Introduction Early diagnosis of lung cancer improves survival and strategies to facilitate this include screening high risk populations. The ongoing UK Lung Screen Trial (UKLS) is investigating this with low-dose CT scans, and positive screens are referred to clinical services for further investigation and treatment. We report the outcome for such cases referred to our large lung cancer unit.
Methods The UKLS reporting radiologists code scans according to their abnormality: local patients with features suspicious for malignancy (category 4) are referred to our MDT, where following counselling they undergo appropriate investigation.
Results We have received 37 referrals (mean age68 [range 61–75], median performance status 1, mean FEV1 78% predicted [33–107], 27 male) during the first 14 months of the trial.
In 23 cases (62%) subsequent investigation confirmed malignancy (11 adenocarcinoma, 8 squamous cell carcinoma, 3 small cell carcinoma, 1 mesothelioma). In 14 cases where malignancy was not confirmed all had been referred for additional investigations (including 3 PET-CT scans, 5 bronchoscopies and 8 CT scans):1 patient underwent wedge resection of a PET positive lesion (granulomatous process) and 13 remain under follow-up for nodule surveillance.
Twenty of those with malignancy (87%) were potentially operable (median stage 1A, mean age 68 [range 61–74], median performance status 1, mean FEV1 80% predicted [33–107], 13 male), including 2 with limited stage small cell carcinoma. Overall, 19 patients were treated by lobectomy with curative intent. The remaining 4 cases all received oncological management.
Discussion The UKLS is the first large randomised controlled trial to assess a CT-based screening protocol for lung cancer in the United Kingdom. We have shown that the majority of referrals from this programme were confirmed as cases of lung cancer of which nearly all were operable. Such screening programmes will help us improve the prognosis in this previously late-diagnosed and often incurable disease.
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