Lung cancer probability and clinical outcomes of baseline and new subsolid nodules detected on low-dose CT screening

BackgroundLimited data are available regarding the management of subsolid nodules detected on lung cancer screening with low-dose CT (LDCT). We aimed to determine the characteristics of screen-detected subsolid nodules, and to evaluate the probability of lung cancer and the clinical course of subsolid nodules detected at baseline and during follow-up screening.MethodsWe evaluated 50 132 asymptomatic adults (22 631 never-smokers and 27 501 ever-smokers) who underwent LDCT screening for lung cancer between May 2003 and June 2019 at a tertiary centre in South Korea. The incidence, characteristics and clinical outcomes of the baseline and new screen-detected subsolid nodules were determined.ResultsA total of 6725 subsolid nodules (5116 pure ground glass opacity nodules and 1609 part-solid nodules) were detected in 4545 participants (1484 new subsolid nodules detected in 937 (1.9%) participants; the overall incidence of subsolid nodules: 10.7% in never-smokers and 7.7% in ever-smokers, p<0.001). Among 4918 subsolid nodules that underwent follow-up with CT scans (the mean number of CT scans, including the baseline LDCT scan: 4.6), 2116 nodules (30.0% of baseline subsolid nodules and 78.9% of new subsolid nodules) resolved spontaneously. Among 293 biopsied subsolid nodules, 227 (77.5%) nodules were diagnosed as lung cancer, of which 226 (99.6%) were adenocarcinomas. No significant difference was observed in pathological invasiveness or the initial stage between the baseline and new cancerous subsolid nodules. Multivariable analyses revealed that new detection at follow-up screening was significantly associated with a lower probability of lung cancer (OR 0.26, 95% CI 0.14 to 0.49) and overall growth (OR 0.39, 95% CI 0.26 to 0.59), but with a higher probability of resolution (OR 6.30, 95% CI 5.09 to 7.81).ConclusionsLDCT screening led to a considerably high rate of subsolid nodule detection, particularly in never-smokers. Compared with the baseline subsolid nodules, the new subsolid nodules were associated with a lower probability of lung cancer and higher probability of spontaneous resolution, indicating their more inflammatory nature. Less aggressive follow-up may be allowed for new subsolid nodules, particularly in screening programmes for Asian populations.

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Radiomic Phenotyping of the Lung Parenchyma: Feasibility Study in a Screening Cohort

10.21203/rs.3.rs-1086873/v1 ◽

2021 ◽

Author(s):

Babak Haghighi ◽

Hannah Horng ◽

Peter B Noël ◽

Eric Cohen ◽

Lauren Pantalone ◽

...

Keyword(s):

Lung Cancer ◽

Cancer Screening ◽

Low Dose ◽

Lung Cancer Screening ◽

Lung Parenchyma ◽

Ct Scans ◽

Lung Field ◽

Reconstruction Algorithms ◽

Low Dose Ct ◽

Significant Difference

Abstract Rationale: High-throughput extraction of radiomic features from low-dose CT scans can characterize the heterogeneity of the lung parenchyma and potentially aid in identifying subpopulations that may have higher risk of lung diseases, such as COPD, and lung cancer due to inflammation or obstruction of the airways. We aim to determine the feasibility a lung radiomics phenotyping approach in a lung cancer screening cohort, while quantifying the effect of different CT reconstruction algorithms on phenotype robustness. Methods: We identified low-dose CT scans (n = 308) acquired with Siemens Healthineers scanners from patients who completed low-dose CT within our lung cancer screening program between 2015-2018 and had two different sets of image reconstructions kernel available (i.e., medium (I30f), sharp (I50f)) for the same acquisition. Following segmentation of the lung field, a total of 26 radiomic features were extracted from the entire 3D lung-field using a previously validated fully-automated lattice-based software pipeline, adapted for low-dose CT scans. The features extracted included gray-level histogram, co-occurrence, and run-length descriptors. Each feature was averaged for each scan within a range of lattice window sizes (W) ranging from 4-20mm. The extracted imaging features from both datasets were harmonized to correct for differences in image acquisition parameters. Subsequently, unsupervised hierarchal clustering was applied on the extracted features to identify distinct phenotypic patterns of the lung parenchyma, where consensus clustering was used to identify the optimal number of clusters (K = 2). Differences between? phenotypes for demographic and clinical covariates including sex, age, BMI, pack-years of smoking, Lung-RADS and cancer diagnosis were assessed for each phenotype cluster, and then compared across clusters for the two different CT reconstruction algorithms using the cluster entanglement metric, where a lower entanglement coefficient corresponds to good cluster alignment. Furthermore, an independent set of low-dose CT scans (n = 88) from patients with available pulmonary function data on lung obstruction were analyzed using the identified optimal clusters to assess associations to lung obstruction and validate the lung phenotyping paradigm. Results: Heatmaps generated by radiomic features identified two distinct lung parenchymal phenotype patterns across different feature extraction window sizes, for both reconstruction algorithms (P < 0.05 with K = 2). Associations of radiomic-based clusters with clinical covariates showed significant difference for BMI and pack-years of smoking (P < 0.05) for both reconstruction kernels. Radiomic phenotype patterns where similar across the two reconstructed kernels, specifically when smaller window sizes (W=4 and 8mm) were used for radiomic feature extraction, as deemed by their entanglement coefficient. Validation of clustering approaches using cluster mapping for the independent sample with lung obstruction also showed two statistically significant phenotypes (P < 0.05) with significant difference for BMI and smoking pack-years.ConclusionsRadiomic analysis can be used to characterize lung parenchymal phenotypes from low-dose CT scans, which appear reproducible for different reconstruction kernels. Further work should seek to evaluate the effect of additional CT acquisition parameters and validate these phenotypes in characterizing lung cancer screening populations, to potentially better stratify disease patterns and cancer risk.

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P45.01 Lung Cancer Probability and Clinical Outcomes of Baseline and New Ground-Glass Opacity Nodules Detected on Low-Dose CT Screening

Journal of Thoracic Oncology ◽

10.1016/j.jtho.2021.01.845 ◽

2021 ◽

Vol 16 (3) ◽

pp. S486-S487

Author(s):

Y.W. Kim ◽

B.S. Kwon ◽

S.Y. Lim ◽

Y.J. Lee ◽

J.S. Park ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Outcomes ◽

Low Dose ◽

Ground Glass Opacity ◽

Ground Glass ◽

Ct Screening ◽

Low Dose Ct

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Screening for lung cancer with low-dose CT scans

Respiratory Investigation ◽

10.1016/j.resinv.2013.10.001 ◽

2013 ◽

Vol 51 (4) ◽

pp. 205-206 ◽

Cited By ~ 1

Author(s):

James R. Jett

Keyword(s):

Lung Cancer ◽

Low Dose ◽

Ct Scans ◽

Low Dose Ct

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Transient asymptomatic pulmonary opacities and interstitial lung disease in EGFR-mutated non-small cell lung cancer treated with osimertinib

Tumori Journal ◽

10.1177/03008916211047888 ◽

2021 ◽

pp. 030089162110478

Author(s):

Gianluca Taronna ◽

Alessandro Leonetti ◽

Filippo Gustavo Dall’Olio ◽

Alessandro Rizzo ◽

Claudia Parisi ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Clinical Outcomes ◽

Cell Lung Cancer ◽

Small Cell ◽

Clinical Variable ◽

Small Cell Lung ◽

Significant Difference ◽

Egfr Mutated

Introduction: Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) approved as first-line therapy for advanced EGFR-mutated non-small cell lung cancer (NSCLC). Some osimertinib-related interstitial lung diseases (ILDs) were shown to be transient, called transient asymptomatic pulmonary opacities (TAPO)—clinically benign pulmonary opacities that resolve despite continued osimertinib treatment—and are not associated with the clinical manifestations of typical TKI-associated ILDs. Methods: In this multicentric study, we retrospectively analyzed 92 patients with EGFR-mutated NSCLC treated with osimertinib. Computed tomography (CT) examinations were reviewed by two radiologists and TAPO were classified according to radiologic pattern. We also analyzed associations between TAPO and patients’ clinical variables and compared clinical outcomes (time to treatment failure and overall survival) for TAPO-positive and TAPO-negative groups. Results: TAPO were found in 18/92 patients (19.6%), with a median follow-up of 114 weeks. Median onset time was 16 weeks (range 6–80) and median duration time 14 weeks (range 8–37). The most common radiologic pattern was focal ground-glass opacity (54.5%). We did not find any individual clinical variable significantly associated with the onset of TAPO or significant difference in clinical outcomes between TAPO-positive and TAPO-negative groups. Conclusions: TAPO are benign pulmonary findings observed in patients treated with osimertinib. TAPO variability in terms of CT features can hinder the differential diagnosis with either osimertinib-related mild ILD or tumor progression. However, because TAPO are asymptomatic, it could be reasonable to continue therapy and verify the resolution of the CT findings at follow-up in selected cases.

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Low-dose CT scan screening for lung cancer: comparison of images and radiation doses between low-dose CT and follow-up standard diagnostic CT

SpringerPlus ◽

10.1186/2193-1801-2-393 ◽

2013 ◽

Vol 2 (1) ◽

Cited By ~ 14

Author(s):

Koji Ono ◽

Toru Hiraoka ◽

Asami Ono ◽

Eiji Komatsu ◽

Takehiko Shigenaga ◽

...

Keyword(s):

Lung Cancer ◽

Ct Scan ◽

Low Dose ◽

Radiation Doses ◽

Low Dose Ct ◽

Diagnostic Ct

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A 3D Probabilistic Deep Learning System for Detection and Diagnosis of Lung Cancer Using Low-Dose CT Scans

IEEE Transactions on Medical Imaging ◽

10.1109/tmi.2019.2947595 ◽

2020 ◽

Vol 39 (5) ◽

pp. 1419-1429 ◽

Cited By ~ 7

Author(s):

Onur Ozdemir ◽

Rebecca L. Russell ◽

Andrew A. Berlin

Keyword(s):

Lung Cancer ◽

Deep Learning ◽

Low Dose ◽

Learning System ◽

Ct Scans ◽

Low Dose Ct ◽

Detection And Diagnosis ◽

Diagnosis Of Lung Cancer

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Clinical outcomes of NSCLC patients with acquired RET rearrangement after resistance to osimertinib.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e20626 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e20626-e20626

Author(s):

Chang Lu ◽

Jia-Tao Cheng ◽

Jin Kang ◽

Yi-Hui Yao ◽

Xiang-Meng Li ◽

...

Keyword(s):

Lung Cancer ◽

Clinical Outcomes ◽

Acquired Resistance ◽

Progression Free Survival ◽

Best Supportive Care ◽

Line Treatment ◽

Significant Difference ◽

Ret Rearrangement ◽

Egfr Mutant

e20626 Background: Resistance mechanisms to osimertinib have raised growing concerns, but those with acquired RET rearrangement is poorly characterized. Methods: We retrospectively identified advanced, EGFR-mutant NSCLC (non-small-cell lung cancer) patients treated with osimertinib between April 9th, 2015 and November 1st, 2018 at our institute. Clinicopathologic features and clinical outcomes were analyzed. Subsequent genetic profiling was performed at the time of progression by next-generation sequencing (NGS). Overall survival (OS) since 1st line treatment was calculated from first-line treatment start to death or last follow up, and OS post-progression was calculated from osimertinib progression. Median follow-up time was 43.4 months. Results: In the 192 patients treated with osimertinib, 57 had follow-up NGS information after progression, and six harboured acquired RET rearrangement (11%, 6/57). For patients with RET rearrangements when progressed on osimertinib, OS since 1st line treatment (22.9m vs 59.5m, P = 0.021) and OS post-progression (2.1m vs 10.0m, P = 0.031) were significantly shorter compared with non- RET-rearranged cases, whereas no significant difference was found in demographics at the initial lung cancer diagnosis or progression-free survival (PFS) of osimertinib (12.1m vs 5.8m, P = 0.34). Among these six patients, one received best supportive care, two continued to use drugs targeting EGFR but deteriorating soon, three patients tried osimertinib combined with cabozantinib with one benefit from this combination approach. Conclusions: RET rearrangements could exist in EGFR-mutant NSCLC with acquired resistance to osimertinib and linked to inferior survival. Study on the molecular evolution and heterogeneity during treatment course are warranted for further therapeutic strategies. [Table: see text]

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