The outcome differences of CT screening for lung cancer pre and post following an algorithm in Zhuhai, China
ABSTRACT To evaluate the change in outcomes from CT screening for lung cancer before and after collaboration with the International Early Lung Cancer Action Program (I-ELCAP) as well as changing from a single-row detector to a multi-row detector CT scanner (MDCT).
All participants in the screening program were 40 years of age and older. From 1994 to 2002, a single slice spiral CT was used, the screening protocol was established empirically at our institution. From 2003 to 2009 a 16 slice MDCT was used and our institute became the first I-ELCAP site in China. Collaboration included use of the I-ELCAP protocol, image reading training, teaching files training and attendance at international conferences. The clinical and CT characteristics of participants and diagnosed lung cancers pre and post-collaboration were summarized. The outcomes before and after collaboration were compared, including nodule positive rate, lung cancer frequency, stage distribution, pathology, intervals between last routine screening and surgery, the rate of surgery for benign disease and survival rate.
3348 participants were enrolled during 1994-2002 and 3582 participants during 2003-2009. Their age, gender, smoking and family cancer histories were comparable. The screening detection rate of lung cancer was 1.1% (36/3348) vs. 1.0% (34/3582) (P=0.6), mean size was 18.6 mm vs. 15.6 mm (P=0.04), stage I lung cancer was 67% vs. 91% (P=0.38), median intervals between last routine screening and surgery was 213 days vs. 96 days (P<0.001), 5-year survival rate due to lung cancer was 75% vs. 95% (P=0.032) in pre- and post collaboration group respectively. The nodule positive rate was 6.2% (208/3348) vs. 9.8% (351/3582) (P<0.001), the rate of surgery for benign disease was 18% (8/44) vs. 8% (3/37) (P=0.4) in pre- and post collaboration group respectively.
Smaller lung cancer were detected, interval between last routine screening and surgery was shorter, surgery for benign disease decreased, and survival rate increased in CT screening for lung cancer in Zhuhai after the collaboration with I-ELCAP and with MDCT. Technology improvements along with a well defined protocol improved outcomes of CT screening for lung cancer in Zhuhai, China.
- CancerSpectrum Knowledge Environment 02/2012; 104(3):254; author reply 255-6. DOI:10.1093/jnci/djr520 · 15.16 Impact Factor
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ABSTRACT: Surgical resection for tissue diagnosis of lung nodules exposes patients to unnecessary risks and consumes health care resources for questionable benefit. We describe the impact of routine percutaneous lung biopsy on the management of suspicious lung nodules. A retrospective review of consecutive patients referred to a regional cancer assessment center for evaluation of suspected primary or metastatic lung cancer was performed. From 2008 to 2010, 901 patients (male to female ratio, 0.97:1 [443 to 458]; mean age, 69.4 ± 0.3 years) underwent 1,016 percutaneous lung biopsy (fluoroscopy, 77%; computed tomography-guided, 20%). Diagnoses were non-small cell lung cancer (602 of 901; 66.8%), other malignancy (159 of 901; 17.6%), indeterminate (61 of 901; 6.8%), benign (47 of 901; 5.2%), or nondiagnostic (32 of 901; 3.6%). Of these, 393 (43.6%) were surgical candidates. Operation was avoided in 16.0% (63 of 393; benign, 36; indeterminate, 13; nondiagnostic, 14). Computed tomography follow-up in 82.5% (52 of 63) showed no change or resolution at 14.0 ± 1 months. Only 2.7% (9 of 330) underwent resection of a pathologically benign nodule. Diagnostic yield of percutaneous lung biopsy was 82.7%. Sensitivity, specificity, and positive and negative predictive values, respectively, were 100% (95% confidence interval, 98 to 100), 75% (95% confidence interval, 22 to 99), 99.7% (95% confidence interval, 98 to 100), and 100% (95% confidence interval, 31 to 100). The mean operating room time saved with this strategy was 165 ± 13.2 hours. The total cost of performing routine percutaneous biopsy ($395,500) was 44.5% of the cost of upfront wedge resection for tissue diagnosis ($888,300). In surgical candidates, routine needle biopsy of suspicious lung nodules may lead to decreased costs, more efficient use of limited operating room resources, and a low probability of resecting pathologically benign lesions.The Annals of thoracic surgery 06/2012; 94(5):1667-72. DOI:10.1016/j.athoracsur.2012.04.096 · 3.65 Impact Factor
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ABSTRACT: Data from the National Lung Screening Trial (NLST) suggested that annual computed tomography (CT) screening of at-risk patients decreaseed lung cancer mortality by 20%. We assessed the effects of low dose CT radiation in mice exposed to 4-(methylnitrosoamino)-1-(3-pyridyl)-1-butanone (NNK) to mimic the effects of annual CT screening in heavy smokers and ex-smokers. A/J mice were treated at 8 weeks with NNK followed one week later by 4 weekly doses of 0, 10, 30, or 50 mGy of whole-body CT and euthanized 8 months later. Irradiated mice exhibited significant 1.8 to 2-fold increases in tumor multiplicity in males (16.1±0.8 vs. 9.1±1.5 tumors/mouse; p<0.0001) and females (21.6±0.8 vs. 10.5±1.4 tumors/mouse; p<0.0001), respectively, compared to unirradiated mice with no dose effect observed; female mice exhibited higher sensitivity to radiation exposure than did males (p<0.0001). Similar results were obtained when tumor area was determined. To assess if the deleterious effects of radiation could be prevented by antioxidants, female mice were fed a diet containing 0.7% N-acetylcysteine (NAC) starting 3 days prior to the first CT exposure and continuing for a total of 5 weeks. NAC prevented CT-induced increases in tumor multiplicity (10.5±1.2 vs. 20.7±1.5 tumors/mouse; p<0.0001) back to levels seen in NNK/unirradiated mice (10.5±1.2). Our data suggest that exposure of sensitive populations to CT radiation increases the risk of tumorigenesis and that antioxidants may prevent the long term carcinogenic effects of low dose radiation exposure. This would allow annual screening with CT while preventing the potential long term toxicity of radiation exposure.Carcinogenesis 10/2012; DOI:10.1093/carcin/bgs332 · 5.27 Impact Factor