Role of sex in lung cancer risk prediction based on single low-dose chest computed tomography.
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ABSTRACT:
SUBMITTER: Simon J
PROVIDER: S-EPMC10616081 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Role of sex in lung cancer risk prediction based on single low-dose chest computed tomography.
Simon Judit J Mikhael Peter P Tahir Ismail I Graur Alexander A Ringer Stefan S Fata Amanda A Jeffrey Yang Chi-Fu YC Shepard Jo-Anne JA Jacobson Francine F Barzilay Regina R Sequist Lecia V LV Pace Lydia E LE Fintelmann Florian J FJ
Scientific reports 20231030 1
A validated open-source deep-learning algorithm called Sybil can accurately predict long-term lung cancer risk from a single low-dose chest computed tomography (LDCT). However, Sybil was trained on a majority-male cohort. Use of artificial intelligence algorithms trained on imbalanced cohorts may lead to inequitable outcomes in real-world settings. We aimed to study whether Sybil predicts lung cancer risk equally regardless of sex. We analyzed 10,573 LDCTs from 6127 consecutive lung cancer scree ...[more]
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| S-EPMC10413016 | biostudies-literature
Project description:BackgroundThe National Lung Screening Trial (NLST) and NELSON trial showed that low-dose chest computed tomography (LDCT) screening significantly reduced the mortality form lung cancer. Although cancer survivors are known to have high risk for second malignant neoplasm (SMN), the usefulness of LDCT screening for lung cancer in cancer survivors is not clear.MethodsBetween August 2016 and August 2017, 633 long-term colorectal cancer (CRC) survivors visited the survivorship clinic in Cancer Prevention Center, Yonsei Cancer Center, Seoul, Republic of Korea. We surveyed the smoking status and recommended LDCT screening to ever-smoking CRC survivors aged 55-80 years. The participants were classified into three risk groups: risk group 1 (RG1) who met the NLST criteria (Age 55-74 years, ≥ 30 pack-years of smoking, smoking cessation < 15 years); risk group 2 (RG2) who would not meet the NLST criteria but were at increased 6-year risk of lung cancer (PLCOM2012 ≥ 0.0151); risk group 3 (RG3) who did not meet any of the criteria above.ResultsAmong 176 ever-smoking CRC survivors, 173 (98.3%) were male, 32 (18.2%) were current-smoker, and median age was 66 years (range, 55-79 years). We found 38 positive findings (non-calcified nodule ≥ 4 mm), 8 clinically significant findings, 66 minor abnormalities, and 64 negative findings on LDCT. Positive findings were identified in 15 of 79 (19.0%) of RG1, in 9 of 36 (25%) of RG2, and in 14 of 61 (23.0%) of RG3. Second primary lung cancers were found in 2 patients of RG2, and in 1 patient of RG3. SMN was most frequently found in RG2 (11 of 36 patients, 30.6%), compared with RG1 (12.7%) or RG3 (9.8%) (P = 0.016).ConclusionsLDCT screening for lung cancer in Korean CRC survivors is feasible. Well-designed clinical trial for defining high risk patients for lung cancer among CRC survivors is needed.
| S-EPMC6453590 | biostudies-literature
Project description:Various methods were suggested to measure skeletal muscle areas (SMAs) using chest low-dose computed tomography (chest LDCT) as a substitute for SMA at 3rd lumbar vertebra level (L3-SMA). In this study, four SMAs (L1-SMA, T12-erector spinae muscle areas, chest wall muscle area at carina level, pectoralis muscle area at aortic arch level) were segmented semi-automatically in 780 individuals taking concurrent chest and abdomen LDCT for healthcare screening. Four SMAs were compared to L3-SMA and annual changes were calculated from individuals with multiple examinations (n = 101). Skeletal muscle index (SMI; SMA/height2) cut-off for sarcopenia was determined by lower 5th percentile of young individuals (age ≤ 40 years). L1-SMA showed the greatest correlation to L3-SMA (men, R2 = 0.7920; women, R2 = 0.7396), and the smallest annual changes (0.3300 ± 4.7365%) among four SMAs. L1-SMI cut-offs for determining sarcopenia were 39.2cm2/m2 in men, and 27.5cm2/m2 in women. Forty-six men (9.5%) and ten women (3.4%) were found to have sarcopenia using L1-SMI cut-offs. In conclusion, L1-SMA could be a reasonable substitute for L3-SMA in chest LDCT. Suggested L1-SMI cut-offs for sarcopenia were 39.2cm2/m2 for men and 27.5cm2/m2 for women in Asian.
| S-EPMC8748601 | biostudies-literature
Project description:ImportanceScreening for lung cancer has the potential to reduce mortality, but in addition to detecting aggressive tumors, screening will also detect indolent tumors that otherwise may not cause clinical symptoms. These overdiagnosis cases represent an important potential harm of screening because they incur additional cost, anxiety, and morbidity associated with cancer treatment.ObjectiveTo estimate overdiagnosis in the National Lung Screening Trial (NLST).Design, setting, and participantsWe used data from the NLST, a randomized trial comparing screening using low-dose computed tomography (LDCT) vs chest radiography (CXR) among 53 452 persons at high risk for lung cancer observed for 6.4 years, to estimate the excess number of lung cancers in the LDCT arm of the NLST compared with the CXR arm.Main outcomes and measuresWe calculated 2 measures of overdiagnosis: the probability that a lung cancer detected by screening with LDCT is an overdiagnosis (PS), defined as the excess lung cancers detected by LDCT divided by all lung cancers detected by screening in the LDCT arm; and the number of cases that were considered overdiagnosis relative to the number of persons needed to screen to prevent 1 death from lung cancer.ResultsDuring follow-up, 1089 lung cancers were reported in the LDCT arm and 969 in the CXR arm of the NLST. The probability is 18.5% (95% CI, 5.4%-30.6%) that any lung cancer detected by screening with LDCT was an overdiagnosis, 22.5% (95% CI, 9.7%-34.3%) that a non-small cell lung cancer detected by LDCT was an overdiagnosis, and 78.9% (95% CI, 62.2%-93.5%) that a bronchioalveolar lung cancer detected by LDCT was an overdiagnosis. The number of cases of overdiagnosis found among the 320 participants who would need to be screened in the NLST to prevent 1 death from lung cancer was 1.38.Conclusions and relevanceMore than 18% of all lung cancers detected by LDCT in the NLST seem to be indolent, and overdiagnosis should be considered when describing the risks of LDCT screening for lung cancer.
| S-EPMC4040004 | biostudies-literature
Project description:BackgroundThe older population is at high risk of lung cancer (LC). However, the importance of lung cancer screening (LCS) in this population is rarely investigated. Herein, we evaluated the effect of LCS with low-dose computed tomography (LDCT) in the older population.MethodsThis retrospective cohort study was conducted in a single center and included patients aged 70-80 years who had undergone LCS with LDCT. They were categorized into the early 70s (70-74 years) and late 70s (75-80 years) groups based on their age. Using propensity score matching, the control group included patients with non-screening-detected LC from an LC cohort. LC detection, characteristics, and treatment were compared between the early and late 70s groups and between screening-detected LC and non-screening-detected LC.ResultsThe study included 1,281 participants who underwent LDCT for LCS, of whom 1,020 were in their early 70s and 261 in their late 70s. Among the screening groups, 87.7% of the patients were ever-smokers. The overall LC detection rate was 2.8%. Interestingly, the LC detection rate in the late 70s group was similar to that in the early 70s group (3.4% vs. 2.7%, P=0.485). Furthermore, the incidence of LC was 6.1 cases and 8.3 cases per 1,000 person-years in the early 70s and late 70s groups, respectively (P=0.428). When comparing LC characteristics, patients with screening-detected LC showed a higher proportion of stage I LC (52.8% vs. 30.6%, P=0.010) and a lower proportion of stage IV LC (19.4% vs. 42.2%, P=0.010) than those with non-screening-detected LC. Moreover, 80.6% of patients with screening-detected LC received appropriate tumor reduction treatment based on the cancer stage.ConclusionsIn the older population, LCS using LDCT showed remarkable detection of LC, with a higher proportion of cases detected at an early stage.
| S-EPMC10654442 | biostudies-literature
Project description:Association between smoking intensity and the quantity and quality of thoracic skeletal muscles (TSMs) remains unexplored. Skeletal muscle index (SMI; skeletal muscle area/height2) and percentage of normal attenuation muscle area (NAMA%) were measured to represent the quantity and quality of the skeletal muscles, respectively, and quantification was performed in pectoralis muscle at aortic arch (AA-PM), TSM at carina (C-TSM), erector spinae muscle at T12 (T12-ESM), and skeletal muscle at L1 (L1-SM). Among the 258 men (median age, 62 years [IQR: 58-69]), 183 were current smokers (median smoking intensity, 40 pack-years [IQR: 30-46]). SMI and NAMA% of AA-PM significantly decreased with pack-year (β = - 0.028 and - 0.076; P < 0.001 and P = 0.021, respectively). Smoking intensity was inversely associated with NAMA% of C-TSM (β = - 0.063; P = 0.001), whereas smoking intensity showed a borderline association with SMI of C-TSM (β = - 0.023; P = 0.057). Smoking intensity was associated with the change in NAMA% of L1-SM (β = - 0.040; P = 0.027), but was not associated with SMI of L1-SM (P > 0.05). Neither NAMA% nor SMI of T12-ESM was affected by smoking intensity (P > 0.05). In conclusion, smoking intensity was associated with the change of TSMs. Its association varied according to the location of TSMs, with the most associated parts being the upper (AA-PM) and middle TSMs (C-TSM).
| S-EPMC10656498 | biostudies-literature
Project description:BackgroundChest low-dose computed tomography (LDCT) is a promising technology for population-based screening because it is non-invasive, relatively inexpensive, associated with low radiation and highly sensitive to lung cancer. To improve the cost-effectiveness of lung cancer screening, simultaneous screening for other diseases could be considered. This systematic review was conducted to analyse studies that published evidence on the cost-effectiveness of chest LDCT screening programs for different diseases.MethodsScopus and PubMed were searched for English publications (1 January 2011-22 July 2022) using search terms related to screening, computed tomography and cost-effectiveness. An additional search specifically searched for the cost-effectiveness of screening for lung cancer, chronic obstructive pulmonary disease or cardiovascular disease. Included publications should present a full health economic evaluation of population screening with chest LDCT. The extracted data included the disease screened for, model type, country context of screening, inclusion of comorbidities or incidental findings, incremental costs, incremental effects and the resulting cost-effectiveness ratio amongst others. Reporting quality was assessed using the 2022 Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.ResultsThe search yielded 1799 unique papers, of which 43 were included. Most papers focused on lung cancer screening (n = 40), and three were on coronary calcium scoring. Microsimulation was the most commonly applied modelling type (n = 16), followed by life table analysis (n = 10) and Markov cohort models (n = 10). Studies reflected the healthcare context of the US (n = 15), Canada (n = 4), the UK (n = 3) and 13 other countries. The reported incremental cost-effectiveness ratio ranged from US$10,000 to US$90,000/quality-adjusted life year (QALY) for lung cancer screening compared to no screening and was US$15,900/QALY-US$45,300/QALY for coronary calcium scoring compared to no screening.DiscussionAlmost all health economic evaluations of LDCT screening focused on lung cancer. Literature regarding the health economic benefits of simultaneous LDCT screening for multiple diseases is absent. Most studies suggest LDCT screening is cost-effective for current and former smokers aged 55-74 with a minimum of 30 pack-years of smoking history. Consequently, more evidence on LDCT is needed to support further cost-effectiveness analyses. Preferably evidence on simultaneous screening for multiple diseases is needed, but alternatively, on single-disease screening.Registration of systematic reviewProspective Register of Ongoing Systematic Reviews registration CRD42021290228 can be accessed https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=290228 .
| S-EPMC10020316 | biostudies-literature
Project description:ObjectiveChest computed tomography (CT) imaging is being increasingly used for potential lung donor assessment. However, the efficacy of CT imaging in this setting remains unknown. We hypothesize that chest CT imaging independently affects the decision-making process in donor lung utilization.MethodsWe conducted a retrospective cohort study of all adult donation after brain death donors managed through our local organ procurement organization from June 2011 to November 2016. An experienced thoracic radiologist independently reviewed donor chest CT and chest x-ray images in a blinded, standardized manner to determine the presence of structural lung disease (eg, emphysema, interstitial lung disease [ILD]) and acute abnormalities (eg, traumatic lung injury [TLI]). Distinct models of lung utilization were fit to groups with initial partial pressure of oxygen (iPaO2) ≤300 mm Hg (suboptimal) and iPaO2 >300 mm Hg (optimal).ResultsThe organ procurement organization managed 753 donors during the study period, with a lung utilization rate ([lung donors/all organ donors] × 100) of 36.5% (275 of 753). Four hundred forty-five (59.1%) donors received chest CT imaging, revealing emphysema (13.7%), ILD (2.5%), and TLI (7.2%). In univariate analysis, findings of TLI (odds ratio [OR], 2.23; 95% confidence interval [CI], 1.08-4.61) were positively associated with lung utilization, whereas findings of emphysema (OR, 0.18; CI, 0.08-0.40) were negatively associated with utilization. In multivariate analysis, CT findings of emphysema (OR, 0.21; CI 0.08-0.54) remained negatively associated with utilization. No potential donors with CT findings of ILD became lung donors. After controlling for chest x-ray findings, chest CT imaging findings of structural lung disease remained negatively associated with utilization (P = .0001). Lung utilization rate in the suboptimal and optimal iPaO2 populations was 35.1% and 41.4%, respectively, and CT findings of emphysema had a significant association with nonutilization in both groups.ConclusionsIn the evaluation of potential lung donors, chest CT imaging findings of structural lung disease, such as emphysema and ILD, have a significant negative association with lung utilization. Our findings suggest that chest CT imaging might be an important adjunct to conventional lung donor assessment criteria.
| S-EPMC6486796 | biostudies-literature
Project description:Background: The diagnosis of osteoporosis is still one of the most critical topics for orthopedic surgeons worldwide. One research direction is to use existing clinical imaging data for accurate measurements of bone mineral density (BMD) without additional radiation. Methods: A novel phantom-less quantitative computed tomography (PL-QCT) system was developed to measure BMD and diagnose osteoporosis, as our previous study reported. Compared with traditional phantom-less QCT, this tool can conduct an automatic selection of body tissues and complete the BMD calibration with high efficacy and precision. The function has great advantages in big data screening and thus expands the scope of use of this novel PL-QCT. In this study, we utilized lung cancer or COVID-19 screening low-dose computed tomography (LDCT) of 649 patients for BMD calibration by the novel PL-QCT, and we made the BMD changes with age based on this PL-QCT. Results: The results show that the novel PL-QCT can predict osteoporosis with relatively high accuracy and precision using LDCT, and the AUC values range from 0.68 to 0.88 with DXA results as diagnosis reference. The relationship between PL-QCT BMD with age is close to the real trend population (from ∼160 mg/cc in less than 30 years old to ∼70 mg/cc in greater than 80 years old for both female and male groups). Additionally, the calculation results of Pearson's r-values for correlation between CT values with BMD in different CT devices were 0.85-0.99. Conclusion: To our knowledge, it is the first time for automatic PL-QCT to evaluate the performance against dual-energy X-ray absorptiometry (DXA) in LDCT images. The results indicate that it may be a promising tool for individuals screened for low-dose chest computed tomography.
| S-EPMC9273929 | biostudies-literature
Project description:AimsPhoton-counting detector computed tomography (PCD-CT), which allows the exclusion of electronic noise, shows promise for significant dose reduction in coronary CT angiography (CCTA). This study aimed to assess the radiation dose and image quality of CCTA using PCD-CT, combined with high-pitch helical scanning and an ultra-low tube potential of 70 kVp, and investigate the effect of a sharp kernel on image quality and stenosis assessment in such an ultra-low-dose CCTA setting.Methods and resultsForty patients (65% male) with stable heart rates and no prior coronary interventions were included. Data on CT dose index volume (CTDIvol) and dose-length product (DLP) were collected, with effective radiation dose estimated using a conversion factor of 0.014. Images were reconstructed using kernels of Bv64 and Bv40 for image quality and stenosis assessment. The mean CTDIvol, DLP, and effective dose of CCTA were 1.72 ± 0.38 mGy, 29.1 ± 6.8 mGy·cm, and 0.41 ± 0.09 mSv, respectively. Image quality was similar (P = 0.75) between the two kernels, with over 95% of segments achieving a rating of good image quality for both kernels. The per-segment stenosis score distribution between Bv40 and Bv64 reconstruction images showed significant differences for both non-calcified and calcified plaques (P < 0.001 for both).ConclusionPCD-CT technology with high-pitch helical scanning and the tube potential of 70 kVp can provide CCTA with ultra-low radiation exposure (DLP, 29 mGy·cm). The noise reduction capability of PCD-CT allows the use of a sharp kernel even in this low-dose CCTA setting without compromising image quality, potentially improving the evaluation of coronary artery stenosis.
| S-EPMC11631184 | biostudies-literature