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D.F. Yankelevitz
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MO11 - Screening and Epidemiology (ID 131)
- Event: WCLC 2013
- Type: Mini Oral Abstract Session
- Track: Imaging, Staging & Screening
- Presentations: 2
- Moderators:P. Zimmerman, J. Bowden
- Coordinates: 10/28/2013, 16:15 - 17:45, Bayside 201 - 203, Level 2
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MO11.08 - The importance of a Regimen of Screening to Maximize Early Diagnosis and Treatment of Lung Cancer (ID 879)
16:55 - 17:00 | Author(s): D.F. Yankelevitz
- Abstract
- Presentation
Background
Writing on behalf of the I-ELCAP Investigators. The goal of CT screening is to maximize lung cancer cure rates by early diagnosis and treatment of lung cancer. To achieve this, a regimen of screening is important, particularly for small nodules. To better understand the importance of a regimen, we compared two large databases of screen-diagnosed lung cancers, the International Early Lung Cancer Action Program (I-ELCAP) and the National Lung Screening Trial (NLST) CT arm as the former had a specified diagnostic workup algorithm while the latter did not mandate any specific approach.Methods
We compared all lung cancers including small-cell and carcinoids, that were diagnosed under screening, that is, either screen-diagnosed because of a positive result of the CT screening or symptom-prompted after a negative CT screening. We compared the stage and size distribution of the screen-diagnosed cancers in the International Early Lung Cancer Action Program (I-ELCAP) from 1993 to 2011 and those in the NLST-CT arm from 2002 to 2006. In I-ELCAP, the screenings were performed according to a common protocol in which the diagnostic workup for a participant was defined by a specified protocol which has been continually updated whereas in the NLST, “… no specific diagnostic evaluation approach was mandated.”Results
In I-ELCAP, a total of 799 patients were diagnosed under screening of which 11 (1.4%) were interim-diagnoses; 8 prior to the first annual repeat screening and 3 between annual rounds, leaving 788 screen-diagnosed patients. In the NLST CT arm, 1060 patients were diagnosed with lung cancer, but only 692 were diagnosed under screening. There were 18 interim-diagnosed cases before the first annual repeat screening and 26 between the 2 annual repeat screenings, a total of 44 (6.4%) interim-diagnosed cases for this cohort. This left 649 screen-diagnosed patients. The frequency of clinical Stage I was 82% (95% CI: 79%-84%) vs. 69% (95% CI: 65%-72%) in I-ELCAP and NLST, respectively. Average tumor size (95% confidence interval) was 17.3 mm (16.6-18.1) vs. 23.1 mm (21.7 -24.4), respectively. Surgical resection was performed in 86% (676/788) and 77% (497/649) of the screen-diagnosed patients, respectively. The frequency of pathologic Stage I (clinical, if not resected) was 73% (95% CI: 70%-76%) vs. 63% (95% CI: 59%-67%).Conclusion
Stage I disease, both clinical and pathologic, was significantly higher in I-ELCAP than NLST. The tumor size was significantly lower in I-ELCAP than NLST, all strongly suggestive of the importance of a specified regimen of screening. This is further substantiated by the reported 71% for pathologic Stage I (clinical, if not resected) by the NELSON study which is close to that reported by I-ELCAP as the NELSON also followed a well-defined regimen of screening.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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MO11.09 - CT Screening for Lung Cancer: Definition of Positive Test Result in the National Lung Screening Trial CT cohort compared with I-ELCAP (ID 872)
17:00 - 17:05 | Author(s): D.F. Yankelevitz
- Abstract
- Presentation
Background
Low-dose CT screening for lung cancer can reduce mortality among high-risk people but to reduce unnecessary evaluations with attendant risks, alternative thresholds for defining positive result and cancer diagnoses needs to be further understood. The purpose of the study is to assess the frequency of positive results and potential delays in diagnosis in the baseline round of screening using more restrictive thresholds.Methods
Among the participants who were randomly assigned to the CT arm of the National Lung Screening Trial (NLST) cohort, we identified the frequency of solid and part-solid pulmonary nodules and the rate of lung cancer diagnoses using a 5.0, 6.0, 7.0. 8.0 and 9.0 mm threshold for the largest noncalcified nodule identified in the baseline CT scan. we compared these results with those previously published for the I-ELCAP cohort.Results
The frequency of positive results in the baseline round, using the definition of positive result (any parenchymal, solid or part-solid, noncalcified nodule > 5.0 mm), was 15.9% (4,104/25,814). Using alternative threshold values of 6.0, 7.0, 8.0 and 9.0 mm, the frequencies (95% CI) of positive results were 10.5% (10.2, 10.9), 7.2% (6.9, 7.5), 5.3% (5.0, 5.6) , and 4.2% (3.9, 4.4), respectively. Use of these alternative definitions would have reduced the workup by 33.8%, 54.7%, 66.6%, and 73.8%, respectively. Concomitantly, proportion of lung cancer diagnoses made within first 12 months would be delayed for 0.9%, 2.6%, 6.1%, and 10.0% of the patients, respectively. These results are similar to those found in I-ELCAP.Conclusion
These results are similar to those found in I-ELCAP and suggest that even in the higher-risk participants enrolled in the NLST, higher threshold values can be used. This reduction in the positive result rate compared to the 28% positive result rate reported in the NLST, which used a 4mm threshold, is considerable.Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
