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C. Betzer
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P2.13 - Radiology/Staging/Screening (ID 714)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Radiology/Staging/Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/17/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P2.13-009 - Results of Low-Dose CT Lung Cancer Screening at a Non-University Tertiary Hospital System in Oregon, USA (ID 9398)
09:30 - 09:30 | Author(s): C. Betzer
- Abstract
Background:
Since the National Lung Screening Trial (NLST), doubt has been expressed as to whether the results could be replicated in a community setting. We aim to document our experience over 3.5 years and over 3000 CT scans.
Method:
The Providence Cancer Center in Portland Oregon initiated a lung cancer screening program in 2013 that included 7 hospitals (2 non-university tertiary medical centers and 5 community hospitals). Lung cancer screening candidates were referred by primary care providers from Noverember 2013 through May 2017. Candidates were screened using NLST criteria. Initially, shared decision making was provided by the team, but in 2015 transitioned to the PCP. Dedicated radiologists at the tertiary centers read all CTs and assigned Lung-RADS assessment categories. All Lung-RADS category 4 scans were reviewed by a multidisciplinary team of thoracic surgery, pulmonary, radiology and oncology to generate management recommendations. The navigator recorded all imaging, procedures, pathology, staging and complications. This individual ensured follow-up scans were completed.
Result:
2983 patients were referred. 353 were not eligible and 529 declined participation. 1950 underwent initial CT screening. 178 were presented at the multidisciplinary conference. Additional imaging included 1160 follow CT scans and 75 PET scans. Invasive diagnostic procedures included bronchoscopy (27) and CT-guided biopsy (19). Thoracic surgical procedures included pneumonectomy (1); lobectomy (21); segmentectomy or wedge resection (10). 55 cancers were diagnosed. 40 non-small cell lung cancers were found including 26 stage I; 5 stage II; 4 stage III and 5 stage IV. 6 small cell lung cancers were diagnosed including limited stage (3) and extensive stage (3). Lung cancer rate was 2.4%. 9 extra-thoracic malignancies were diagnosed including thyroid, renal cell (4), breast, colon, liver and prostate. The intervention rate was 5.6% with 46 major procedures (surgery) and 64 minor procedures (bronchoscopy, CT-guided biopsy, EUS, EGD). Adverse event rate was low and included pneumothorax (8) with 4 requiring chest tube, intra-operative bleeding requiring thoracotomy (1) and post-operative bleeding requiring repeat thoracoscopy (1). There was one death in a post-operative lobectomy patient.
Conclusion:
Low-dose CT screening for lung cancer can be done with low intervention and complication rates in a non-university setting using a systematic, multidisciplinary approach. This large group of screened patients demonstrates a stage shift toward early stage lung cancers with complication rates approximating those of the NLST. Our data contradict the argument that lung cancer screening cannot be done successfully and safely in the community.
