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M. Hu
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P3.06 - Poster Session/ Screening and Early Detection (ID 220)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.06-019 - Lung Cancer Deaths in the NLST Attributed to Nonsolid Nodules (ID 3022)
09:30 - 09:30 | Author(s): M. Hu
- Abstract
Background:
There has been increasing awareness of the more indolent course of cancers manifesting in nonsolid nodules, especially among those where the nodule is solitary or dominant. There have been reports of virtually 100% cure rates upon resection and most recently, the recommendation from the ACR in their Lung-RADS screening guidelines is for those nonsolid nodules less than 2 centimeters to be followed by annual screening without additional evaluation. In order to further evaluate the aggressiveness of these types of cancers in the screening setting, we determined how frequently they were the cause of death (COD) within the NLST.
Methods:
We searched the NLST database to identify all participants who had a diagnosis of lung cancer after a positive result on CT screening and whose death was attributed to lung cancer by the NLST endpoint verification process. Among them, 28 participants had at least one nonsolid nodule identified on CT in a screening round. Among these, all cases where the nonsolid nodule could not identified in the study year the cancer was first identified (cancyr) or in the location of the confirmed lung cancer were excluded. All images associated with the remaining 8 cases were downloaded from The Cancer Imaging Archive (TCIA) using the NLST Query Tool and reviewed by three radiologists (DY, DX, MH) to assess nodule consistency and location.
Results:
Among the 8 cases reviewed by the radiologists, only 5 cases had at least one nonsolid nodule. The remaining three cases had no CT evidence of a non-solid nodule (Table 1). Among the 5 cases with nonsolid nodules, 2 cases had another large solid nodule (average diameter of 54.5mm and 15 mm) in the same lobe which was the probable lung cancer that was the cause of death. In another case, the nodule was less than 5 mm in diameter and stable for 3 years, and in another the cause of death was small cell carcinoma which is not known to manifest as a nonsolid cancer. One case manifested on baseline scan with multiple nonsolid and part-solid nodules which all grew on successive annual scans. Table 1. Lung cancer deaths with non-solid nodules in NLST database
*ns-nonsolid; ps-part-solidCase Any NS nodules Size of largest NS Multiple/solitary Stage/Cell-type Comments 128534 Y 29 x 19 Solitary NS Solitary solid IIIA/Squamous cell Large solid nodule (57 x 52) 134088 Y 27 x 20 Multiple NS Multiple solid IV/Small-cell 212718 Y 26 x 26 Multiple NS Multiple PS IV/BAC Cancer reported in all lobes 116279 Y 5 x 4 Solitary NS IV/Carcinoma NOS NS nodule appears stable over 3 years 126576 Y Multiple NS Solitary solid IA/Adeno-mixed Growing solid nodule, 15 mm 117025 N Multiple solid IV/Adeno NOS 208792 N Solitary solid IIIA/Squamous cell 218307 N Solitary solid IIIA/Squamous cell
Conclusion:
It seems unlikely that within the NLST, there were cases of lung cancer specific death that were attributable to cancers manifesting as a solitary or dominant nonsolid nodule. This lends further support that lung cancers manifesting as nonsolid nodules have an indolent course.
