Author of

• 20177

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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)

  • 23492

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    P2.13-023 - Lung Cancer Risk and Eligibility for Lung Cancer Screening in Patients Undergoing Computed Tomography Coronary Angiography (ID 10465)

    09:30 - 09:30  |  Author(s): S. Zaw
    • Abstract

    Background:
    Computed Tomography Coronary Angiography (CTCA) is frequently performed for non-invasive coronary artery assessment. Extracardiac findings are frequent, with indeterminate pulmonary nodules the commonest incidental finding. Given the established efficacy of lung cancer screening with low dose CT (LDCT), CTCA has been suggested to be an opportunity for “opportunistic” lung cancer screening. This rationale has been used to justify full field of view imaging, despite limited field of view significantly reducing prevalence of nodules detected and therefore reduce downstream healthcare costs. Distribution of lung cancer risk of patients undergoing Cardiac CT has not previously been reported. We performed a cross-sectional survey to determine the proportion of patients undergoing CTCA who would be eligible for lung cancer screening, and to determine the lung cancer risk profile of eligible patients.
    
    Method:
    Patients attending two tertiary hospitals in Melbourne, Australia, for clinically indicated out-patient CT coronary angiography were screened for inclusion in the study. Patients eligible for Lung Cancer screening according to the US Preventive Services Task Force (USPSTF) recommendations were invited to complete a questionnaire including smoking history and demographic details, to determine 6-year lung cancer risk, according to the PLCO~m2012~ risk prediction model. A threshold PLCOm2012 risk at least 1.5% was used to identify a sub-group in whom LDCT screening is most likely to be cost-effective and reduce lung cancer mortality.
    
    Result:
    In a four month period, 216 patients (60% male) were screened prior to CTCA across both sites. Only 57 patients (26%) were potentially eligible for lung cancer screening according to USPSTF guidelines: 126 (58.3%) were never-smokers, with a further 33 patients (15.3%) outside the reccomended 55-80 years age range. Of 57 eligible patients, 48 (84%) consented to the questionnaire. Thirty-four were male (71%), with mean age 65.6+/-6.0 years. Median (IQR) PLCOm2012 risk was 1.30% (0.45–2.19%). Only 22 patients (45.8% of patients completing the questionnaire, estimated 12% of total cohort)had a PLCO~m2012~ risk score >1.5%, and just 18 of 48 (37.5% of patients completing the questionnaire) had a PLCOm2012 risk > 2.0%
    
    Conclusion:
    A majority of patients undergoing CTCA were never-smokers. Only 26% would be eligible for screening according to USPSTF criteria. Therefore routine use of Cardiac CT for “opportunistic” lung cancer screening is likely to result in net harm and is not appropriate A small proportion of patients undergoing CTCA have high risk for lung cancer and may benefit from full thoracic imaging at the time of CTCA