Development and Cost Analysis of a Lung Nodule Management Strategy Combining Artificial Intelligence and Lung-RADS for Baseline Lung Cancer Screening
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Nodule (geology)
Patients with a known primary malignancy and one or more suspicious skeletal lesions are often assumed to have skeletal involvement by the known malignancy. We set out to determine how often one would be correct in making this assumption.All CT-guided bone biopsies performed at our institution between January 2006 and January 2009 in patients with a history of a single biopsy-proven malignancy were retrospectively reviewed. Pathology results were assigned to one of three outcomes: skeletal involvement by known malignancy, newly diagnosed malignancy, or no malignancy identified. Patients categorized as no malignancy identified required repeat biopsy or stability on follow-up imaging for confirmation.Of 104 patients with a known primary malignancy, 11 were excluded. Of the 93 included patients, there was skeletal involvement by the known malignancy in 82 (88%), a newly diagnosed malignancy in seven (8%), and no malignancy identified in four (4%).Biopsy of a suspicious skeletal lesion in a patient with a solitary known malignancy reveals a newly diagnosed malignancy or no evidence of malignancy in 12% of patients, emphasizing the importance of biopsy.
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Parallel and often unrelated developments in health care and technology have all been necessary to bring about early detection of lung cancer and the opportunity to decrease mortality from lung cancer through early detection of the disease by computed tomography. Lung cancer screening programs provide education for patients and clinicians, support smoking cessation as primary prevention for lung cancer, and facilitate health care for tobacco-associated diseases, including cardiovascular and chronic lung diseases. Guidelines for lung cancer screening will need to continue to evolve as additional risk factors and screening tests are developed. Data collection from lung cancer screening programs is vital to the further development of fiscally responsible guidelines to increase detection of lung cancer, which may include small groups with elevated risk for reasons other than tobacco exposure.
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The purpose of our study was to evaluate the performance of a computer-aided program that performs automated matching of pulmonary nodules imaged in three serial screening chest MDCT studies.Forty subjects with pulmonary nodules depicted in three annual (T0, T1, T2) low-dose MDCT screening studies for lung cancer were selected from the National Lung Screening Trial database at a single institution. All CT images were reevaluated by two radiologists in consensus. One hundred forty-three nodules were identified and characterized by type (solid parenchymal, juxtavascular, juxtapleural, and ground-glass opacity) and size (< or = 4 mm, 4-6 mm, 6-8 mm, and > 8 mm). Using an automated program, nodules at T0 were matched to nodules at T1, and the same nodules at T1 were matched to nodules at T2. Associations between nodule matching rate (i.e., number of nodules matched by the program divided by the number of nodules determined to match by radiologists) and nodule type or size were analyzed.The combined matching rate of the nodules was 92.7% (T0 vs T1, 91.6%; T1 vs T2, 93.7%). By nodule type, the matching rate was 94.6% (parenchymal), 98.4% (juxtavascular), 85.8% (juxtapleural), and 100% (ground-glass opacity), with the rate significantly lower for juxtapleural nodules (p < 0.01). Matching rates were not significantly influenced by nodule size (p = 0.67).The automated matching rate for pulmonary nodules in screening MDCT scans was high (92.7%) and was not affected by the nodule size but was slightly lower with nodules at juxtapleural locations.
Nodule (geology)
Ground-glass opacity
Solitary pulmonary nodule
Parenchyma
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This pilot study conducted in Switzerland aims to assess the implementation, execution, and performance of low-dose CT lung cancer screening (LDCT-LCS). With lung cancer being the leading cause of cancer-related deaths in Switzerland, the study seeks to explore the potential impact of screening on reducing mortality rates. However, initiating a lung cancer screening program poses challenges and depends on country-specific factors. This prospective study, initiated in October 2018, enrolled participants meeting the National Lung Cancer Study criteria or a lung cancer risk above 1.5% according to the PLCOm2012 lung cancer risk-model. LDCT scans were assessed using Lung-RADS. Enrollment and follow-up are ongoing. To date, we included 112 participants, with a median age of 62 years (IQR 57–67); 42% were female. The median number of packs smoked each year was 45 (IQR 38–57), and 24% had stopped smoking before enrollment. The mean PLCOm2012 was 3.7% (±2.5%). We diagnosed lung cancer in 3.6% of participants (95%, CI:1.0–12.1%), with various stages, all treated with curative intent. The recall rate for intermediate results (Lung-RADS 3,4a) was 15%. LDCT-LCS in Switzerland, using modified inclusion criteria, is feasible. Further analysis will inform the potential implementation of a comprehensive lung cancer screening program in Switzerland.
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Tumor-associated autoantibodies are considered promising markers for early lung cancer detection; so far, however, their capacity to detect cancer has been tested mostly in a clinical context, but not in population screening settings. This study evaluates the early detection accuracy, in terms of sensitivity and specificity, of EarlyCDT®-Lung-a test panel of seven tumor-associated autoantibodies optimized for lung cancer detection-using blood samples originally collected as part of the German Lung Cancer Screening Intervention Trial.The EarlyCDT®-Lung test was performed for all participants with lung cancer detected via low-dose computed tomography and with available blood samples taken at detection, and for 180 retrospectively selected cancer-free participants at the end of follow-up: 90 randomly selected from among all cancer-free participants (baseline controls) and 90 randomly selected from among cancer-free participants with suspicious imaging findings (suspicious nodules controls). Sensitivity and specificity of lung cancer detection were estimated in the case group and the two control groups, respectively.In the case group, the test panel showed a sensitivity of only 13.0% (95% CI: 4.9-26.3%). Specificity was estimated at 88.9% (95% CI: 80.5-94.5%) in the baseline control group, and 91.1% (95% CI: 83.2-96.1%) among controls presenting CT-detected nodules.The test panel showed insufficient sensitivity for detecting lung cancer at an equally early stage as with low-dose computed tomography screening.
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Objective To explore the value of MSCT features in predicting the malignancy degree of gastrointestinal stromal tumor(GIST).Methods CT Data of 44 patients with pathologically proved GIST were reviewed.The differences of CT features among different malignancy degrees of GIST were analyzed.Results Pathology confirmed very low malignancy GIST in 5 patients,low malignancy in 9,moderate malignancy in 7 and high malignancy in 23.The tumor size,location,growth pattern,enhancement pattern,contour,mesenteric fat infiltration,cystic-necrosis,tumor vascularization and direct organ invasion had statistical differences among different malignancy degrees(all P0.05).Conclusion Tumor size,location,growth pattern,enhancement pattern,border,mesenteric fat infiltration,cystic-necrosis,tumor vascularization and direct organ invasion might be predictive indexes for malignancy of GIST.
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Infiltration (HVAC)
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Screening for lung cancer is somewhat controversial in that very few evaluations of the screening process have been made, and even fewer have involved the use of concomitant, unscreened controls.This report of the Mayo Lung Project provides evaluation of a randomly selected 4500 clinic patients, offered screening for lung cancer at four-month intervals for six years.Another 4500 randomly selected controls not offered screening were merely observed.Good screening is defined, the Mayo project is evaluated, and puzzling results are presented and discussed.From the screened group, 98 new cases of lung cancer have been detected, 67 by study screening and 31 by spontaneous reporting of symptoms (15) or by x-ray examinations (16) done in other than study circumstances.From the controls, 64 new lung cancer cases have been detected, 43 by symptoms and 21 by other methods.Lung cancer mortality is 39 for study patients and 41 for controls.There is thus no evidence at this time that early case finding has decreased mortality from lung cancer.
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lung cancer screening: lung cancer screeningNew research finds that low-dose computed tomography (LDCT) lung cancer screening and lung nodule detection and reporting programs are complementary. Combining the two could expand access to early lung cancer detection and curative treatment to different-risk populations, as well as alleviate emerging disparities in access to early lung cancer detection. In a study recently published in the Journal of Clinical Oncology, researchers evaluated two approaches to early lung cancer detection—LDCT and program-based management of incidentally detected lung nodules (2022; doi: 10.1200/JCO.21.02496). “Although lung cancer screening saves lives, implementing low-dose CT lung cancer screenings has been very challenging,” noted Raymond Osarogiagbon, MD, Chief Scientist and Director of the Multidisciplinary Thoracic Oncology Program at Baptist Memorial Health Care, and lead author of the study. Osarogiagbon and his colleagues hypothesized that program-based establishment of guideline-concordant management of incidental lung nodules provides an alternative pathway to early diagnosis of lung cancer. They also noted that the characteristics of lung cancer diagnosed through such programs would be similar to LDCT-detected lung cancer, but “there would be synergy between programs by providing access to different-risk populations.” The authors also hypothesized that lung cancer diagnosed through the two early detection programs—LDCT and incidental lung nodule—would have earlier stage and better outcomes than lung cancer diagnosed outside them, according to Osarogiagbon. He noted that the researchers used Baptist Memorial's multidisciplinary thoracic oncology program to provide lung cancer patients with diagnosis outside these early-detection programs. Study Details The authors conducted a prospective observational study that enrolled patients in the early detection programs. For context, the researchers compared them with patients managed in a multidisciplinary care program, comparing clinical stage distribution, surgical resection rates, 3- and 5-year survival rates, and eligibility for LDCT screening of patients diagnosed with lung cancer. From 2015 to May 2021, 22,886 patients were enrolled in the study, with nearly 5,700 in LDCT, more than 15,000 in lung nodule, and close to 1,800 in multidisciplinary care. Overall, the researchers found that less than half of patients diagnosed with lung cancer (46%) would have been eligible to receive LDCT based on the U.S. Preventive Services Task Force (USPSTF) 2013 criteria. Fifty-four percent would have been eligible using the 2021 criteria. Still, the team found that the lung nodule program would have been able to identify 20 percent of Stage I and Stage II lung cancer cases among all participating patients diagnosed with the disease, even if all patients deemed eligible for LDCT according to the USPSTF's 2021 recommendation had received the exam. In comparison to those undergoing LDCT, patients diagnosed with lung cancer who participated in the lung nodule program were more likely to be Black, uninsured, and have given up smoking. And, eligibility for lung cancer screening increased across all three programs with the 2021 USPSTF recommendations. There has been a steep rise in the CT scans for diagnostics across North America and Europe since the 1970s, noted Osarogiagbon, adding that these scans often reveal lesions, some of which turn out to be lung cancer. By starting from the point of lesion detection, incidental lung nodule programs avoid several barriers that impair access to LDCT, including limitations of the eligibility criteria, recruitment of eligible patients, and insurance barriers, he noted. “A lot of the patients enrolled into the lung nodule program, for example, had their lesion-detecting CT scan performed in the ED for other reasons. A high proportion of such patients may never otherwise have presented for preventive care services,” Osarogiagbon stated. Ultimately, these results help illustrate the way in which LDCT screening and lung nodule programs can work together to increase patient access to early lung cancer detection and treatment, as well as impact how radiology teams provide care for these patients, he noted. “In terms of sheer volume of diagnosis, for every one lung cancer diagnosed through the LDCT program, five were diagnosed through the lung nodule program; 60 percent of patients in both programs had Stage I/II lung cancer,” Osarogiagbon said. Noting that fewer than 50 percent of the patients diagnosed with lung cancer in the nodule program would have been eligible for LDCT even by the new 2021 USPSTF criteria, “the key intervention with the incidental lung nodule program was to develop an automated means of using the electronic health record system to capture the radiology reports in which the radiologist expressed concern about the presence of a potentially malignant or premalignant lesion,” he explained. “This digital health approach improved the probability of guideline-concordant care, overcoming human errors in the hand off from radiologist to subsequent care delivery teams.” Mark McGraw is a contributing writer.
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