Diagnostic Performance of Low-Dose Computed Tomography Screening for Lung Cancer over Five Years

Veronesi, Giulia; Maisonneuve, Patrick; Spaggiari, Lorenzo; Rampinelli, Cristiano; Pardolesi, Alessandro; Bertolotti, Raffaella; Filippi, Niccolò; Bellomi, Massimo

doi:10.1097/jto.0000000000000200

Cited by 55 publications

(36 citation statements)

References 28 publications

(26 reference statements)

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“…The detection rates in this study were similar to a prior lung phantom study that showed a detection rate of 91% for standard CT acquisition and 97% of standard acquisition with CAD [18], and also to studies investigating CT acquisitions of real patients, such as the study of Veronesi et al that showed a sensitivity of 90% with a standard lung CT protocol [27]. A recent study by Doo et al, using exactly the same anthropomorphic chest phantom as the present study, investigated the detectability of 5 mm and 8 mm ground-glass nodules (-630 and -800 HU) with a low-dose acquisition and iterative construction (effective does of 0.47 mSv) [28].…”

Section: Discussionsupporting

confidence: 73%

Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging

et al. 2016

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Section: Discussionsupporting

confidence: 73%

Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging

et al. 2016

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“…The overall sensitivity of PET-CT alone in our study (64%) was somewhat lower than the 71% of the Danish study, where 8 (40%) out of the overall 20 malignancies were identified at baseline, compared with 60 (30%) out of 196 in our experience. Baseline cancers are usually more often PET-positive since they are more often large and dense [22].…”

Section: Discussionmentioning

confidence: 99%

Positron emission tomography in the diagnostic work-up of screening-detected lung nodules

et al. 2014

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Low-dose computed tomography (CT) screening for lung cancer can reduce lung cancer mortality, but overdiagnosis, false positives and invasive procedures for benign nodules are worrying. We evaluated the utility of positron emission tomography (PET)-CT in characterising indeterminate screeningdetected lung nodules. 383 nodules, examined by PET-CT over the first 6 years of the COSMOS (Continuous Observation of Smoking Subjects) study to diagnose primary lung cancer, were reviewed and compared with pathological findings (surgically-treated patients) or follow-up (negative CT for ⩾2 years, considered negative); 196 nodules were malignant.The sensitivity, specificity and accuracy of PET-CT for differentially diagnosing malignant nodules were, respectively, 64%, 89% and 76% overall, and 82%, 92% and 88% for baseline-detected nodules. Performance was lower for nodules found at repeat annual scans, with sensitivity ranging from 22% for nonsolid to 79% for solid nodules ( p=0.0001). Sensitivity (87%) and specificity (73%) were high for nodules ⩾15 mm, better (sensitivity 98%) for solid nodules ⩾15 mm.PET-CT was highly sensitive for the differential diagnosis of indeterminate nodules detected at baseline, nodules ⩾15 mm and solid nodules. Sensitivity was low for sub-solid nodules and nodules discovered after baseline for which other methods, e.g. volume doubling time, should be used. @ERSpublications PET-CT is good at differentially diagnosing large, solid and baseline-detected lung nodules in the screening setting

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“…Veronesi et al (55) described the causes of false negatives in the COSMOS lung cancer screening study. Centrally located or endobronchial lesions were disproportionately represented in missed lung cancers.…”

Section: Factors Leading To Missed Lung Cancer On Chest Ctmentioning

confidence: 99%

Missed lung cancer: when, where, and why?

Ciello

Franchi²,

Contegiacomo³

et al. 2017

Diagn Interv Radiol

131

106

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L ung cancer accounts for 1.59 million deaths per year worldwide (1). It has one of the poorest survival outcomes of all cancers, with over two-thirds of patients diagnosed at an advanced stage, when curative treatment is no longer feasible. Early diagnosis of lung cancer is the main goal to improve survival. Patients with non-small cell lung cancer (NSCLC) at an operable stage have higher survival rates than those presenting with metastatic disease, with five-year survival of 71%-77% for stage IA and 58% for stage IB (2).Initial identification of lung cancer in asymptomatic patients usually occurs on chest radiography or chest computed tomography (CT). When missed on imaging, lung cancer is inclined to progress from early-stage to advanced-stage disease, particularly if many years pass between radiologic exams (3), with potential medicolegal consequences.Legal actions involving malignancies of the bronchus or lung represent the sixth most common medicolegal issue, and among radiologists it is the second most common cause for litigation (4). About 90% of presumed mistakes in pulmonary tumor diagnosis occurred on chest radiography, only 5% on CT examinations, and the remaining 5% on other imaging studies (4).Awareness of the possible causes for overlooking a pulmonary lesion can help radiologists to reduce the occurrence of this eventuality. In this review, we analyze factors leading to a misdiagnosis of lung cancer mainly on chest radiography, and we discuss the impact of misdiagnosis on prognosis, its medicolegal implications, and methods to reduce the incidence of missed lung cancer. Finally, we briefly analyze the possible causes of errors on CT scans and potential aids. Factors leading to missed lung cancer on chest radiographyFormerly, different authors recognized the burden of missed lung cancer on radiography of the thorax. Indeed, early studies on the analysis of factors leading to overlooked lung lesions date back to the middle of last century. Despite extensive technological advancement, this issue is currently present and not much has changed since then. Factors that contribute to missed lung cancer on chest X-ray can be classified as deriving from observer error, tumor characteristics, and technical considerations. C H E S T I MAG I N G R E V I E W ABSTRACTMissed lung cancer is a source of concern among radiologists and an important medicolegal challenge. In 90% of the cases, errors in diagnosis of lung cancer occur on chest radiographs. It may be challenging for radiologists to distinguish a lung lesion from bones, pulmonary vessels, mediastinal structures, and other complex anatomical structures on chest radiographs. Nevertheless, lung cancer can also be overlooked on computed tomography (CT) scans, regardless of the context, either if a clinical or radiologic suspect exists or for other reasons. Awareness of the possible causes of overlooking a pulmonary lesion can give radiologists a chance to reduce the occurrence of this eventuality. Various factors contribute to a misdiagnosis of lung cancer ...

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Diagnostic Performance of Low-Dose Computed Tomography Screening for Lung Cancer over Five Years

Cited by 55 publications

References 28 publications

Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging

Performance of ultralow-dose CT with iterative reconstruction in lung cancer screening: limiting radiation exposure to the equivalent of conventional chest X-ray imaging

Positron emission tomography in the diagnostic work-up of screening-detected lung nodules

Missed lung cancer: when, where, and why?

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