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The Pittsburgh Lung Screening Study (PLuSS): outcomes within 3 years of a first computed tomography scan.

ABSTRACT: The role of computed tomography (CT) screening for lung cancer is controversial, currently under study, and not yet fully elucidated.To report findings from initial and 1-year repeat screening low-radiation-dose CT of the chest and 3-year outcomes for 50- to 79-year-old current and ex-smokers in the Pittsburgh Lung Screening Study (PLuSS).Notified of findings on screening CT, subjects received diagnostic advice from both study and personal physicians. Tracking subjects for up to three years since initial screening, we obtained medical records to document diagnostic procedures, lung cancer diagnoses, and deaths.3,642 and 3,423 subjects had initial and repeat screening. A total of 1,477 (40.6% of 3,624) were told about noncalcified lung nodules on the initial screening and, before repeat screening, 821 (55.6% of 1,477, 22.5% of 3,642) obtained one or more subsequent diagnostic imaging studies (CT, positron emission tomography [PET], or PET-CT). Tracking identified 80 subjects with lung cancer, including 53 subjects with tumor seen at initial screening. In all, 36 subjects (1.0% of the 3,642 screened), referred for abnormalities on either the initial or repeat screening, had a major thoracic surgical procedure (thoracotomy, video-assisted thoracoscopic surgery [VATS], median sternotomy, or mediastinoscopy) leading to a noncancer final diagnosis. Out of 82 subjects with thoracotomy or VATS to exclude malignancy in a lung nodule, 28 (34.1%) received a noncancer final diagnosis. Forty of 69 (58%) subjects with non-small cell lung cancer had stage I disease at diagnosis.Though leading to the discovery of early stage lung cancer, CT screening also led to many diagnostic follow-up procedures, including major thoracic surgical procedures with noncancer outcomes.

SUBMITTER: Wilson DO

PROVIDER: S-EPMC2720144 | biostudies-literature | 2008 Nov

REPOSITORIES: biostudies-literature

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The Pittsburgh Lung Screening Study (PLuSS): outcomes within 3 years of a first computed tomography scan.

Wilson David O DO Weissfeld Joel L JL Fuhrman Carl R CR Fisher Stephen N SN Balogh Paula P Landreneau Rodney J RJ Luketich James D JD Siegfried Jill M JM

American journal of respiratory and critical care medicine 20080717 9

<h4>Rationale</h4>The role of computed tomography (CT) screening for lung cancer is controversial, currently under study, and not yet fully elucidated.<h4>Objectives</h4>To report findings from initial and 1-year repeat screening low-radiation-dose CT of the chest and 3-year outcomes for 50- to 79-year-old current and ex-smokers in the Pittsburgh Lung Screening Study (PLuSS).<h4>Methods</h4>Notified of findings on screening CT, subjects received diagnostic advice from both study and personal phy ...[more]

PMID: 18635890

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Project description:BackgroundIn China, over 50% of lung cancer cases occur in nonsmokers. Thus, identifying high-risk individuals for targeted lung cancer screening is crucial. Beyond age and smoking, determining other risk factors for lung cancer in the Asian population has become a focal point of research. Using 30,000 participants in the prospectively enrolled cohort at China's National Cancer Center (NCC) over the past 14 years, we categorized participants by risk, with an emphasis on nonsmoking females.Materials and methodsBetween November 2005 and December 2019, 31,431 individuals voluntarily underwent low-dose computed tomography (LDCT) scans for lung cancer screening at the NCC. We recorded details like smoking history, exposure to hazards, and family history of malignant tumors. Using the 2019 NCCN criteria, participants were categorized into high-, moderate-, and low-risk groups. Additionally, we separated non-high-risk groups into female never smokers (aged over 40) exposed to second-hand smoke (SHS) and others. Any positive results from initial scans were monitored per the I-ELCAP protocol (2006), and suspected malignancies were addressed through collaborative decisions between patients and physicians. We analyzed and compared the detection rates of positive results, confirmed lung cancers, and cancer stages across risk, age, and gender groups.ResultsOut of 31,431 participants (55.9% male, 44.1% female), 3695 (11.8%) showed positive baseline LDCT scans with 197 (0.6%; 106 females, 91 males) confirmed as lung cancer cases pathologically. Malignancy rate by age was 0.1% among those aged under 40 years, 0.4% among those aged 40-49 years, 0.8% among those aged 50-59 years, and 1.2% among those aged 60 years and older. From the 25,763 participants (56.9% male, 43.1% female) who completed questionnaires, 1877 (7.3%) were categorized as high risk, 6500 (25.2%) as moderate risk, and 17,386 (67.5%) as low risk. Of the 23,886 in the non-high-risk category, 8041 (33.7%) were females over 40 years old exposed to SHS. The high-risk group showed the highest lung cancer detection rate at 1.4%. However, females exposed to SHS had a notably higher detection rate than the rest of the non-high-risk group (1.1% vs. 0.5%; p < 0.0001). In this cohort, 84.8% of the detected lung cancers were at an early stage.ConclusionsIn our study, using LDCT for lung cancer screening proved significant for high-risk individuals. For non-high-risk populations, LDCT screening could be considered for nonsmoking women with exposure to SHS.

Project description:IntroductionIn this study, we evaluated the use and the contribution of radiopharmaceuticals to the field of lung neoplasms imaging using positron emission tomography/computed tomography.MethodsWe conducted review of the current literature at PubMed/MEDLINE until February 2020. The search language was English.ResultsThe most widely used radiopharmaceuticals are the following:Experimental/pre-clinical approaches: (18)F-Misonidazole (18F-MISO) under clinical development, D(18)F-Fluoro-Methyl-Tyrosine (18F-FMT), 18F-FAMT (L-[3-18F] (18)F-Fluorothymidine (18F-FLT)), (18)F-Fluoro-Azomycin-Arabinoside (18F-FAZA), (68)Ga-Neomannosylated-Human-Serum-Albumin (68Ga-MSA) (23), (68)Ga-Tetraazacyclododecane (68Ga-DOTA) (as theranostic agent), (11)C-Methionine (11C-MET), 18F-FPDOPA, ανβ3 integrin, 68Ga-RGD2, 64Cu-DOTA-RGD, 18F-Alfatide, Folate Radio tracers, and immuno-positron emission tomography radiopharmaceutical agents.Clinically approved procedures/radiopharmaceuticals agents: (18)F-Fluoro-Deoxy-Glucose (18F-FDG), (18)F-sodium fluoride (18F-NaF) (bone metastases), and (68)Ga-Tetraazacyclododecane (68Ga-DOTA). The quantitative determination and the change in radiopharmaceutical uptake parameters such as standard uptake value, metabolic tumor volume, total lesion glycolysis, FAZA tumor to muscle ratio, standard uptake value tumor to liver ratio, standard uptake value tumor to spleen ratio, standard uptake value maximum ratio, and the degree of hypoxia have prognostic and predictive (concerning the therapeutic outcome) value. They have been associated with the assessment of overall survival and disease free survival. With the positron emission tomography/computed tomography radiopharmaceuticals, the sensitivity and the specificity of the method have increased.ConclusionIn terms of lung cancer, positron emission tomography/computed tomography may have clinical application and utility (a) in personalizing treatment, (b) as a biomarker for the estimation of overall survival, disease free survival, and (c) apply a cost-effective patient approach because it reveals focuses of the disease, which are not found with the other imaging methods.

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.

Project description:ObjectivesComputed tomography angiography (CTA) is the imaging modality most frequently used to diagnosis type A aortic dissection for chest pain with a high degree of sensitivity and specificity. False negative and positive errors in diagnosis are infrequent. Despite initial negative imaging studies for dissection, surgeons must consider early operation in patients with recent onset chest pain in the presence of an ascending aortic aneurysm.MethodsWe report 4 cases (2004-2021) of patients with a mean age of 51.25 years (male:female = 3:1) who presented with chest pain. Two had a history of syncope. On computed tomography angiography, all had an ascending aortic aneurysm and no dissection flap. Three had thickening of the ascending aorta and 1 had a chronic type B dissection. On echocardiography, aortic regurgitation was moderate-severe in 2 patients, 2 had a pericardial effusion, and none had a definitive dissection flap. All were operated on because of the surgeon's concern for the association of chest pain and an ascending aortic aneurysm. The Institutional Review Board at George Washington University Committee on Human Research has determined that the research is exempt from review under Department of Health and Human Services regulatory category 4 (#FWA00005945). The project as described in the application may proceed without further oversight by the Office of Human Resources on September 9, 2022.ResultsThe diagnosis of type A aortic dissection was made at operation (3 on median sternotomy and 1 after aortotomy). All patients did well. One patient who had peripheral cannulation (no malperfusion) and severe coagulopathy developed a compartment syndrome and postoperatively required a below-knee amputation.ConclusionsSurgeons must maintain a high index of suspicion for aortic dissection when patients present with chest pain and are found to have an ascending aortic aneurysm even in the absence of initial, classic features of dissection on computed tomography angiography. Improvements in imaging techniques and analysis are required.

Dataset Information

The Pittsburgh Lung Screening Study (PLuSS): outcomes within 3 years of a first computed tomography scan.

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The Pittsburgh Lung Screening Study (PLuSS): outcomes within 3 years of a first computed tomography scan.

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