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S. Singharuksa
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P1.03 - Poster Session with Presenters Present (ID 455)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
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P1.03-043 - Practical Difficulty of Low Dose Computerized Tomography as a Lung Cancer Screening Tool in an Endemic Area of Tuberculosis (ID 5849)
14:30 - 14:30 | Author(s): S. Singharuksa
- Abstract
Background:
Low-dose computerized tomography (LDCT) is a current standard technique for lung cancer screening to reduce lung cancer death. Clinical and radiographic finding for lung cancer can also be found in Tuberculosis(TB). No clear evidence of benefits from lung cancer screening has been established in a high-risk population residing in an endemic area of TB.
Methods:
A 5-year prospective lung cancer screening using LDCT enrolled 634 former or current heavy smokers (>30 pack-years) aged 50-70 years without a history of active TB within a recent year between July 2012 and January 2014 at Chulabhorn Hospital in Thailand. The results were classified as negative, indeterminate, or positive for primary lung cancer. The preliminary data demonstrated from three rounds of low-dose CT screening for lung cancer (rounds T0, T1, and T2).
Results:
At initial screening LDCT, 3.5% had positive test (solid/part solid nodule>10ยท0 mm/volume >500 mm[3] or consolidation, obstructive atelectasis, pleural effusion, or mediastinal lymphadenopathy). Most of participants with non calcified lung nodule(NCN)(s) had 2-4 nodules, the higher proportion of multiple pulmonary nodules was observed in the larger size. Nine cases(1.4%) were proven lung cancer (56% stage I, 22% stage II/III, 22% stage IV) within 12 months. All cases of stage I-II had 2-10 lung nodules, while all stage III- IV lung cancers had single lung nodule. PPV of positive LDCT test, NCN(s)>10 mm and GGN(s)>10 mm for diagnosis lung cancer were 27.3%, 40%, and 75%, respectively. The incidence of lung cancer in T1 and T2 were 0.67% and 0.70%, respectively. Half of them had baseline lesions suspected inflammation/infection. The incidence of active pulmonary TB in T1 and T2 was 0.50% and 0.52%, respectively.
Conclusion:
Despite a high burden of TB in Thailand, LDCT screening in heavy smokers could yield a high rate of early stage of primary lung cancer in this population at risk and also high rate of active pulmonary tuberculosis. However, high prevalence of lung nodules and high proportion of multiple pulmonary nodules of individuals were major problems in diagnosis and staging lung cancer in endemic area of Tuberculosis. Regarding the high probability of malignancy in GGN diameter >10 mm and newly seen or progressive lesion of baseline lesion suspected of inflammation/infection, nodule management protocol would be adapted in this population.
