HUNCHEST-II contributes to a shift to earlier-stage lung cancer detection: final results of a nationwide screening program

The introduction of low-dose CT (LDCT) altered the landscape of lung cancer (LC) screening and contributed to the reduction of mortality rates worldwide. Here we report the final results of HUNCHEST-II, the largest population-based LDCT screening program in Hungary, including the screening and diagnostic outcomes, and the characteristics of the LC cases.A total of 4215 high-risk individuals aged between 50 and 75 years with a smoking history of at least 25 pack-years were assigned to undergo LDCT screening. Screening outcomes were determined based on the volume, growth, and volume doubling time of pulmonary nodules or masses. The clinical stage distribution of screen-detected cancers was compared with two independent practice-based databases consisting of unscreened LC patients.The percentage of negative and indeterminate tests at baseline were 74.2% and 21.7%, respectively, whereas the prevalence of positive LDCT results was 4.1%. Overall, 76 LC patients were diagnosed throughout the screening rounds (1.8% of total participants), out of which 62 (1.5%) patients were already identified in the first screening round. The overall positive predictive value of a positive test was 58%. Most screen-detected malignancies were stage I LCs (60.7%), and only 16.4% of all cases could be classified as stage IV disease. The percentage of early-stage malignancies was significantly higher among HUNCHEST-II screen-detected individuals than among the LC patients in the National Koranyi Institute of Pulmonology's archive or the Hungarian Cancer Registry (p < 0.001).HUNCHEST-II demonstrates that LDCT screening for LC facilitates early diagnosis, thus arguing in favor of introducing systematic LC screening in Hungary.HUNCHEST-II is the so-far largest population-based low-dose CT screening program in Hungary. A positive test's overall positive predictive value was 58%, and most screen-detected malignancies were early-stage lesions. These results pave the way for expansive systematic screening in the region.• Conducted in 18 medical facilities, HUNCHEST-II is the so far largest population-based low-dose CT screening program in Hungary. • The vast majority of screen-detected malignancies were early-stage lung cancers, and the overall positive predictive value of a positive test was 58%. • HUNCHEST-II facilitates early diagnosis, thus arguing in favor of introducing systematic lung cancer screening in Hungary

Gyorsan növekvő óriás solitaer fibrosus pleuratumor

A pleura solitaer fibrosus tumora viszonylag ritkán előforduló, mesenchymalis sejtekből kiinduló daganat. A legtöbb beteg még nagy tumorméret ellenére is sokáig teljesen tünetmentes. Általában jóindulatú, ám gyakori a lokális recidíva, így különösen fontos az ép széllel történő eltávolításuk. Esetünkben a 77 éves férfi beteget nehézlégzéses panaszok miatt készült mellkasi röntgenfelvétel alapján szűrték ki. A mellkas-CT-vizsgálat egy jobb oldali, rekesz fölötti, éles szélű, dorsalisan elhelyezkedő terimét írt le. Transthoracalis ’core’ (vastagtű-) biopszia történt, mely igazolta a pleura solitaer fibrosus tumorát. Műtét során egy 17 × 16 × 5 cm-es tumort in toto sikerült eltávolítani. Az enyhe tünetekkel jelentkező betegek mellkasröntgen-felvételén látott homogén, éles szélű elváltozások kapcsán gondolni kell a solitaer fibrosus tumor lehetőségére. Mivel kialakulhat a szövettanilag benignus solitaer fibrosus pleuratumor malignus transzformációja, a műtét során teljes reszekcióra kell törekedni. A lokális recidíva lehetősége miatt a beteg szoros klinikai és radiológiai utánkövetése javasolt. Orv Hetil. 2024; 165(19): 754–758