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

Assessment of Systemic and Cerebral Oxygen Saturation during Diagnostic Bronchoscopy: A Prospective, Randomized Study

Background. Arterial hypoxemia occurs in about 2.5–69% of cases during fiberoptic bronchoscopy and may necessitate administration of supplemental oxygen. Whether routine supplementary administration is indicated for all patients is a debated issue. In this prospective randomized study, we assessed the incidence of systemic desaturation (SpO2 4% decrease lasting for more than 60 s) and wanted to find out whether cerebral desaturation occurs in parallel with systemic changes. Patients and Methods. 92 consecutive patients scheduled for diagnostic bronchoscopy were randomly assigned to the no oxygen (O2- group), 2 l/min supplemental O2, or 4 l/min supplemental O2 groups. Primary end points were systemic and cerebral desaturation rate during the procedure. Secondary end points were to delineate the main risk factors of systemic and cerebral desaturation. Results. In the entire cohort, systemic desaturation occurred in 18.5% of patients (n = 17), corresponding to 5 patients (16%) in the O2 (−)group, 6 patients (19%) in the 2 l/min group, and 6 patients (20%) in 4 l/min group, respectively. In the O2 (−) group, the probability of desaturation was 41.7 times higher than that in the 2 l/min group (p=0.014 s), while there was no difference in the probabilities of desaturation between the 2 l/min and 4 l/min groups (p=0.22). Cerebral desaturation (more than 20% rSO2 decrease compared to baseline) did not occur in any patients in the three groups. Systemic desaturation developed earlier, and recovery after desaturation was longer in the O2 (−) group. Male gender, smoking, and systemic oxygen saturation at baseline and FEV1% were the most significant factors contributing to systemic desaturation during bronchoscopy. Conclusions. Administration of supplemental oxygen does not prevent systemic desaturation during flexible bronchoscopy, but may contribute to the shortening of desaturation episodes and faster normalization of oxygen saturation. According to our results, 2 l/min supplemental oxygen should routinely be administered to patients throughout the procedure. This trial is registered with NCT0400260