Lung Cancer Screening Using Low-Dose Spiral CT: Results of Baseline and 1-Year Follow-up Studies

doi:10.1378/chest.122.1.15

Chest

Volume 122, Issue 1, July 2002, Pages 15-20

https://doi.org/10.1378/chest.122.1.15 Get rights and content

Study objective

To evaluate the feasibility of lung cancer screening using low-dose spiral CT as a part of annual health examinations.

Design

Nonrandomized, screening practice.

Methods

From April 1998 to August 2000, CT screening was performed as a part of annual health examinations on a total of 7,956 individuals who belonged to the Hitachi Employee's Health Insurance Group. Of those participants, 5,568 were rescreened 1 year later. When a noncalcified solitary pulmonary nodule (SPN) ≥ 8 mm was detected on CT screening, a detailed CT scan was carried out approximately 1 month later.

Results

During the baseline screening, a total of 2,865 noncalcified SPNs were detected among the 7,956 participants. Primary lung cancer was histologically confirmed in 40 patients (41 lesions). The prevalence was 0.44% of all participants from the baseline, and 0.07% from the repeated screening. Thirty-five of 41 tumors were stage I. Current or former smokers represented only 17 of 40 cases. The detection rate was rather high in female participants.

Conclusion

Low-dose spiral CT seems to be a promising method for screening early lung cancer as a part of annual health examinations. Female and nonsmoking subjects should be included in the baseline screening. However, for yearly repeat screening, the participants may be selected on the basis of gender, smoking history, and results at the baseline screening.

Section snippets

Subjects

All participants gave informed consent at presentation for CT screening, and filled out questionnaires about respiratory symptoms and smoking history. From April 1998 to August 2000, A total of 13,524 CT screening procedures were performed, consisting of 7,956 procedures as baseline screening and 5,568 procedures as repeat screening 1 year later. The characteristics of the participants are summarized in Table 1. The majority of participants were men, with ages ranging from 50 to 59 years. The

Prevalence of SPNs at Baseline Screening

During the baseline screening, a total of 2,865 noncalcified SPNs (in 2,099 patients) were detected in 7,956 patients (26.3%). The prevalence of SPNs by age and sex is shown in Figure 2. The prevalence of SPNs seemed to be high among the elderly participants. There was no significant difference by smoking history at any age.

Results of the Baseline Screening

Of the 7,956 participants, 541 patients (6.8%) were encouraged to undergo a detailed CT scan (Table 2). In total, 64 patients underwent additional examinations consisting of

Discussion

Henschke et al⁸ reported that low-dose CT identified 233 individuals as having from one to six noncalcified nodules, among 1,000 participants. Our data were similar to those of their report, and we found these nodules in 26.3% of participants. Although the prevalence of CT-detected SPNs has not yet been reported in Japan, it seems to be high in view of the age of participants in this study (approximately 70% were 50 to 59 years old). The high prevalence of granulomatous disease, especially old

ACKNOWLEDGMENT

We thank Katsuyuki Endo, MD; Noboru Yanai, MD; Masataka Irokawa, MD; and Shimao Fukai, MD for thorough examination and treatment of screened cases, and also all related staff who took part in this screening program.

References (14)

CI Henschke et al.
Early Lung Cancer Action Project: overall design and findings from baseline screening
Lancet
(1999)
BJ Flehinger et al.
Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial-Sloan Kettering study
Am Rev Respir Dis
(1984)
RS Fontana et al.
Early lung cancer detection; results of the initial (prevalence) radiologic and cytologic screening in the Mayo clinic study
Am Rev Respir Dis
(1984)
RS Fontana et al.
Lung cancer screening: the Mayo program
J Occup Med
(1986)
M Tockman
Survival and mortality from lung cancer in a screened population: the Johns Hopkins study
Chest
(1986)
M Kaneko et al.
Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography
Radiology
(1996)

There are more references available in the full text version of this article.

Cited by (301)

Results of 10-year mobile low-dose computed tomography screenings for lung cancer in Shimane, Japan
2022, Respiratory Investigation
Some randomized controlled trials have evaluated the effects of low-dose computed tomography (CT) screening on lung cancer mortality in heavy smokers. Based on the results of those trials, our CT screening program recommended screening for people aged ≥40 years with a history of smoking. This retrospective study aimed to verify the validity of our CT screening program and elucidate the current state of CT screening program.
We retrospectively examined lung cancer detection in 25,189 participants who underwent chest CT screening by a mobile low-dose CT screening unit in the 10-year period from April 2009 to March 2019. Participants were recruited at Japan Agricultural Cooperatives (JA) Shimane Kouseiren. Participants requested CT screening for lung cancer. CT images were read by two pulmonologists.
Lung cancer was identified in 82 of the 25,189 participants over 10 years, an overall lung cancer detection rate (percentage of lung cancers detected among all participants) of 0.33%. Lung cancer among never smokers accounted for 54.9% of the detected cases. The lung cancer detection rate was similar for smokers versus never smokers. The stage IA detection rate (percentage of stage IA lung cancers among all lung cancers detected) was 62%, while the stage Ⅳ detection rate was 10%.
Chest CT detected lung cancer in never smokers as well as current or former smokers. Our CT screening program was not effective for never smokers; thus, further study of the effectiveness of CT screening in never smokers is needed.
Low-dose Lung Cancer Screening at an Academic Medical Center: Initial Experience and Dose Reduction Strategies
2018, Academic Radiology
Implementation of low dose computed tomography (LDCT) lung cancer screening programs has followed the demonstration of reduced lung cancer mortality in the National Lung Screening Trial and subsequent consensus screening recommendations. Here we aim to assess the initial results of a screening program at an academic medical center, to discuss the challenges of implementing such a program, and suggest strategies for reducing patient dose.
Retrospective review of all patients who underwent LDCT lung cancer screening at our institution between March 2015 and July 2016 was performed to assess the lung cancer detection rate, the spectrum of imaging findings (nodule or mass characteristics, degree of emphysema, etc.), and patient radiation dose indices.
A total of 272 patients were screened during the study period. Approximately 50% (n = 135) were women. The lung cancer detection rate was 2.2% (n = 6). One patient underwent chemoradiation therapy, whereas the remainder underwent uneventful thoracoscopic resection. Approximately, 80% of screened patients met United States Preventative Services Task Force criteria for LDCT screening. The median pack-years of smoking was 42 pack-years. The mean volume CT dose index for the screening CTs was 3.12 mGy. Utilizing tube current modulation and iterative reconstruction, where available, resulted in lower patient doses.
Initial LDCT lung cancer screening at our institution yielded results similar to those of the National Lung Screening Trial. Thorough prescreening evaluation, joint decision-making, centralized coordination of screening-related care, and patient size conscious scanning protocols are critical elements of a safe and successful lung cancer screening program.
Opportunistic lung cancer screening with low-dose computed tomography in National Cancer Center of China: The first 14 years' experience
2024, Cancer Medicine
Accuracy of baseline low-dose computed tomography lung cancer screening: a systematic review and meta-analysis
2023, Chinese Medical Journal
The value of artificial intelligence in the diagnosis of lung cancer: A systematic review and meta-analysis
2023, PLoS ONE
Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality
2022, Cochrane Database of Systematic Reviews

View all citing articles on Scopus

View full text

Chest

Clinical InvestigationsLung Cancer ScreeningLung Cancer Screening Using Low-Dose Spiral CT: Results of Baseline and 1-Year Follow-up Studies

Study objective

Design

Methods

Results

Conclusion

Section snippets

Subjects

Prevalence of SPNs at Baseline Screening

Results of the Baseline Screening

Discussion

ACKNOWLEDGMENT

Lancet

Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial-Sloan Kettering study

Am Rev Respir Dis

Early lung cancer detection; results of the initial (prevalence) radiologic and cytologic screening in the Mayo clinic study

Am Rev Respir Dis

Lung cancer screening: the Mayo program

J Occup Med

Survival and mortality from lung cancer in a screened population: the Johns Hopkins study

Chest

Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography

Radiology

Clinical Investigations
Lung Cancer Screening
Lung Cancer Screening Using Low-Dose Spiral CT: Results of Baseline and 1-Year Follow-up Studies