Lung Cancer Screening With Low-Dose Computed Tomography: A Non-Invasive Diagnostic Protocol for Baseline Lung Nodules

Lung Cancer. 2008 Sep;61(3):340-9. doi: 10.1016/j.lungcan.2008.01.001. Epub 2008 Mar 4.

Abstract

Background: Indeterminate non-calcified lung nodules are frequent when low-dose spiral computed tomography (LD-CT) is used for lung cancer screening. We assessed the diagnostic utility of a non-invasive work-up protocol for nodules detected at baseline in volunteers enrolled in our single-centre screening trial, and followed for at least 1 year.

Methods: 5201 high-risk volunteers, recruited over 1 year from October 2004, underwent baseline LD-CT; 4821 (93%) returned for the first repeat LD-CT. Nodules <or=5mm underwent repeat LD-CT at 1 year; nodules 5.1-8mm underwent LD-CT 3 months later; lesions >8mm received combined CT-positron emission tomography (CT-PET). A subset of nodules >8mm was studied by CT with contrast. Protocol failures were delayed diagnosis with disease progression beyond stage I, and negative surgical biopsy.

Results: 2754 (53%) volunteers presented one or more non-calcified nodules. Ninety-two lung cancers were diagnosed: 55 at baseline and 37 at annual screening (66% stage I). Among the 37 incident cancers, 17 had a baseline nodule that remained stage I, 7 had a baseline nodule that progressed beyond stage I, and 13 presented a new malignant nodule. Baseline and annual cancers were 79 (1.5%) and 13 (0.2%), respectively. In 15 of 104 (14%) invasive diagnostic procedures, the lesion was benign. Sensitivity, and specificity were 91 and 99.7%, respectively, for the entire protocol; 88 and 93% for CT-PET; and 100 and 59% for CT with contrast.

Conclusions: The protocol limits invasive diagnostic procedures while few patients have diagnosis delay, supporting the feasibility of lung cancer screening in high-risk subjects by LD-CT. Nevertheless further optimization of the clinical management of screening-detected nodules is necessary.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Chi-Square Distribution
  • Contrast Media
  • Disease Progression
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Incidence
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Neoplasm Staging
  • Positron-Emission Tomography / methods
  • Prospective Studies
  • Radiation Dosage
  • Radiographic Image Interpretation, Computer-Assisted
  • Radiopharmaceuticals
  • Sensitivity and Specificity
  • Statistics, Nonparametric
  • Tomography, X-Ray Computed / methods*

Substances

  • Contrast Media
  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18