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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 45(7): 605-8, 2011 Jul.
Article in Chinese | MEDLINE | ID: mdl-22041563

ABSTRACT

OBJECTIVE: To discuss the effect of different positive criteria on the sensitivity and specificity of sputum cytology screening for lung cancer among Yunnan tin miners. METHODS: 9223 Yunnan tin miners who received at least one annual sputum cytology screening for lung cancer during the period between 1992 and 1999 were recruited in the study. At time of enrollment, all participants were aged over 40 years old, had at least 10 years of employment as an underground miner and(or) smelter, and had not been diagnosed with malignancy. In our study, a true positive was categorized as having at least one prior positive sputum screening and a diagnosis of lung cancer, while a true negative, by our definition, signified negative sputum examinations and no diagnosis of lung cancer during the follow up time. Based on different positive criteria, sensitivity and specificity of sputum cytology were computed and receiver operating characteristic (ROC) curve analysis was conducted. Z statistic was used to test the differences of the area under ROC based on Hanley and McNeil method. RESULTS: By the end of following up on December 31, 2001, a total 500 lung cancer cases were diagnosed among 9223 participants: most were squamous cell carcinoma (55.8% (222/398)) and central lung cancers (68.5% (316/461)). 150 lung cancer cases had a previous positive sputum screening result. When positive criteria were taken as grave atypical metaplasia, moderate atypical metaplasia and slight atypical metaplasia, the corresponding sensitivities were 30.0% (150/500), 36.4% (182/500), 53.0% (265/500) respectively; while the corresponding specificities were 98.9% (8628/8723), 95.1% (8611/8723), 77.9% (7033/8723) respectively. The areas under ROC curve according to different positive criterias were 0.645 (95%CI: 0.635 - 0.654), 0.657 (95%CI: 0.668 - 0.667), 0.655 (95%CI: 0.645 - 0.664) respectively. There were no significant differences found in the comparisons between grave and moderate atypical metaplasia, grave and slight atypical metaplasia, moderate and slight atypical metaplasia(Z statistics were 0.780, 0.645, 0.209 respectively, all P values > 0.05). CONCLUSION: While the standard of positive criteria for diagnosis of lung cancer decreased, the sensitivity of sputum cytology screening increased and the specificity decreased. Since there were no significant differences of accuracy for different positive criteria.


Subject(s)
Cytodiagnosis/methods , Cytodiagnosis/standards , Lung Neoplasms/diagnosis , Sputum/cytology , Female , Humans , Male , Mass Screening/methods , Sensitivity and Specificity
2.
Lung Cancer ; 72(2): 258-63, 2011 May.
Article in English | MEDLINE | ID: mdl-21367481

ABSTRACT

We used the data from a prospective cohort study among tin miners in Yunnan, China to investigate whether prior lung disease is a risk factor for lung cancer. Information on prior lung disease was obtained from baseline questionnaires. The Cox proportional hazards model was used to examine the relationship between prior lung disease and lung cancer risk. From 1992 to 2001, a total of 502 lung cancer cases were confirmed among 9295 cohort participants. Prior chronic bronchitis was associated with an increase in lung cancer risk with an adjusted HR of 1.50 (95% CI: 1.24-1.81). There was an increased risk of developing squamous cell carcinoma in the setting of prior chronic bronchitis and small cell carcinoma in association with asthma with an adjusted HRs of 1.57 (95% CI: 1.19-2.09) and 2.56 (95% CI: 1.38-4.75), respectively. This prospective study provides further evidence that prior chronic bronchitis correlates with increased lung cancer risk, especially for squamous cell carcinoma. Asthma is associated with increased risk of small cell lung carcinoma.


Subject(s)
Asthma/epidemiology , Bronchitis/epidemiology , Carcinoma, Small Cell/epidemiology , Carcinoma, Squamous Cell/epidemiology , Lung Neoplasms/epidemiology , Adult , Aged , Aged, 80 and over , Asthma/pathology , Asthma/physiopathology , Bronchitis/pathology , Bronchitis/physiopathology , Carcinoma, Small Cell/pathology , Carcinoma, Small Cell/physiopathology , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/physiopathology , China , Chronic Disease , Humans , Lung Neoplasms/pathology , Lung Neoplasms/physiopathology , Male , Middle Aged , Occupational Exposure/adverse effects , Prospective Studies , Risk , Surveys and Questionnaires
3.
Chest ; 135(3): 778-785, 2009 Mar.
Article in English | MEDLINE | ID: mdl-19265088

ABSTRACT

BACKGROUND: Individuals with cytologic atypia in sputum may be at high risk for the development of lung cancer. METHODS: A prospective cohort study was conducted among occupational tin miners in Yunnan, China, based on an annual lung cancer screening program. Sputum samples were collected prospectively at baseline and the following seven annual screenings. The associations between risk factors and sputum cytology were analyzed by univariate and multivariate logistic regression. A proportional hazard model was used to analyze the association between the baseline sputum results and the incidence of lung cancer. The effect of consecutive sputum cytology on the increase of lung cancer risk was analyzed by logistic regression. RESULTS: Sputum cytologic atypia was associated with age, smoking, occupational radon and arsenic exposure, and asthma. Sputum cytologic atypia was an independent risk factor for lung cancer with an adjusted hazard ratio (HR) of 3.82 (95% confidence interval [CI], 2.82 to 5.18) in comparing normal to moderate or worse atypia. Compared to the lung cancer risk associated with normal sputum, the risk was significantly higher according to the degree of atypia for squamous carcinomas, small cell lung cancer and central lung cancer, with adjusted HRs of 5.70 (95% CI, 3.78 to 8.59), 3.32 (95% CI, 1.31 to 8.45), and 4.93 (95% CI, 3.51 to 6.92), respectively. CONCLUSIONS: Sputum atypia is associated with an increased risk of lung cancer. Sputum cytologic examination combined with other screening examinations may play an important role in the early detection of lung cancer or in the selection of the optimal target population for more intensive lung cancer screening among this occupational cohort or similar population.


Subject(s)
Lung Neoplasms/diagnosis , Mining , Occupational Diseases/diagnosis , Sputum/cytology , Tin , Adult , Aged , Arsenic/adverse effects , Chi-Square Distribution , Female , Humans , Lung Neoplasms/etiology , Male , Middle Aged , Neoplasms, Radiation-Induced/diagnosis , Neoplasms, Radiation-Induced/etiology , Occupational Diseases/etiology , Occupational Exposure , Radon/adverse effects , Risk Factors , Smoking/adverse effects
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