scholarly journals Incidental renal tumours on low-dose CT lung cancer screening exams

2016 ◽  
Vol 24 (2) ◽  
pp. 104-109 ◽  
Author(s):  
Paul F Pinsky ◽  
Barbara Dunn ◽  
David Gierada ◽  
P Hrudaya Nath ◽  
Reginald Munden ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Renal Cancer ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
National Lung Screening Trial ◽  
Renal Tumours ◽  
Chest X Ray ◽  
Low Dose Computed Tomography ◽  
Lung Screening

Introduction Renal cancer incidence has increased markedly in the United States in recent decades, largely due to incidentally detected tumours from computed tomography imaging. Here, we analyze the potential for low-dose computed tomography lung cancer screening to detect renal cancer. Methods The National Lung Screening Trial randomized subjects to three annual screens with either low-dose computed tomography or chest X-ray. Eligibility criteria included 30 + pack-years, current smoking or quit within 15 years, and age 55–74. Subjects were followed for seven years. Low-dose computed tomography screening forms collected information on lung cancer and non-lung cancer abnormalities, including abnormalities below the diaphragm. A reader study was performed on a sample of National Lung Screening Trial low-dose computed tomography images assessing presence of abnormalities below the diaphragms and abnormalities suspicious for renal cancer. Results There were 26,722 and 26,732 subjects enrolled in the low-dose computed tomography and chest X-ray arms, respectively, and there were 104 and 85 renal cancer cases diagnosed, respectively (relative risk = 1.22, 95% CI: 0.9–1.5). From 75,126 low-dose computed tomography screens, there were 46 renal cancer diagnoses within one year. Abnormalities below the diaphragm rates were 39.1% in screens with renal cancer versus 4.1% in screens without (P < 0.001). Cases with abnormalities below the diaphragms had shorter median time to diagnosis than those without (71 vs. 160 days, P = 0.004). In the reader study, 64% of renal cancer cases versus 13% of non-cases had abnormalities below the diaphragms; 55% of cases and 0.8% of non-cases had a finding suspicious for renal cancer (P < 0.001). Conclusion Low-dose computed tomography screens can potentially detect renal cancers. The benefits to harms tradeoff of incidental detection of renal tumours on low-dose computed tomography is unknown.

scholarly journals AN UPDATE ON LOW DOSE COMPUTED TOMOGRAPHY FOR LUNG CANCER SCREENING

2017 ◽  
Vol 3 (2) ◽  
Author(s):  
Ali Saeed Wahla
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Low Dose ◽  
Lung Cancer Screening ◽  
Target Population ◽  
Current Evidence ◽  
National Lung Screening Trial ◽  
The Cost ◽  
Low Dose Computed Tomography ◽  
Lung Screening

Since the publication of the National Lung Screening Trial (NLST) showing a mortality reduction with use of low dose computed tomography (LDCT) there has been considerable interest about the use of this modality to screen for lung cancer. This article reviews the NLST and current evidence behind screening for lung cancer in smokers.  It also attempts to look at different lung cancer risk models to help better define the ideal target population and lastly touches on the cost-effectiveness of LDCT screening in patients at high risk of lung cancer.

False-positive screens and lung cancer risk in the National Lung Screening Trial: Implications for shared decision-making

2017 ◽  
Vol 25 (2) ◽  
pp. 110-112 ◽  
Author(s):  
Paul F Pinsky ◽  
Christina R Bellinger ◽  
David P Miller
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Risk ◽  
False Positive ◽  
Low Dose ◽  
Lung Cancer Risk ◽  
National Lung Screening Trial ◽  
Low Dose Computed Tomography ◽  
Lung Screening ◽  
Screening Trial

Objectives Low-dose computed tomography lung cancer screening has been shown to reduce lung cancer mortality but has a high false-positive rate. The precision medicine approach to low-dose computed tomography screening assesses subjects’ benefits versus harms based on their personal lung cancer risk, where harms include false-positive screens and resultant invasive procedures. We assess the relationship between lung cancer risk and the rate of false-positive LDCT screens. Methods The National Lung Screening Trial randomized high-risk subjects to three annual screens with low-dose computed tomography or chest radiographs. Following the completion of National Lung Screening Trial, the Lung CT Screening Reporting and Data System (Lung-RADS) classification system was developed and retrospectively applied to National Lung Screening Trial low-dose computed tomography findings. The rate of false-positive screens (by Lung-RADS) and the resultant invasive procedures were examined as a function of lung cancer risk estimated by a model. Results Of 26,722 subjects randomized to the low-dose computed tomography arm, 26,309 received a baseline screen and were included in the analysis. The proportion with any false positive over three screening rounds increased from 12.9% to 25.9% from lowest to highest risk decile, and the proportion with an invasive procedure following a false positive also significantly increased from 0.7% to 2.0% from lowest to highest risk decile. Conclusion These findings indicate a need for personalized low-dose computed tomography lung cancer screening decision aids to accurately convey the benefits to harm trade-off.

scholarly journals Thyroid Incidentalomas in Association With Low-Dose Computed Tomography in the National Lung Screening Trial

2019 ◽  
Vol 189 (1) ◽  
pp. 27-33
Author(s):  
Holli A Loomans-Kropp ◽  
Barbara K Dunn ◽  
Barnett S Kramer ◽  
Paul Pinsky
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Incidental Findings ◽  
Low Dose ◽  
Screening Methods ◽  
National Lung Screening Trial ◽  
Increased Risk ◽  
Low Dose Computed Tomography ◽  
Lung Screening ◽  
Screening Trial

Abstract Advances in cancer screening methods have opened avenues for incidental findings and cancer overdiagnosis. We performed a secondary analysis of the National Lung Screening Trial (enrollment from 2002–2004), a randomized controlled trial comparing low-dose computed tomography (LDCT; n = 26,722) with chest radiography (CXR; n = 26,732) for lung cancer detection, to examine incidental findings related to thyroid cancer (ThCa). Three screening rounds were included, and median follow-up was 6.6 years for LDCT and 6.5 years for CXR. Radiologists reported lung and non-lung-related abnormalities. In the LDCT arm, 5.7%, 4.7%, and 4.5% of participants had abnormalities above the diaphragm (AADs) detected at baseline, year 1, and year 2, respectively, compared with 2.3%, 1.5%, and 1.3% in the CXR arm. In the LDCT arm, 205 AADs (7.0%) were thyroid-related. Overall, 60 ThCas were reported, 35 in the LDCT arm and 25 in the CXR arm (P = 0.2). In the LDCT arm, participants with a prior AAD had a 7.8-fold increased risk (95% confidence interval: 4.0, 15.1) of ThCa compared with those who did not have an AAD. Early and persistent excess of ThCas diagnosed earlier in the LDCT arm suggests overdiagnosis. The use of sensitive screening modalities for early detection of lung cancer might result in the discovery of thyroid incidentalomas.

scholarly journals Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe

Cancers ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1672 ◽  
Author(s):  
Giulia Veronesi ◽  
David R. Baldwin ◽  
Claudia I. Henschke ◽  
Simone Ghislandi ◽  
Sergio Iavicoli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Cancer Screening ◽  
Low Dose ◽  
Controlled Trial ◽  
Lung Cancer Screening ◽  
Lung Cancer Mortality ◽  
Mortality Data ◽  
Low Dose Computed Tomography ◽  
Lung Screening

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39–61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the “Initiative for European Lung Screening (IELS)”—a large international group of physicians and other experts concerned with lung cancer—agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.

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