Computed Tomography (CT) and Chest X-ray (CXR) Screening for Lung Cancer (LC): Mortality (MORT), Survival (SURV), and Randomized Population Trials (RPTs) - Analysis of the Mayo Lung Project (MLP) and the National Lung Screening Trial (NLST)

CHEST Journal ◽  
2015 ◽  
Vol 148 (4) ◽  
pp. 554A
Author(s):  
Gary Strauss ◽  
John Paul Flores ◽  
Lorenzo Dominioni
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
X Ray ◽  
National Lung Screening Trial ◽  
Chest X Ray ◽  
Lung Screening ◽  
Screening Trial

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.

SU-GG-I-62: Entrance Skin Air Kerma of National Lung Screening Trial Chest X-Ray Exams

2010 ◽  
Vol 37 (6Part3) ◽  
pp. 3115-3115
Author(s):  
P Judy ◽  
R Kruger ◽  
C Cagnon ◽  
M Flynn ◽  
J Seibert ◽  
...  
Keyword(s):  
X Ray ◽  
Air Kerma ◽  
National Lung Screening Trial ◽  
Chest X Ray ◽  
Lung Screening ◽  
Screening Trial

scholarly journals Computed Tomography Screening for Lung Cancer: Has It Finally Arrived? Implications of the National Lung Screening Trial

2013 ◽  
Vol 31 (8) ◽  
pp. 1002-1008 ◽  
Author(s):  
Denise R. Aberle ◽  
Fereidoun Abtin ◽  
Kathleen Brown
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Early Stage ◽  
Helical Computed Tomography ◽  
Future Research ◽  
Early Stage Disease ◽  
Screening Programs ◽  
National Lung Screening Trial ◽  
Lung Screening ◽  
Screening Trial

The National Lung Screening Trial (NLST) has provided compelling evidence of the efficacy of lung cancer screening using low-dose helical computed tomography (LDCT) to reduce lung cancer mortality. The NLST randomized 53,454 older current or former heavy smokers to receive LDCT or chest radiography (CXR) for three annual screens. Participants were observed for a median of 6.5 years for outcomes. Vital status was available in more than 95% of participants. LDCT was positive in 24.2% of screens, compared with 6.9% of CXRs; more than 95% of all positive LDCT screens were not associated with lung cancer. LDCT detected more than twice the number of early-stage lung cancers and resulted in a stage shift from advanced to early-stage disease. Complications of LDCT screening were minimal. Lung cancer–specific mortality was reduced by 20% relative to CXR; all-cause mortality was reduced by 6.7%. The major harms of LDCT are radiation exposure, high false-positive rates, and the potential for overdiagnosis. This review discusses the risks and benefits of LDCT screening as well as an approach to LDCT implementation that incorporates systematic screening practice with smoking cessation programs and offers opportunities for better determination of appropriate risk cohorts for screening and for better diagnostic prediction of lung cancer in the setting of screen-detected nodules. The challenges of implementation are considered for screening programs, for primary care clinicians, and across socioeconomic strata. Considerations for future research to complement imaging-based screening to reduce the burden of lung cancer are discussed.

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 Micronodules Detected on Computed Tomography During the National Lung Screening Trial: Prevalence and Relation to Positive Studies and Lung Cancer

2019 ◽  
Vol 14 (9) ◽  
pp. 1538-1546 ◽  
Author(s):  
Reginald F. Munden ◽  
Caroline Chiles ◽  
Phillip M. Boiselle ◽  
JoRean D. Sicks ◽  
Denise R. Aberle ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
National Lung Screening Trial ◽  
Lung Screening ◽  
Screening Trial

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.

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