Increased use of diagnostic CT imaging increases the detection of stage IA lung cancer:pathways and patient characteristics

BACKGROUND: At Silkeborg Regional Hospital, Denmark, the number of stage IA lung cancer increased after implementation of increased use of CT investigations and a corresponding reduction in chest X-ray. The aim of the present study was to understand the changes in referral pathways, patient characteristics and imaging procedures behind the observed increase in early-stage lung cancer. METHODS: The referral and imaging pathways for all patients diagnosed with lung cancer in 2013–2018 were described based on manually curated information from the electronic health care systems and staging information from the Danish Lung Cancer Registry. We compared the clinical characteristics of patients diagnosed in 2013–2015 and in 2016–2018 after implementation of a change in the use of low dose CT scan (LDCT). For patients diagnosed in 2016–2018, stage IA lung cancer were compared to higher stages using univariable logistic regression analysis. RESULTS: Five hundred and forty-seven patients were diagnosed with lung cancer in 2013–2018. Stage IA constituted 13.8% (34/247) in 2013–2015, and 28.3% (85/300) in 2016–2018. Stage IA patients in 2016–2018 were characterised by more comorbidity, fewer packyears and tended to be older than patients with higher stages. In 2016–2018, the largest proportion of stage IA patients (55%) came from within-hospital referrals. The majority of these lung cancers were detected due to imaging procedures with other indications than suspicion of lung cancer. The proportion of stage IA increased from 12% (12/99) to 36% (47/129) (p < 0.001) for hospital referrals and from 17% (22/129) to 23% (38/165) for GP referrals (p = 0.21). The imaging procedures contributing to the increase in stage IA was contrast enhanced CT (22%¸11/51), LDCT (35%; 18/51) and X-ray followed by LDCT (25%; 13/51). CONCLUSION: The increased access to LDCT for patients referred from general practice and the increased hospital requested CT activity resulted in an increase in the number of stage IA lung cancers. Incidental findings on imaging performed for diagnostic purposes unrelated to suspicion of lung cancer contributed a large proportion of the increase. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12885-022-09585-2

Potential impact of texture analysis in contrast enhanced CT in non-small cell lung cancer as a marker of survival: A retrospective feasibility study

The objective of this feasibility study was to assess computed tomography (CT) texture analysis (CTTA) of pulmonary lesions as a predictor of overall survival in patients with suspected lung cancer on contrast-enhanced computed tomography (CECT). In a retrospective pilot study, 94 patients (52 men and 42 women; mean age, 67.2 ± 10.8 yrs) from 1 center with non-small cell lung cancer (NSCLC) underwent CTTA on the primary lesion by 2 individual readers. Both simple and multivariate Cox regression analyses correlating textural parameters with overall survival were performed. Statistically significant parameters were selected, and optimal cutoff values were determined. Kaplan-Meier plots based on these results were produced. Simple Cox regression analysis showed that normalized uniformity had a hazard ratio (HR) of 16.059 (3.861-66.788, P < .001), and skewness had an HR of 1.914 (1.330-2.754, P < .001). The optimal cutoff values for both parameters were 0.8602 and 0.1554, respectively. Normalized uniformity, clinical stage, and skewness were found to be prognostic factors for overall survival in multivariate analysis. Tumor heterogeneity, assessed by normalized uniformity and skewness on CECT may be a prognostic factor for overall survival

Identification and management of interstitial lung abnormalities

Interstitial lung abnormalities (ILA) are incidentally observed specific CT findings in patients without clinical suspicion of interstitial lung disease (ILD). ILA with basal and peripheral predominance and features suggestive of fibrosis in more than 5% of any part of the lung should be referred for pulmonologist review. The strategy for monitoring as described in this review is based on clinical and radiological risk factors. ILA are associated with risk of progression to ILD and increased mortality. Early identification and assessment of risk factors for progression are essential to improve outcome.</p

Increased use of diagnostic CT imaging increases the detection of stage IA lung cancer: pathways and patient characteristics

Abstract Background At Silkeborg Regional Hospital, Denmark, the number of stage IA lung cancer increased after implementation of increased use of CT investigations and a corresponding reduction in chest X-ray. The aim of the present study was to understand the changes in referral pathways, patient characteristics and imaging procedures behind the observed increase in early-stage lung cancer. Methods The referral and imaging pathways for all patients diagnosed with lung cancer in 2013–2018 were described based on manually curated information from the electronic health care systems and staging information from the Danish Lung Cancer Registry. We compared the clinical characteristics of patients diagnosed in 2013–2015 and in 2016–2018 after implementation of a change in the use of low dose CT scan (LDCT). For patients diagnosed in 2016–2018, stage IA lung cancer were compared to higher stages using univariable logistic regression analysis. Results Five hundred and forty-seven patients were diagnosed with lung cancer in 2013–2018. Stage IA constituted 13.8% (34/247) in 2013–2015, and 28.3% (85/300) in 2016–2018. Stage IA patients in 2016–2018 were characterised by more comorbidity, fewer packyears and tended to be older than patients with higher stages. In 2016–2018, the largest proportion of stage IA patients (55%) came from within-hospital referrals. The majority of these lung cancers were detected due to imaging procedures with other indications than suspicion of lung cancer. The proportion of stage IA increased from 12% (12/99) to 36% (47/129) (

Additional file 1 of Increased use of diagnostic CT imaging increases the detection of stage IA lung cancer: pathways and patient characteristics

Additional file 1: Supplementary table 1.Logistic regression analysis of 294 lung cancer patients, Silkeborg Regional Hospital 2016-2018. Multivariate analysis example

Increased use of diagnostic CT imaging increases the detection of stage IA lung cancer: pathways and patient characteristics

Abstract Background At Silkeborg Regional Hospital, Denmark, the number of stage IA lung cancer increased after implementation of increased use of CT investigations and a corresponding reduction in chest X-ray. The aim of the present study was to understand the changes in referral pathways, patient characteristics and imaging procedures behind the observed increase in early-stage lung cancer. Methods The referral and imaging pathways for all patients diagnosed with lung cancer in 2013–2018 were described based on manually curated information from the electronic health care systems and staging information from the Danish Lung Cancer Registry. We compared the clinical characteristics of patients diagnosed in 2013–2015 and in 2016–2018 after implementation of a change in the use of low dose CT scan (LDCT). For patients diagnosed in 2016–2018, stage IA lung cancer were compared to higher stages using univariable logistic regression analysis. Results Five hundred and forty-seven patients were diagnosed with lung cancer in 2013–2018. Stage IA constituted 13.8% (34/247) in 2013–2015, and 28.3% (85/300) in 2016–2018. Stage IA patients in 2016–2018 were characterised by more comorbidity, fewer packyears and tended to be older than patients with higher stages. In 2016–2018, the largest proportion of stage IA patients (55%) came from within-hospital referrals. The majority of these lung cancers were detected due to imaging procedures with other indications than suspicion of lung cancer. The proportion of stage IA increased from 12% (12/99) to 36% (47/129) (

Additional file 1 of Increased use of diagnostic CT imaging increases the detection of stage IA lung cancer: pathways and patient characteristics

Additional file 1: Supplementary table 1.Logistic regression analysis of 294 lung cancer patients, Silkeborg Regional Hospital 2016-2018. Multivariate analysis example