Skip to main content

Advertisement

Log in

Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers

  • Chest
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

The aim of this study was analysis of incidence results in a prospective one-arm feasibility study of lung cancer screening with low-radiation-dose spiral computed tomography in heavy smokers. Eight hundred seventeen smokers (≥40 years, ≥20 pack years of smoking history) underwent baseline low-dose CT. Biopsy was recommended in nodules >10 mm with CT morphology suggesting malignancy. In all other lesions follow-up with low-dose CT was recommended. Annual repeat CT was offered to all study participants. Six hundred sixty-eight (81.8%) of the 817 subjects underwent annual repeat CT with a total of 1735 follow-up years. Follow-up of non-calcified nodules present at baseline CT demonstrated growth in 11 of 792 subjects. Biopsy was performed in 8 of 11 growing nodules 7 of which represented lung cancer. Of 174 new nodules, 3 represented lung cancer. The 10 screen-detected lung cancers were all non-small cell cancer (6 stage IA, 1 stage IB, 1 stage IIIA, 2 stage IV). Five symptom-diagnosed cancers (2 small cell lung cancer: 1 limited disease, 1 extensive disease, 3 central/endobronchial non-small cell lung cancer, 2 stage IIIA, 1 stage IIIB) were diagnosed because of symptoms in the 12-month interval between two annual CT scans. Incidence of lung cancer was lower than prevalence, screen-detected cancers were smaller, and stage I was found in 70% (7 of 10) of screen-detected tumors. Only 27% (4 of 15) of invasive procedures was performed for benign lesions; however, 33% (5 of 15) of all cancers diagnosed in the population were symptom-diagnosed cancers (3 central NSCLC, all stage III, 2 SCLC) demonstrating the limitations of CT screening.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3a, b
Fig. 4a, b
Fig. 5
Fig. 6a, b
Fig. 7a, b
Fig. 8

Similar content being viewed by others

References

  1. American Cancer Society: cancer facts and figures (2001) American Cancer Society, Atlanta

  2. Mountain CF (1997) Revisions in the International System for Staging Lung Cancer. Chest 111:1710–1717

    PubMed  Google Scholar 

  3. Kaneko M, Eguchi K, Ohmatsu H, Kakinuma R, Naruke T, Suemasu K, Moriyama N (1996) Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. Radiology 201:798–802

    CAS  PubMed  Google Scholar 

  4. Sone S, Takashima S, Li F, Yang Z, Honda T, Maruyama Y, Hasegawa M, Yamanda T, Kubo K, Hanamura K, Asakura K (1998) Mass screening for lung cancer with mobile spiral computed tomography scanner. Lancet 351:1242–1245

    CAS  PubMed  Google Scholar 

  5. Henschke CI, McCauley DI, Yankelevitz DF et al. (1999) Early lung cancer action project: overall design and findings from baseline screening. Lancet 354:99–105

    CAS  PubMed  Google Scholar 

  6. Diederich S, Wormanns D, Semik M, Thomas M, Lenzen H, Roos N, Heindel W (2002) Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers. Radiology 222:773–781

    PubMed  Google Scholar 

  7. Swensen S, Jett JR, Slon JA, Midthun DE, Hartman TE, Sykes AM, Aughenbaugh GL, Zink FE, Hillman SL, Noetzel GR, Marks RS, Clayton AC, Pairolero PC (2002) Screening for lung cancer with low-dose spiral computed tomography. Resp Crit Care Med 4:508–513

    Google Scholar 

  8. Nawa T, Nakagawa T, Kusano S, Kawasaki Y, Sugawara Y, Nakata H (2002) Lung cancer screening using low-dose spiral CT. Chest 122:15–20

    Article  PubMed  Google Scholar 

  9. Pastorino U, Bellomi M, Landoni C, Fiori E de, Arnaldi P, Picchio M, Pelosi G, Boyle P, Fazio F (2003) Early lung cancer detection with spiral CT and positron emission tomography in heavy smokers: two-year results. Lancet 23:593–597

    Article  Google Scholar 

  10. Swensen SJ, Jett JR, Hartman TE, Midthun DE, Sloan JA, Sykes AM, Aughenbaugh GL, Clemens MA (2003) Lung cancer screening with CT: Mayo Clinic experience. Radiology 226:756–761

    PubMed  Google Scholar 

  11. Sobue T, Moriyama N, Kaneko M, Kusumoto M, Kobayashi T, Tsuchiya R, Kakinuma R, Ohmatsu H, Nagai K, Nishiyama H, Matsui E, Eguchi K (2002) Screening for lung cancer with low-dose helical computed tomography: anti-lung cancer association project. J Clin Oncol 20:911–920

    Article  PubMed  Google Scholar 

  12. Sone S, Yang ZG, Honda T, Maruyama Y, Takashima S, Hasegawa M, Kawakami S, Kubo K, Haniuda M, Yamanda T (2001) Results of 3-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner. Br J Cancer 84:25–32

    Article  CAS  PubMed  Google Scholar 

  13. Henschke CI, Naidich DP, Yankelevitz DF, McGuiness G, McCauley DI, Smith JP, Libby D, Pasmantier M, Vazquez M, Koizumi J, Flieder D, Altorki N, Miettinnen OS (2001) Early lung cancer action project: initial findings on repeat screenings. Cancer 92:153–159

    Article  CAS  PubMed  Google Scholar 

  14. Swensen SJ, Viggiano RW, Midthun DE, Müller NL, Sherrick A, Yamashita K, Naidich DP, Patz EF, Hartman TE, Muhm JR, Weaver AL (2000) Lung nodule enhancement at CT: multicenter study. Radiology 214:73–80

    CAS  PubMed  Google Scholar 

  15. Patz EF, Goodman PC, Bepler G (2000) Screening for lung cancer. N Engl J Med 343:1627–1633

    Google Scholar 

  16. Patz EF, Black WC, Goodman PC (2001) CT screening for lung cancer: not ready for routine practice. Radiology 221:587–591

    PubMed  Google Scholar 

  17. http//: www.I-ELCAP.org

  18. Holland JM, Arsanjani A, Liem BJ, Hoffelt SC, Cohen JI, Stevens KR Jr (2002) Second malignancies in early-stage laryngeal carcinoma patients treated with radiotherapy. Laryngol Otol 116:190–193

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by grants by the German Cancer Society (Deutsche Krebshilfe: 70–2021-Di 2 and 70–2501-Di 3) and the Medical Faculty of Münster University (IMF Di-1–4-I/97–22).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Stefan Diederich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Diederich, S., Thomas, M., Semik, M. et al. Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers. Eur Radiol 14, 691–702 (2004). https://doi.org/10.1007/s00330-003-2200-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-003-2200-5

Keywords

Navigation