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

Computed Tomography Screening: The International Early Lung Cancer Action Program Experience

No abstrac

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

Errors in systematic reviews: An example of computed tomography screening for lung cancer

Systematic reviews are utilized in evidence-based medicine and are increasingly being used to help guide standards, guidelines, and clinical practice. The National Lung Screening Trial results prompted such a review of lung cancer screening literature. The review was endorsed by five major medical societies. We aimed at assessing its accuracy. Two independent groups of two reviewers reviewed the systematic review, including its source literature. Errors were placed into three major categories and tabulated: (i) selection of studies, (ii) misrepresentation of published reports, and (iii) errors in calculation and rounding. A total of 151 errors were found. There were 13 errors in selection of studies, 124 errors due to misrepresentation of published reports, and 14 errors in calculations and rounding. The extent of these errors raises concern about the credibility of the conclusions of the recent lung cancer screening systematic review. A process that allows for a thorough checking of data included in systematic reviews should be established. © 2013 Wolters Kluwer Health

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

Molecular characterization of small peripheral lung tumors based on the analysis of fine needle aspirates

Summary. 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

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