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R. Bertolotti



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    MO11 - Screening and Epidemiology (ID 131)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      MO11.01 - Positron Emission Tomography in lung cancer screening: Six-year results (ID 1816)

      16:15 - 16:20  |  Author(s): R. Bertolotti

      • Abstract
      • Presentation
      • Slides

      Background
      Lung cancer computed tomography (CT) screening is a controversial topic. Results from the National Lung Screening Trial showed that low dose CT (LD-CT) can reduce lung cancer mortality by at least 20%. However a critical issue is the high rate of indeterminate lung nodules and false positive cases. The aim of the study was to evaluate the diagnostic accuracy of CT/PET for lung cancer diagnosis in the context of lung cancer screening.

      Methods
      Between 2004 and 2005, 5203 asymptomatic high-risk individuals (≥20 pack-years, age ≥50 years) were enrolled to undergo annual LD-CT for 10 years. Nodules ≤5 mm were scheduled for repeat LD-CT a year later. Nodules >5.0≤8.0mm received LD-CT 3-6 months later. Nodules >8.0mm or growing nodules underwent CT-PET. Results from all PET scans performed during the screening workup of COSMOS participants were reviewed. Those performed for suspected collateral disease (pleura, mediastinum, other cancers) were excluded. Outcome was based on the pathological findings for patients who underwent surgery or on findings at follow-up. Outcome was considered negative for those with negative CT findings for at least two years. PET results were visually evaluated by expert radiologists.

      Results
      383 nodules in 351 patients were studied by CT/PET. In 5 occasions, PET evaluation was dubious. 197 nodules turned out to be malignant. Overall sensitivity, specificity and accuracy of CT/PET to distinguish between benign and malignant nodules was 64%, 89% and 76% while it was 82%, 92%, 88% when considering only PET scans performed during baseline screening work-up. Diagnostic performance was high (sensitivity 87%, specificity 73%) for nodules larger than 15 mm in their maximum diameter, reaching 98% sensitivity for solid nodules larger than 15 mm. The diagnostic performance of the test was significantly lower for nodules investigated at annual repeat CT compared to baseline CT (p<0.0001, sensitivity ranging from 30 to 71%) and for non-solid compared to solid nodules (p=0.0001; sensitivity 22% for non-solid versus 79% for solid nodules).

      Strata PETs VN FN FP VP Sensitivity Specificity Accuracy p-value accuraccy
      Overall 378 164 70 21 123 64% 89% 76%
      Diam <10mm 145 75 40 4 26 39% 95% 70%
      Diam 10-15mm 104 51 19 4 30 61% 93% 78%
      Diam >15mm 117 30 10 11 66 87% 73% 82% 0.06
      Solid 263 123 26 16 98 79% 88% 84%
      Non solid 48 15 25 1 7 22% 94% 46%
      Partially solid 65 25 19 3 18 49% 89% 66%
      Non/Part solid 114 41 44 4 25 36% 91% 58% <0.0001
      Age <60 147 64 31 14 38 55% 82% 69%
      Age >60 231 100 39 7 85 69% 93% 80% 0.02
      Inferior lobe 139 69 29 8 33 53% 90% 73%
      Superior lobe 208 85 33 9 81 71% 90% 80%
      Other location 30 10 8 3 9 53% 77% 63% 0.09
      Left lobe 148 64 27 8 49 64% 89% 76%
      Right lobe 206 90 35 10 71 67% 90% 78% 0.70
      Baseline 148 81 11 7 49 82% 92% 88%
      2[nd] year 57 17 11 3 26 70% 85% 75%
      3[rd] year 62 19 28 3 12 30% 86% 50%
      4[th] year 44 10 10 4 20 67% 71% 68%
      5[th] year 47 31 6 4 6 50% 89% 79%
      6[th] year 20 6 4 0 10 71% 100% 80% <0.0001
      Male 264 113 44 12 95 68% 90% 79%
      Female 114 51 26 9 28 52% 85% 69% 0.05
      Non/part solid <15mm 72 27 34 2 9 21% 93% 50%
      Non/part solid >15mm 37 10 9 2 16 64% 83% 70%
      Solid <15mm 177 99 25 6 47 65% 94% 82%
      Solid >15mm 80 20 1 9 50 98% 69% 88% <0.0001

      Conclusion
      CT/PET is a highly sensitive test for the differential diagnosis of screening-detected cancer, in particular at baseline CT, for solid nodules and those with a diameter larger than 15mm. Sensitivity of CT/PET for sub-solid nodules is very low suggesting that other diagnostic tests, such as volume doubling time, should be used.

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