Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers

Radiology. 2002 Mar;222(3):773-81. doi: 10.1148/radiol.2223010490.


Purpose: To present prevalence screening data from a nonrandomized screening trial by using low-dose computed tomography (CT) and a simple algorithm based on the size and attenuation of detected nodules to guide diagnostic work-up.

Materials and methods: Eight hundred seventeen asymptomatic volunteers (age range, 40-78 years; median age, 53 years; median tobacco consumption, 45 pack-years) underwent spiral low-dose CT of the chest without contrast material enhancement. We regarded all noncalcified pulmonary nodules greater than 10 mm in diameter as potentially malignant and recommended histologic examination or follow-up after 3, 6, 12, and 24 months to exclude growth. For noncalcified pulmonary nodules of 10 mm or smaller, repeat low-dose CT was recommended to exclude growth.

Results: In 43% (350 of 817) of individuals, 858 noncalcified pulmonary nodules were found. Thirty-two nodules in 29 subjects were larger than 10 mm. Biopsy of 15 lesions revealed lung cancer in 12 lesions in 11 subjects (prevalence for all ages, 1.3% [11 of 817 subjects]; >50 years of age, 2.1% [11 of 519 subjects]; >60 years of age, 3.9% [eight of 206 subjects]), with a high proportion of early tumor stages (seven tumors, stage I; two, stage II; and three, stage III); three lesions were benign. In 17 nodules larger than 10 mm, follow-up with low-dose CT for a minimum of 24 months did not demonstrate growth.

Conclusion: Lung cancer screening with low-dose CT demonstrated a prevalence of asymptomatic cancers in 1.3% of a smoking population, including a high proportion of early tumor stages and a 20% (three of 15) rate of invasive procedures for benign lesions.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Calcinosis / diagnostic imaging
  • Female
  • Humans
  • Lung / diagnostic imaging
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / epidemiology
  • Lung Neoplasms / etiology
  • Male
  • Mass Screening
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Smoking / adverse effects*
  • Tomography, X-Ray Computed* / methods