Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT

Pegna, Andrea Lopes; Picozzi, Giulia; Mascalchi, Mario; Carozzi, Francesca; Carrozzi, Laura; Comin, Camilla E.; Spinelli, Cheti; Falaschi, Fabio; Grazzini, Maddalena; Innocenti, F.; Rabascio, Cristina; Paci, Euǵenio

doi:10.1016/j.lungcan.2008.07.003

Cited by 255 publications

(147 citation statements)

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“…These included the National Lung Cancer Screening Trial (NLST) in the United States [10] and the Nelson Trial and others in Europe [11][12][13][14][15]. The results of the NLST trial were published in 2011 [16].…”

mentioning

confidence: 99%

Lung cancer screening: current status

McLoud

2013

Radiol med

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Lung cancer remains the leading cause of death from malignancy with approximately 1.3 million deaths occurring world wide per year [1]. Approximately 70 % of cases have incurable disease at presentation which is either widely metastatic or locally advanced [1]. The overall 5-year survival still remains very low at only 14 % [1]. Lung cancer, however, which is detected early in its course, demonstrates much better survival data. Survival in non-small-cell lung cancer Stage I is greater than 70 % and small peripheral less than 1 cm lung cancers have survival rates of greater than 80 % [2]. The rationale for screening is, therefore, obvious. Diagnosis of lung cancer early in preclinical stages has a higher cure rate and, therefore, high-risk asymptomatic individuals are likely to benefit from screening.The introduction of helical and subsequently multidetector CT in the 1990s led to a number of feasibility studies in which CT was used as a screening tool for the detection of early asymptomatic lung cancer. Observational single arm trials were conducted for several years in many countries including the United States, Japan, and Europe [3][4][5][6][7][8]. These studies established the sensitivity of low-dose CT for early lung cancer detection. These trials also tested algorithms for diagnostic workup and demonstrated a reduction in the incidence of advanced non-small-cell lung cancer with screening. A high percentage (84-93 %) was Stage I lung cancers [3][4][5]. They also produced somewhat similar results. They demonstrated that detection of earlystage lung cancer was higher than that reported previously with standard chest radiography [9] but that the false positive rate was at least three times that of standard radiographs. In regard to diagnostic algorithms, these studies provided evidence that peripheral nodules greater than 8-10 mm in size required further investigation because of the high likelihood of lung cancer. Such investigations included further imaging with PET-CT, percutaneous biopsy or resection and often led to invasive procedures. Smaller nodules (\8 mm diameter) could be managed with CT follow-up to determine interval growth indicating the likelihood of malignancy.These single arm feasibility and observational studies provided compelling evidence of the effectiveness of helical and MDCT as a screening tool for early detection of lung cancer. However, they were not sufficient to determine screening effectiveness because they were not able to assess the influence of CT screening on lung cancer mortality. Only randomized controlled trials can determine effectiveness of screening where the end point must be a decrease in mortality in the screened group as compared to a non-screened control.Subsequently, several prospective randomized controlled trials were undertaken both in the United States and Europe. These included the National Lung Cancer Screening Trial (NLST) in the United States [10] and the Nelson Trial and others in Europe [11][12][13][14][15]. The results of the NLST trial were published in 2...

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confidence: 99%

Lung cancer screening: current status

McLoud

2013

Radiol med

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“…In addition, many screening programs have adopted a 5 mm diameter nodule size as the cutoff between positive and negative nodules on CT 1 , 2 , 3 , 4 , 5 , 6 , 7 . Therefore, we used 6 mm HGGOs and analyzed the relationship between the visibility, SNR M 2 and CTDI vol .…”

Section: Methodsmentioning

confidence: 99%

“…Low‐dose computed tomography (CT) for lung cancer screening has been well established as a more effective method of detecting nodules and lung cancers, including early‐stage cancers, than plain chest radiography 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 . In low‐dose CT for lung cancer screening (LDCT), the detection task is typically the observation of focal lung opacities or nodules.…”

Section: Introductionmentioning

confidence: 99%

A phantom study investigating the relationship between ground‐glass opacity visibility and physical detectability index in low‐dose chest computed tomography

Ichikawa

Kobayashi

Sagawa

et al. 2015

J Applied Clin Med Phys

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In this study, the relationship between ground‐glass opacity (GGO) visibility and physical detectability index in low‐dose computed tomography (LDCT) for lung cancer screening was investigated. An anthropomorphic chest phantom that included synthetic GGOs with CT numbers of ‐630 Hounsfield units (HU; high attenuation GGO: HGGO) and ‐800 HU (low attenuation GGO: LGGO), and three phantoms for physical measurements were employed. The phantoms were scanned using 12 CT systems located in 11 screening centers in Japan. The slice thicknesses and CT dose indices (CTDIvol) varied over 1.0–5.0 mm and 0.85–3.30 mGy, respectively, and several reconstruction kernels were used. Physical detectability index values were calculated from measurements of resolution, noise, and slice thickness properties for all image sets. Five radiologists and one thoracic surgeon, blind to one another's observations, evaluated GGO visibility using a five‐point scoring system. The physical detectability index correlated reasonably well with the GGO visibility (R2=0.709,p<0.01 for 6 mm HGGO and R2=0.646,p<0.01 for 10 mm LGGO), and was nearly proportional to the CTDIvol. Consequently, the CTDIvol also correlated reasonably well with the GGO visibility (R2=0.701,p<0.01 for 6 mm HGGO and R2=0.680,p<0.01 for 10 mm LGGO). As a result, the CTDIvol was nearly dominant in the GGO visibility for image sets with different reconstruction kernels and slice thicknesses, used in this study.PACS numbers: 81.70.Tx, 87.57.Q‐

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“…Even in lung cancers screening designed for strong smokers enrolled with various criteria, were occasionally included asbestos-exposed subjects (22)(23)(24)37). In I-ELCAP study, subjects with professional asbestos exposure enrolled were about 5% (23), while in NLST (38) study 4.6% of active group and 4.8% of control group were asbestos exposed workers.…”

Section: Ldct Lung Cancer Screening In Asbestos-exposed Workersmentioning

confidence: 99%

Imaging of malignant pleural mesothelioma: it is possible a screening or early diagnosis program?—a systematic review about the use of screening programs in a population of asbestos exposed workers

Falaschi¹,

Romei²,

Fiorini

et al. 2018

J. Thorac. Dis.

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Malignant pleural mesothelioma (MPM) in an uncommon neoplasia with high mortality rate, mostly related to professional asbestos exposure. Clinical manifestations are not specific so that diagnosis is performed at advanced stage and screening protocols are not feasible now. On the other hand, asbestosexposed workers have a high incidence of developing lung cancer. Low-dose computed tomography (LDCT) is a volumetric acquisition technique with high spatial resolution and a low dose exposure; it is used in many trials to detect lung tumours at an early stage in screening protocols, reducing mortality rate in smoker subjects. In recent papers, the possibly role of lung cancer screening was evaluated and recommended also in subjects exposed to asbestos. This article summarizes previous and present clinical trials validated for lung cancer screening, to discuss the possibility of early diagnosis or screening programs in a population of asbestos exposed workers by LDCT.

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Design, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT

Cited by 255 publications

References 20 publications

Lung cancer screening: current status

Lung cancer screening: current status

A phantom study investigating the relationship between ground‐glass opacity visibility and physical detectability index in low‐dose chest computed tomography

Imaging of malignant pleural mesothelioma: it is possible a screening or early diagnosis program?—a systematic review about the use of screening programs in a population of asbestos exposed workers

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