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Purpose. The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low radiation dose computed tomography (low-dose CT) in persons at high-risk for lung cancer.Methods. Since starting in 1993, the ELCAP has enrolled 1,000 asymptomatic persons, 60 years of age or older, with at least 10 pack-years (1 pack per day for 10 years, or 2 packs per day for 5 years) of cigarette smoking, no prior cancer, and medically fit to undergo thoracic surgery. After a structured interview and informed consent, baseline chest radiographs and low-dose CT were obtained on each subject. The diagnostic work-up of screen-detected noncalcified pulmonary nodules (NCN) was guided by ELCAP recommendations which included short-term highresolution CT follow-up for the smallest nodules.Baseline Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021, USA. Telephone: 212-746-2529; Fax: 212-746-2811 Received October 10, 2000 accepted for publication February 23, 2001. ©AlphaMed Press 1083-7159/2001 INTRODUCTIONIn the United States, the cure rate of lung cancer is a dismal 10%, and the 5-year survival rate is only slightly higher than the cure rate. In stage I lung cancer, by contrast, the 5-year survival rate upon resection is as high as 70%; but if left unresected, that rate is again of the order of a mere 10% [1,2]. While these rates imply that the cure rate of lung cancer can be substantially enhanced by screening and its associated earlier intervention, results of randomized trials have been interpreted as indicating that this is not the case [3].This paradox points to the possibility that the negative results of the randomized trials were a consequence of flaws in their design, execution and/or analysis. To quantify the

In modern CT screening for lung cancer at baseline, detected noncalcified nodules smaller than 5.0 mm in diameter do not justify immediate work-up but only annual repeat screening to determine whether interim growth has occurred.

Visual assessment of CAC on low-dose CT scans provides clinically relevant quantitative information as to cardiovascular death.

Abstract. We have studied the interaction between virulent Legionella pneumophila and human alveolar macrophages, the resident phagocytes at the site of infection in Legionnaires' disease. L. pneumophila multiplied 2.5-5 logs within 3 d, as measured by colony forming units, when incubated with freshly explanted alveolar macrophages in monolayer culture. At the peak of bacterial multiplication, the alveolar macrophage monolayers were destroyed. L. pneumophila multiplied more rapidly in 4-d-old than in freshly explanted alveolar macrophages. Inside alveolar macrophages, L. pneumophila were located within membrane-bound vacuoles whose cytoplasmic sides were studded with ribosomes.Alveolar macrophages that were incubated with concanavalin A (Con A) stimulated human mononuclear cell supernatants (cytokines), inhibited L. pneumophila multiplication, and the degree of inhibition was proportional to the concentration of Con A supernatant added.Anti-L. pneumophila antibody in conjunction with complement promoted phagocytosis of L. pneumophila by alveolar macrophages. By electron microscopy, most (75%) of the phagocytized L. pneumophila were intracellular. However, freshly explanted alveolar macroThis work was presented in part at the

In comparison with historically reported response rates, these data suggest that the addition of a selective COX-2 inhibitor may enhance the response to preoperative paclitaxel and carboplatin in patients with NSCLC. Moreover, treatment with celecoxib 400 mg twice daily was sufficient to normalize the increase in PGE2 levels found in NSCLC patients after treatment with paclitaxel and carboplatin. Confirmatory trials are planned.

As the Writing Committee for the I-ELCAP InvestigatorsPurpose:To empirically address the distribution of the volume doubling time (VDT) of lung cancers diagnosed in repeat annual rounds of computed tomographic (CT) screening in the International Early Lung Cancer Action Program (I-ELCAP), first and foremost with respect to rates of tumor growth but also in terms of cell types. Materials and Methods:All CT screenings in I-ELCAP from 1993 to 2009 were performed according to HIPAA-compliant protocols approved by the institutional review boards of the collaborating institutions. All instances of first diagnosis of primary lung cancer after a negative screening result 7-18 months earlier were identified, with symptom-prompted diagnoses included. Lesion diameter was calculated by using the measured length and width of each cancer at the time when the nodule was first identified for further work-up and at the time of the most recent prior screening, 7-18 months earlier. The length and width were measured a second time for each cancer, and the geometric mean of the two calculated diameters was used to calculate the VDT. The x 2 statistic was used to compare the VDT distributions. Results:The median VDT for 111 cancers was 98 days (interquartile range, 108). For 56 (50%) cancers it was less than 100 days, and for three (3%) cancers it was more than 400 days. Adenocarcinoma was the most frequent cell type (50%), followed by squamous cell carcinoma (19%), small cell carcinoma (19%), and others (12%). Lung cancers manifesting as subsolid nodules had significantly longer VDTs than those manifesting as solid nodules (P , .0001). Conclusion:Lung cancers diagnosed in annual repeat rounds of CT screening, as manifest by the VDT and cell-type distributions, are similar to those diagnosed in the absence of screening.q RSNA, 2012

COPD is the fourth leading cause of death in the United States and causes . 2.5 million deaths worldwide each year. [1][2][3] The most frequent cause of death in advanced COPD is respiratory failure, but in mild and moderate COPD, lung cancer and cardiovascular diseases account for two-thirds of the deaths. 4 GOLD (Global Initiative for Chronic Obstructive Lung Disease) defi nes COPD as a disease state characterized by the presence of airway obstruction that is not fully reversible. 5 In these patients, airfl ow obstruction is caused by a mixture of small airways disease (obstructive bronchiolitis) and parenchymal destruction (emphysema); the relative contributions vary from person to person. Airway obstruction, readily determined by spirometry, has been shown to predict an increased mortality rate in the general population. 6 Emphysema has been extensively studied physiologically, pathologically, and at autopsy, but not until recent advances in CT scan technology has there been a reliable means for its in vivo diagnosis and characterization. However, data regarding the signifi cance of CT scan-detected emphysema in deter mining outcomes are scarce. Studies have shown that the presence of emphysema on low-dose chest CT scan in a cohort participating in a lung cancer screening study is an independent risk factor for lung cancer. 7,8 A study that was limited to patients with lung cancer showed that CT scan-detected emphysema, but not airway obstruction, was associated with a worse prognosis. 9 Recently, the presence of emphysema on a CT scan has been associated with an increase in mortality in a small cohort of patients with COPD, most of whom entered the study in advanced stages of the disease. 10 To date, no relationship between emphysema as identifi ed on chest CT scan and mortality in the general population or in asymptomatic smokers has been reported. In the present study, we explored whether the presence and extent of emphysema detected on low-dose CT scans are risk factors for mortality from COPD or lung cancer among a large cohort of asymptomatic smokers.Objective: Our objective was to assess the usefulness of emphysema scores in predicting death from COPD and lung cancer. Methods: Emphysema was assessed with low-dose CT scans performed on 9,047 men and women for whom age and smoking history were documented. Each scan was scored according to the presence of emphysema as follows: none, mild, moderate, or marked. Follow-up time was calculated from time of CT scan to time of death or December 31, 2007, whichever came fi rst. Cox regression analysis was used to calculate the hazard ratio (HR) of emphysema as a predictor of death. Results: Median age was 65 years, 4,433 (49%) were men, and 4,133 (46%) were currently smoking or had quit within 5 years. Emphysema was identifi ed in 2,637 (29%) and was a signifi cant predictor of death from COPD (HR, 9.3; 95% CI, 4.3-20.2; P , .0001) and from lung cancer (HR, 1.7; 95% CI, 1.1-2.5; P 5 .013), even when adjusted for age and smoking history. Conclusions: Visual asses...