size thresholds and in surveillance, the volume doubling time are useful methods to differentiate malignant dangerous lung lesions from benign or premalignant indolent tumours as shown by the investigators of the NELSON study [6,11], combined with selective use of PET scan [13,14]. New guidelines show how a combination of nodule size, risk prediction models, and PET-CT scanning can accurately predict malignancy and guide management [15,16,17]. …”

Section: Pulmonary Nodule Management Algorithm: Europe Should Adopt Amentioning

confidence: 99%

EU Policy on Lung Cancer CT Screening 2017

Field

Zulueta²,

Veronesi

et al. 2017

Biomed Hub

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Background: Lung cancer kills more Europeans than any other cancer. In 2013, 269,000 citizens of the EU-28 died from this disease. Lung cancer CT screening has the potential to detect lung cancer at an early stage and improve mortality. All of the randomised controlled trials and cohort low-dose CT (LDCT) screening trials across the world have identified very early stage disease (∼70%); the majority of these LDCT trial patients were suitable for surgical interventions and had a good clinical outcome. The 10-year survival in CT screen-detected cancer was shown to be even higher than the 5-year survival for early stage disease in clinical practice at 88%. Methods: Setting up of an EU Commission expert group can be done under Article 168(2) of the Treaty on the Functioning of the European Union, to develop policy and recommendation for Lung cancer CT screening. The Expert Group would undertake: (a) assist the Commission in the drawing up policy documents, including guidelines and recommendations; (b) advise the Commission in the implementation of Union actions on screening and suggest improvements to the measures taken; (c) advise the Commission in the monitoring, evaluation and dissemination of the results of measures taken at Union and national level. Results: This EU Expert Group on lung cancer screening should be set up by the EU Commission to support the implementation and suggest recommendations for the lung cancer screening policy by 2019/2020. Conclusion: Reduce lung cancer in Europe by undertaking a well-organised lung cancer CT screening programme.

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The British Thoracic Society guidelines on the investigation and management of pulmonary nodules

Cited by 401 publications

References 10 publications

Assessment of chest CT at CTDIvol less than 1 mGy with iterative reconstruction techniques

Assessment of chest CT at CTDIvol less than 1 mGy with iterative reconstruction techniques

Low-Dose Computed Tomography Screening for Lung Cancer

EU Policy on Lung Cancer CT Screening 2017

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