42 research outputs found
The Liverpool Statement 2005: Priorities for the European Union/United States Spiral Computed Tomography Collaborative Group
The Liverpool Statement 2005 was developed at the Fourth International Lung Cancer Molecular Biomarkers Workshop in Liverpool (October 27-29, 2005) and focused on the priorities for the European Union/United States (EU-US) Spiral Computed Tomography (CT) Collaborative Group. The application of spiral CT technology for early lung cancer screening has gained enormous momentum in the past 5 years. The EU-US Spiral CT Collaboration was initiated in 2001 in Liverpool, and subsequent meetings throughout Europe have resulted in the development of collaborative protocols and minimal data sets that provide a mechanism for the different trial groups to work together, with the ultimate aim to pool results. Considerable progress has been made with major national screening trials in the U.S. and Europe, which include IELCAP, NLST, and NELSON. The major objective of this international collaboration is the planned cross-analysis of the individual studies after they are reported. The EU-US researchers have agreed to a number of long-term objectives and to explore strategic areas for harmonization of complementary investigations
Emphysema scores predict death from COPD and lung cancer
OBJECTIVE:
Our objective was to assess the usefulness of emphysema scores in predicting death from COPD and lung cancer.
METHODS:
Emphysema was assessed with low-dose CT scans performed on 9,047 men and women for whom age and smoking history were documented. Each scan was scored according to the presence of emphysema as follows: none, mild, moderate, or marked. Follow-up time was calculated from time of CT scan to time of death or December 31, 2007, whichever came first. Cox regression analysis was used to calculate the hazard ratio (HR) of emphysema as a predictor of death.
RESULTS:
Median age was 65 years, 4,433 (49%) were men, and 4,133 (46%) were currently smoking or had quit within 5 years. Emphysema was identified in 2,637 (29%) and was a significant predictor of death from COPD (HR, 9.3; 95% CI, 4.3-20.2; P < .0001) and from lung cancer (HR, 1.7; 95% CI, 1.1-2.5; P = .013), even when adjusted for age and smoking history.
CONCLUSIONS:
Visual assessment of emphysema on CT scan is a significant predictor of death from COPD and lung cancer
Recommendations for implementing lung cancer screening with low-dose computed tomography in Europe
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was
demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease.
European mortality data has recently become available from the Nelson randomised controlled
trial, which confirmed lung cancer mortality reductions by 26% in men and 39–61% in women.
Recent studies in Europe and the USA also showed positive results in screening workers exposed to
asbestos. All European experts attending the “Initiative for European Lung Screening (IELS)”—a
large international group of physicians and other experts concerned with lung cancer—agreed that
LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and
guidelines for its effective and safe implementation still need to be formulated. To this purpose, the
IELS was asked to prepare recommendations to implement LCS and examine outstanding issues.
A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at
a meeting held in Milan in November 2018. The present recommendations reflect that consensus
was reached
Recommendations for implementing lung cancer screening with low-dose computed tomography in Europe
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39–61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the “Initiative for European Lung Screening (IELS)”—a large international group of physicians and other experts concerned with lung cancer—agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached
Computed Tomography Screening: The International Early Lung Cancer Action Program Experience
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The impact of the regimen of screening on lung cancer cure: A comparison of I-ELCAP and NLST
The aim of this study was to assess the impact of the regimen of screening on the frequency of early diagnosis and resection in two computed tomography screening programs. The stage and size distribution of all screendiagnosed lung cancers was compared. A total of 775 patients in the International Early Lung Cancer Action Program (I-ELCAP) and 664 patients in the National Lung Screening Trial (NLST) were screen-diagnosed; that is, resulting from a positive result requiring further diagnostic workup. The frequency of stage I diagnoses, resections, tumor size, and lung cancer-specific survival were determined. Cox regression was used to identify the key determinants of lung cancer cure. The frequency of clinical stage I lung cancer in I-ELCAP was 82%, and in the NLST it was 67% (P<0.0001). The frequency of stage I (pathologic and clinical if not resected) was 78% in I-ELCAP and 62% in the NLST (P<0.0001). Surgical resection was performed in 86% (664/755) in I-ELCAP and 76% (492/644, P<0.0001) in the NLST. The average tumor size was 17mm in I-ELCAP and 23mm in the NLST (P<0.0001). The 5-year survival rate was 83% in I-ELCAP and 62% in the NLST (P<0.0001). Cox regression showed that I-ELCAP provided a 50% better survival benefit than the NLST and that stage I and resection were key determinants of survival, independent of age, smoking history, and tumor size. The higher frequency of stage I disease and resection and smaller tumor size resulted in a significantly higher survival rate in I-ELCAP than in the NLST. These differences strongly support the importance of a specified regimen of screening, as alternative explanations have been addressed. \ua9 2015 Wolters Kluwer Health, Inc. All rights reserved
Molecular characterization of small peripheral lung tumors based on the analysis of fine needle aspirates
The computed tomography (CT)-based early
lung cancer diagnostic technologies allow the detection
of very small stage I lung tumors. As part of these
screening protocols any suspicious nodule has to be
diagnosed morphologically, which requires CT-guided
Fine Needle Aspiration, open biopsy or surgery. Fine
Needle Aspiration (FNA) cytology is a well-recognised
method for a rapid and accurate diagnosis of small lung
tumors. Molecular analysis of the FNA specimens could
complement cytology diagnosis by the characterization
of the biological traits at the preoperative stage. In this
study, we aimed to characterize the biological profile of
33 paraffin-embedded transthoracic FNA samples
obtained from three groups of lung cancer patients: two
groups of small early-detected lung adenocarcinomas
(radiologically subsolid and solid nodules) and a third
group of small metastatic adenocarcinomas. Genetic
analysis was performed by fluorescence in situ
hybridization using the four-color LAVysion probe. p53
and Ki-67 protein expression was also evaluated by
immunocytochemistry. The samples showed gains for all
targets analyzed; two cases had EGFR gene
amplification and two cases had MYC amplification.
There were no significant differences in the percentage of genetically malignant cells and the expression of Ki-
67 among the three groups. However, p53 accumulation
was significantly higher in the metastatic group
compared to the subsolid early-detected group (P =
0.001). In conclusion, molecular analysis of FNA
specimens may provide useful information at
preoperative stages. In our series, a good prognostic
profile in subsolid early detected adenocarcinomas is
suggested