ABSTRACT
Lung cancer is the leading cause of cancer-related death in China. The effectiveness of low-dose computed tomography (LDCT) screening has been further validated in recent years, and significant progress has been made in research on identifying high-risk individuals, personalizing screening interval, and management of screen-detected findings. The aim of this study is to revise China national lung cancer screening guideline with LDCT (2018 version). The China Lung Cancer Early Detection and Treatment Expert Group (CLCEDTEG) designated by the China's National Health Commission, and China Lung Oncolgy Group experts, jointly participated in the revision of Chinese lung cancer screening guideline (2023 version). This revision is based on the recent advances in LDCT lung cancer screening at home and abroad, and the epidemiology of lung cancer in China. The following aspects of the guideline were revised: (1) lung cancer risk factors besides smoking were considered for the identification of high risk population; (2) LDCT scan parameters were further classified; (3) longer screening interval is recommended for individuals who had negative LDCT screening results for two consecutive rounds; (4) the follow-up interval for positive nodules was extended from 3 months to 6 months; (5) the role of multi-disciplinary treatment (MDT) in the management of positive nodules, diagnosis and treatment of lung cancer were emphasized. This revision clarifies the screening, intervention and treatment pathways, making the LDCT screening guideline more appropriate for China. Future researches based on emerging technologies, including biomarkers and artificial intelligence, are needed to optimize LDCT screening in China in the future. .
Subject(s)
Humans , Lung Neoplasms/epidemiology , Early Detection of Cancer/methods , Artificial Intelligence , Mass Screening/methods , Tomography, X-Ray Computed/methods , China/epidemiologyABSTRACT
O câncer de pulmão é reconhecidamente um dos mais agressivos dentre os tumores, com alta letalidade. A detecção precoce do câncer de pulmão com tomografia computadorizada de baixa dose tem sido avaliada em diversos países e implementada em alguns. Entretanto, a implementação do rastreamento com uso dessa tecnologia para detecção precoce de novos casos, permanece questionado no mundo, e no Brasil não está recomendado. Por esse motivo, foi elaborada uma avaliação de custo-efetividade do uso da tomografia computadorizada de baixa dose como estratégia de rastreamento para detecção precoce do câncer de pulmão em população de risco sob a perspectiva do Sistema Único de Saúde como órgão financiador. Inicialmente uma revisão sistemática foi elaborada e descrita uma síntese das diferentes abordagens disponíveis nas avaliações econômicas. Os 30 estudos selecionados e incluídos na revisão mostraram qualidade global, com bom padrão metodológico, que atendeu a mais de 80% dos critérios estabelecidos pelo formulário (Consensus Health Economic Criteria list). A análise da eficiência comparativa entre duas alternativas (anual e bianual) para o diagnóstico precoce de câncer de pulmão, considerando a estratégia de rastreamento com tomografia computadorizada de baixa dose e a conduta clínica sem rastreio, como cenário de referência, teve por base uma coorte hipotética de 100.000 indivíduos assintomáticos, e tabagistas de alto risco. O horizonte temporal considerou a expectativa de vida dos indivíduos, e a perspectiva foi o Sistema Único de Saúde como financiador da assistência à saúde. Apenas os custos médicos diretos dos itens relacionados ao processo de diagnóstico e tratamento foram estimados. O desfecho foi medido em anos de vida ganhos. O desconto de 5% foi aplicado aos custos e benefícios. E realizadas análises de sensibilidade determinística univariada e probabilística. A razão de custo-efetividade incremental da estratégia de rastreamento anual com a tomografia computadorizada de baixa dose para a detecção precoce de câncer de pulmão foi estimada em R$ 97.583,52 por cada ano de vida ganho e de R$ 56.642,20 por ano de vida ganho, com o rastreio a cada dois anos. A análise determinística mostrou que o impacto da redução da incidência de câncer de pulmão, em ambas as alternativas (anual e bianual), chega a gerar quase o triplo dos gastos estimados para a razão de custo-efetividade incremental. Para o anual esse aumento chega a R$ 176.834,47, fora do limiar de R$105.000,00, enquanto o rastreamento bianual, mesmo dobrando os gastos, ainda se manteria dentro do limiar de custo-efetividade atualmente definido para o país. Os demais parâmetros de relevância (sensibilidade do rastreamento para detecção de câncer e a proporção de diagnósticos em estadio I/II com o rastreamento) não impactaram nos resultados finais. A análise probabilística das alternativas de rastreamento mostrou para o rastreamento anual 52% das simulações dentro do limiar estabelecido e 94,2% referente ao bianual. O resultado do modelo econômico mostrou resultados favoráveis com a adoção da estratégia de rastreamento de câncer de pulmão com uso de tomografia computadorizada de baixa dose comparada a condução clínica, realizada a cada dois anos em população de alto risco, sob a perspectiva do SUS. (AU)
Lung cancer is one of the most aggressive tumors, with high lethality. Early detection of lung cancer with low-dose computed tomography has been evaluated in several countries and implemented in some. However, the implementation of screening using this technology for early detection of new cases remains questioned worldwide, but in Brazil, it has not been recommended. Thus, a cost-effectiveness assessment of a screening strategy with low-dose computed tomography for early lung cancer detection in a high-risk population under the Unified Health System perspective as a funding body. First, a systematic review was performed and synthesized the different approaches available in economic evaluations. Thirty studies selected and included in the review showed overall quality, with a well-designed methodological standard, which met more than 80% of the criteria established by the Consensus Health Economic Criteria (CHEC) list form. The analysis of the comparative efficiency between two alternatives (annual and biannual) for the early diagnosis of lung cancer, considering the screening strategy with low-dose computed tomography and the clinical management, without screening, as a reference scenario, was based on a cohort hypothetical 100,000 asymptomatic individuals, and high-risk smokers. The time horizon considered the individuals' life expectancy, and the perspective was the Brazilian Unified Health System as the funder of health care. Only the direct medical costs of items related to the diagnosis and treatment process were estimated. The outcome measure was life years gained. A discount of 5% has been applied to costs and benefits. A deterministic and probabilistic sensitivity analysis has been performed. The incremental cost-effectiveness ratio of the annual screening strategy for early lung cancer detection has been estimated at BRL 97,583.52 for each life-year gained and BRL 56,642.20 per year of life gained, with screening every two years. The deterministic analysis showed that the impact of reducing the incidence of lung cancer, in both alternatives (annual and biannual) generated almost three times the estimated expenses for the incremental cost-effectiveness ratio. For the annual survey, this increase reaches BRL 176,834.47, outside the BRL 105,000.00 threshold, while biannual screening, even doubling the expenses, would remain within the cost-effectiveness threshold currently defined for the country. The other relevant parameters (screening sensitivity for cancer detection and the proportion of stage I/II diagnoses with screening) have no impact on the final results. The probabilistic analysis showed that 52% of simulations within the established threshold correspond to the annual screening, and 94.2% to the biannual. The economic model designed to evaluate the cost-effectiveness of lung cancer screening using low-dose computed tomography compared to clinical care showed favorable results from the strategy performed every two years in a high-risk population, under the SUS perspective. (AU)
Subject(s)
Humans , Unified Health System , Tomography, X-Ray Computed , Mass Screening , Early Detection of Cancer , Lung Neoplasms , Brazil , Cost-Effectiveness AnalysisABSTRACT
OBJECTIVES@#Low dose computed tomography (LDCT) is the best method for early diagnosis of lung cancer. Even though it has been widely used in clinic, the selection of screening objects and the management scheme of pulmonary nodules are still not unified among research institutions. This study aims to evaluate the effect of LDCT in detection effect and follow-up process for pulmonary nodules in asymptomatic participants.@*METHODS@#A total of 1 600 asymptomatic participants (37 to 82 years old), who came from Yantian District People's Hospital, Southern University of Science and Technology, received LDCT. The lung nodules were categorized into positive nodules and semi-positive nodules, and according to the density of positive nodules they were categorized into 4 types: solid nodules (SN), partial solid nodules (pSN), pure ground glass nodules (pGGN), and pleural nodules (PN). The number, detection rate, imaging findings, follow-up change of lung nodules, and the postoperative pathological results of positive nodules were recorded and analyzed.@*RESULTS@#Lung nodules were found in 221 cases by LDCT. The total detection rate of lung nodule was 13.8% (221/1 600), and the detection rate in positive nodules was 4.9% (79/1 600). The detected nodules were mainly single (173 cases), solid (133 cases) and semi-positive nodules (142 cases). Most of nodules (177 cases) had no change in the follow-up process. The enlargement and/or increased density of nodules (5 cases) were lung cancer. Pathological results were obtained in 10 cases, 8 cases were malignant (1 small cell lung cancer and 7 adenocarcinomas), 2 cases were benign (cryptococcal infection and alveolar epithelial dysplasia). The detection rate of lung cancer was 0.5% (8/1 600), and the proportion of early lung cancer was 75% (6/8).@*CONCLUSIONS@#LDCT screening can identify and increase the detection rate in the early lung cancer, which is an effective screening method. It is safe and feasible to take regular follow-up and re-examination for nodules with diameter less than 5 mm. When the size and or density of nodule increases, it indicates the malignant prognosis of the nodule and timely clinical intervention is needed.
Subject(s)
Adult , Aged , Aged, 80 and over , Humans , Middle Aged , Adenocarcinoma , Early Detection of Cancer/methods , Lung Neoplasms/pathology , Mass Screening/methods , Tomography, X-Ray Computed/methodsABSTRACT
Objective:To analyze recent economic evaluation studies of low-dose CT screening for lung cancer in order to provide recommendations for such economic evaluation in China. Methods:A systematic search and analysis was conducted to identify articles on low-dose CT screening for lung cancer published from 2015 to 2019. Results:According to the literature inclusion criteria， 15 studies were included. Most of the studies were conducted in Europe， the United States and other developed countries. The majority adopted model simulation approaches. Low-dose CT screening was suggested to be cost-effective compared with no-screening or chest radiography for lung cancer in 13 studies. Only 2 studies showed no cost-effectiveness. Conclusion:The latest evidence of economic evaluation shows that low-dose CT screening for lung cancer is cost-effective and has a more consistent result than previous reviews. Methodologically， use of microsimulation models is increasing for better economic evaluation at the individual level. However， evidence from developing countries is still insufficient. It is necessary to conduct economic evaluation in combination with the domestic practice of lung cancer screening and localized data．
ABSTRACT
@#The widespread use of low-dose computed tomography (LDCT) in lung cancer screening has enabled more and more lung nodules to get identified of which more than 20% are multiple pulmonary nodules. At present, there is no guideline or consensus for multiple pulmonary nodules whose management is based primarily on the pulmonary imaging characteristics and associated risk factors. Herein, this review covers the imaging methods, CT appearances and management of multiple pulmonary nodules.
ABSTRACT
Objective@#To evaluate the efficacy of lung cancer screening in urban areas of Henan province by low-dose computed tomography (LDCT) from 2013 to 2017.@*Methods@#A cluster sampling method was used to select the residents of 40-74 years old in Henan province to investigate the risk factors and conduct lung cancer risk assessment. Subjects with high risk of lung cancer received LDCT for screening.@*Results@#A total of 179 002 residents completed the lung cancer risk assessment, and 35 672 subjects were identified as high risk of lung cancer, with a high risk rate of 19.93%. A total of 13 383 subjects with high risk received LDCT, and the screening rate was 37.52%. There were 786 cases diagnosed as positive nodules, and the detection rate was 5.87%. Among them, 755 cases of solid/partial solid nodule were ≥5 mm, 23 cases of non-solid nodules were ≥8 mm, 8 cases were intratracheal nodules, and 115 cases were diagnosed as suspicious lung cancer. The detection rate in males was 6.74%, which was higher than 5.02% in females. The detection rate was positively related with age (P<0.05).@*Conclusions@#The application of LDCT is a useful screening method which can elevate the early detection rate of positive nodules and other related diseases in lungs. In the future, males and older populations should be paid more attention to improve screening efficacy.
ABSTRACT
Lung cancer is a leading cause of cancer death worldwide. The effectiveness of lung cancer targeted high-risk population using low dose chest computed tomography has been reported several randomized controlled trials. Thus, recently, lung cancer screening to high-risk group is recommended internationally. National Cancer Center reported a lung cancer screening guideline by evidence-based methods in 2015. Korean national lung cancer screening program started from 2019 after evaluation of Korean lung cancer screening demonstration project (K-LUCAS) nationwide. K-LUCAS obtained comparable high early lung cancer detection rate, lower false positive rate and lower complication rate compared with clinical trials conducted in other countries. Also psychological anxiety of screening participants had been low, but willingness of smoking cessation had been increased after screening. This paper will review the evidence of lung cancer screening from clinical trials, also, evaluate the benefits and harms of screening based on K-LUCAS.
Subject(s)
Anxiety , Korea , Lung Neoplasms , Lung , Mass Screening , Medical Overuse , Smoking Cessation , ThoraxABSTRACT
PURPOSE: To reduce lung cancer mortality, lung cancer screening was recommended using low-dose computed tomography (LDCT) to high-risk population. A protocol for multicenter lung cancer screening pilot project was developed to evaluate the effectiveness and feasibility of lung cancer screening to implement National Cancer Screening Program in Korea. MATERIALS AND METHODS: Multidisciplinary expert committee was comprised to develop a standardized protocol for Korean Lung Cancer Screening Project (K-LUCAS). K-LUCAS is a population-based single arm trial that targets high-risk population aged 55-74 years with at least 30 pack-year smoking history. LDCT results are reported by Lung-RADS suggested by American Radiology Society. Network-based system using computer-aided detection program is prepared to assist reducing diagnostic errors. Smoking cessation counselling is provided to all currently smoking participants. A small pilot test was conducted to check the feasibility and compliance of the protocols for K-LUCAS. RESULTS: In pilot test, 256 were participated. The average age of participants was 63.2 years and only three participants (1.2%) were female. The participants had a smoking history of 40.5 pack-year on average and 53.9% were current smokers. Among them, 86.3% had willing to participate in lung cancer screening again. The average willingness to quit smoking among current smokers was 12.7% higher than before screening. In Lung-RADS reports, 10 (3.9%) were grade 3 and nine (3.5%) were grade 4. One participant was diagnosed as lung cancer. CONCLUSION: The protocol developed by this study is assessed to be feasible to perform K-LUCAS in multicenter nationwide scale.
Subject(s)
Female , Humans , Arm , Compliance , Diagnostic Errors , Early Detection of Cancer , Korea , Lung Neoplasms , Lung , Mass Screening , Mortality , Pilot Projects , Smoke , Smoking , Smoking CessationABSTRACT
PURPOSE: Because of growing concerns about lung cancer in female never smokers, chest low-dose computed tomography (LDCT) screening is often performed although it has never shown clinical benefits. We examinewhether or not female never smokers really need annual LDCT screening when the initial LDCT showed negative findings. MATERIALS AND METHODS: This retrospective cohort study included 4,365 female never smokers aged 40 to 79 years who performed initial LDCT from Aug 2002 to Dec 2007. Lung cancer diagnosis was identified from the Korea Central Cancer Registry Database registered until December 31, 2013. We calculated the incidence, cumulative probability, and standardized incidence ratio (SIR) of lung cancer by Lung Imaging Reporting and Data System (Lung-RADS) categories showed on initial LDCT. RESULTS: After median follow-up of 9.69 years, 22 (0.5%) had lung cancer. Lung cancer incidence for Lung-RADS category 4 was 1,848.4 (95% confidence interval [CI], 1,132.4 to 3,017.2) per 100,000 person-years and 16.4 (95% CI, 7.4 to 36.4) for categories 1, 2, and 3 combined. The cumulative probability of lung cancer for category 4 was 10.6% at 5 years and 14.8% at 10 years while they were 0.07% and 0.17% when categories 1, 2, and 3 were combined. The SIR for subjects with category 4 was 43.80 (95% CI, 25.03 to 71.14), which was much higher than 0.47 (95% CI, 0.17 to 1.02) for categories 1, 2, and 3 combined. CONCLUSION: Considering the low risk of lung cancer development in female never smokers, it seems unnecessary to repeat annual LDCT screening for at least 5 years or even longer unless the initial LDCT showed Lung-RADS category 4 findings.
Subject(s)
Female , Humans , Cohort Studies , Diagnosis , Follow-Up Studies , Incidence , Information Systems , Korea , Lung Neoplasms , Lung , Mass Screening , Retrospective Studies , Thorax , Tomography, X-Ray ComputedABSTRACT
Objective@#To evaluate the changes of volume and mass of pulmonary nodules which were detected in low-dose computed tomography (LDCT) screening, and to analyze the influencing factors.@*Methods@#This retrospective study analyzed the CT images of the participants who underwent at least two chest LDCT scanning from March 2009 to December 2015 in National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The inclusion criteria was the nodule diameter ≥6 mm; the volume growth was defined as ≥20%. Fifty-one pulmonary nodules (PNs) were selected among 51 enrolled participants (26 men and 25 women). According to characteristic of nodule and risk stratification of participant, the nodules were classified into different groups (10 non-solid nodules, 17 part-solid nodules and 24 solid nodules; 14 PNs in high-risk group, 12 PNs in moderate-risk group and 25 PNs in low-risk group). The Lung-VCAR software was used to measure the diameter and volume of the PNs, and all nodules were calculated for the volume doubling time (VDT) and mass doubling time (MDT).@*Results@#Among the 51 PNs, the diameter of 33 nodules increased more than 1.5 mm while 18 nodules increased less than 1.5 mm. The median VDT of part-solid nodules was 364 days, which was shorter than that of non-solid nodules and solid nodules (761 and 819 days, respectively), the differences were statistically significant (both P<0.05). The median MDT of part-solid nodules was 351 days, which was lower than that of non-solid nodules and solid nodules (772 days and 840 days, respectively). The difference was statistically significant (P<0.05). The median VDT and MDT of the pulmonary nodules in the high-risk group were 181 days and 256 days, respectively, which were lower than those in the low risk group (1 037 days and 1 035 days, respectively). VDT has good correlation with MDT (r=0.909, P<0.001).@*Conclusions@#Both the characteristic of PNs and the risk status of the participants could affect the growth of nodules in LDCT screening. The part-solid nodules and high-risk group nodules grew relatively faster, which should be closely focused on. Compared with the two-dimensional diameter, the three-dimensional quantitative indicators (VDT and MDT) were more sensitive for nodule growth. The mass changes of part-solid nodules were earlier than that of volume.
ABSTRACT
Lung cancer has become one of the most threatening malignant tumors in human life.Its morbidity and mortality rank is the first place in malignant tumors,so it is particularly important to screen for lung cancer.With the widespread use of low-dose CT,the detection rate of pulmonary nodules is increasing,and its research is also in-depth.This article described the status of lung cancer screening,factors of benign and malignant pulmonary nodules.It could provide the basis information for prevention and treatment of the lung cancer and pulmonary nodules.