Increased use of diagnostic CT imaging increases the detection of stage IA lung cancer: pathways and patient characteristics

Abstract

Background At Silkeborg Regional Hospital, Denmark, the number of stage IA lung cancer increased after implementation of increased use of CT investigations and a corresponding reduction in chest X-ray. The aim of the present study was to understand the changes in referral pathways, patient characteristics and imaging procedures behind the observed increase in early-stage lung cancer. Methods The referral and imaging pathways for all patients diagnosed with lung cancer in 2013–2018 were described based on manually curated information from the electronic health care systems and staging information from the Danish Lung Cancer Registry. We compared the clinical characteristics of patients diagnosed in 2013–2015 and in 2016–2018 after implementation of a change in the use of low dose CT scan (LDCT). For patients diagnosed in 2016–2018, stage IA lung cancer were compared to higher stages using univariable logistic regression analysis. Results Five hundred and forty-seven patients were diagnosed with lung cancer in 2013–2018. Stage IA constituted 13.8% (34/247) in 2013–2015, and 28.3% (85/300) in 2016–2018. Stage IA patients in 2016–2018 were characterised by more comorbidity, fewer packyears and tended to be older than patients with higher stages. In 2016–2018, the largest proportion of stage IA patients (55%) came from within-hospital referrals. The majority of these lung cancers were detected due to imaging procedures with other indications than suspicion of lung cancer. The proportion of stage IA increased from 12% (12/99) to 36% (47/129) (p < 0.001) for hospital referrals and from 17% (22/129) to 23% (38/165) for GP referrals (p = 0.21). The imaging procedures contributing to the increase in stage IA was contrast enhanced CT (22%¸11/51), LDCT (35%; 18/51) and X-ray followed by LDCT (25%; 13/51). Conclusion The increased access to LDCT for patients referred from general practice and the increased hospital requested CT activity resulted in an increase in the number of stage IA lung cancers. Incidental findings on imaging performed for diagnostic purposes unrelated to suspicion of lung cancer contributed a large proportion of the increase.

Laterocervical lymph node metastases from suspected thyroidal primary site that turned out to be metastases of lung cancer: A case report

“…25 Thyroglobulin differentiates primary thyroid tumor from lung one but, in case of poor differentiation, differentiating metastatic lesion in thyroid gland is not easy. 22 In fact, FNAB accurately diagnosed metastatic disease 58% of cases, while it identified a malignancy in approximately 90% of cases. 23 Fine-needle aspiration (FNA) cytology coupled with needle-wash thyroglobulin (FNA-Tg) testing is recommended for detection of cervical lymph node metastasis in patients with papillary thyroid carcinoma, but this test has some limitations.…”

“…The pooled analysis shows that CTLS screening is associated with a significant increase in the surgical resection rate and, therefore, a reduction in LC‐related mortality of about 20% 20 . CTLS in this selected population allows obtaining a significant increase of early stage tumors diagnosis (stage IA) 22,23 . Finally, the U.S. Preventive Services Task Force (USPSTF) recommends annual screening for LC with LDCT in adults aged 50–80 years who have a history of 20 packs of cigarettes and currently smoke or have quit within the last 15 years.…”

“…However, lung adenocarcinoma and papillary thyroid carcinoma share architectural and nuclear changes and both lesions display TTF‐1 expression 25 . Thyroglobulin differentiates primary thyroid tumor from lung one but, in case of poor differentiation, differentiating metastatic lesion in thyroid gland is not easy 22 . In fact, FNAB accurately diagnosed metastatic disease in 58% of cases, while it identified a thyroid malignancy in approximately 90% of cases 23 …”

A collection of multiregistry data on patients at high risk of lung cancer—a Danish retrospective cohort study of nearly 40,000 patients

“…Additionally, in 2007, there was an extension allowing general practitioners to refer patients directly for CT scans in cases of vague symptoms suggestive of cancer. The rise in referrals for LC fast-track clinics and the direct path to CT scans from general practice contribute to an increased frequency of CT scans, a factor that has been demonstrated to lead to a stage shift toward early-stage LC ( 29 , 30 ).…”

Early Detection of Lung Cancer: Biomarkers and CT Scans

“…The use of CT thorax per 1,000 inhabitants differed by more than 50% in 2013, and the annual increase in CT thorax per 1,000 patients ranged from 1.9 to 3.4 among the regions (74). These regional differences are likely to arise from issues such as variation in patients' demand for CT exams, a potential shortage of radiologists in some regions and, as previously shown in a single-center study, restricted vs. liberal access to CT exams for clinicians (100).…”