European Radiology

, Volume 14, Issue 4, pp 691–702

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

  • Stefan Diederich
  • Michael Thomas
  • Michael Semik
  • Horst Lenzen
  • Nikolaus Roos
  • Anushe Weber
  • Walter Heindel
  • Dag Wormanns
Chest

DOI: 10.1007/s00330-003-2200-5

Cite this article as:
Diederich, S., Thomas, M., Semik, M. et al. Eur Radiol (2004) 14: 691. doi:10.1007/s00330-003-2200-5

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.

Keywords

Lung cancer screening Pulmonary nodule Incidence results Symptom-diagnosed cancer 

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Stefan Diederich
    • 1
    • 4
  • Michael Thomas
    • 2
  • Michael Semik
    • 3
  • Horst Lenzen
    • 1
  • Nikolaus Roos
    • 1
  • Anushe Weber
    • 1
  • Walter Heindel
    • 1
  • Dag Wormanns
    • 1
  1. 1.Department of Clinical RadiologyUniversity of MünsterMünsterGermany
  2. 2.Department of Haematology/Oncology and Respiratory MedicineUniversity of MünsterMünsterGermany
  3. 3.Department of Thoracic and Cardiovascular SurgeryUniversity of MünsterMünsterGermany
  4. 4.Department of Diagnostic and Interventional RadiologyMarien Hospital, Academic Teaching HospitalDüsseldorfGermany

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