Author of

• 11905

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  P2.20 - Poster Session 2 - Early Detection and Screening (ID 173)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Imaging, Staging & Screening
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 11908

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    P2.20-003 - Diagnostic work-up and surgery in participants of Gdansk lung cancer screening program - the extent of futile procedures in non-malignant condition (ID 1062)

    09:30 - 09:30  |  Author(s): J. Ksiazek
    • Abstract

    Background
    Low-dose computed tomography (LDCT) screening improves lung cancer prognosis, but also results in diagnostic work-up and surgical treatment in many individuals without cancer. We therefore analyzed procedures that screening participants underwent to better understand the extent of overdiagnosis.

    Methods
    Between 2009 and 2011, 8649 healthy volunteers in the age 50-75 with 20 pack-years smoking history underwent LDCT screening with two years control in individuals with lung nodules. Participants with nodules diameter >10 mm or with suspected tumor morphology underwent diagnostic work-up. It was performed in 283(6%) of 4694(54%) screening participants with detected lung nodules. One hundred four individuals were operated, 27 were underwent oncological treatment and in 154 patients without cancer diagnosis further follow up with LDCT was applied.

    Results
    Our results showed that in 75% of the participants accepted for diagnostic work-up those procedures were futile. The same holds for 25% receiving surgery. Only in 70(24,7%) participants a specific diagnosis was obtained. That was mainly due to low efficacy of Fine Needle Aspiration Biopsy (Sensitivity 65,2%, NPV 95,9%) and bronchofiberoscopy (sensitivity 71,4%, NPV 50%) caused by overinterpretation of LDCT (PPV 2%). Of 104(36.7%) participants that were accepted for surgery, forty-three patients (41,4%) had preoperative cancer diagnosis and 61(58,6%) underwent operations without obtained pathology. In the latter group intervention was justified in 35(57,3%) patients. Complications occurred in 49 (17.3%) participants subjected to diagnostic work-up. In patients accepted for surgery 67 (64.4%) malignant and 37 (35.6%) benign lesions were resected. In the latter group intervention was justified in only 11 (29,7%) patients. No patient died as a result of diagnostic or treatment procedures during the study. The complication rate was 14,5% in the malignant and 10,8% in the benign groups. Finally in 94 screening participants a neoplasm was found. Of those, 67(71.3%) patients underwent operation; the remaining 27(28.7%) patients were not candidates for surgery. Adenocarcinoma accounted for 49/67(73%) operated NSCLC patients; 56/67(84%) patients had stage I non-small cell lung cancer, and 26/67(38%) underwent video-assisted thoracoscopic surgery lobectomy.

    Conclusion
    Futile diagnostic work-ups and operations must be reduced before LDCT screening can be broadly used. Stage I adenocarcinoma dominated in the operated NSCLC patients.