Lung Cancer Associated With Cystic Airspaces

Farooqi, Ali; Cham, Matt; Zhang, Lijuan; Beasley, Mary Beth; Austin, John; Miller, Albert; Zulueta, Javier J.; Roberts, Heidi C.; Cole, Enser; Kao, Shu Huei; Thorsen, M K; Smith, James P.; Libby, Daniel M.; Yip, Rowena; Yankelevitz, David F.; Henschke, Claudia I.

doi:10.2214/ajr.11.7812

Cited by 110 publications

(99 citation statements)

References 17 publications

(28 reference statements)

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“…Although several screening trials have used the maximum diameter of nodules on transverse sections to estimate size, others (iELCAP) have used the average of long-and short-axis diameters measured by using lung windows (4,5,7,14,15). Prediction models used to estimate malignancy yield better results with the average diameter than with the maximum transverse diameter (16).…”

Section: Recommendations For Managing Incidentally Discovered Pulmonamentioning

confidence: 99%

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

et al. 2017

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The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. Table. These are followed by graded ratings of each recommendation using the American College of Chest Physicians recommendations for evidence grading in clinical guidelines (9). Additional explanations are provided regarding the rationale for each recommendation, which is based on the consensus of a multidisciplinary team and a systematic review of the literature, further details of which are included in Appendix E1 [online]. The minimum threshold size for recommending follow-up is based on an estimated cancer risk in a nodule on the order of 1% or greater. This criterion is necessarily arbitrary, and we recognize that a higher threshold may be considered appropriate in some environments and that this threshold will ultimately depend on social and economic factors. Several general considerations regarding technical aspects of using these recommendations are also presented. Finally, in Appendix E1 (online), additional information regarding methods and risk factors is given. detected at CT in adult patients who are at least 35 years old. Separate guidelines have been issued for lung cancer screening, such as those from the American College of Radiology (ACR), and we support the use of those guidelines when interpreting the results of CT screening (8). Specific recommendations are provided for patients with multiple solid and subsolid nodules, and several other commonly encountered clinical situations are addressed.These guidelines are not intended for use in patients with known primary cancers who are at risk for metastases, nor are they intended for use in immunocompromised patients who are at risk for infection; in these patients, treatment should be based on the specific clinical situation. Also, because lung cancer is rare in children and adults younger than 35 years, these guidelines are no...

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Section: Recommendations For Managing Incidentally Discovered Pulmonamentioning

confidence: 99%

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

et al. 2017

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“…Solid nodules may have external or internal cystic airspace or internal cavitation (15). Subsolid nodules may be either nonsolid or part-solid (7,19,20).…”

Section: Definition Of Nodule Consistencymentioning

confidence: 99%

“…Other findings on the CT scan of the chest should also be reported and these include the presence of discrete cystic airspaces because when the walls of these airspaces show progressive thickening, both in increasing thickness and increasing circumferential wall involvement, these maybe due to lung cancer (15).…”

Section: Other Findings On the Ct Scanmentioning

confidence: 99%

“…Starting with the initial protocol developed for CT screening for lung cancer in 1992 (2-4), the protocol has been continuously updated based on the results of conferences held every 6 months (5,6) and on subsequent data emerging from CT screening (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The protocol has been recently updated, integrating the latest technologies advances and knowledge (21).…”

Section: Introductionmentioning

confidence: 99%

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The importance of the regimen of screening in maximizing the benefit and minimizing the harms

Henschke¹,

Li²,

Yip³

et al. 2016

Ann. Transl. Med.

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Background: In CT screening for lung cancer, the regimen of screening is critical in diagnosing lung cancer early while limiting unnecessary tests and invasive procedures. The International Early Lung Cancer Action Program (I-ELCAP) has developed a regimen based on evidence collected in the I-ELCAP cohort of more than 70,000 participants.Methods: Important in the development of the regimen is the recognition of the profound difference between the first, baseline round of screening and all subsequent rounds of repeat screening. For each person undergoing screening, the baseline round happens only once while repeat rounds will be performed annually for many years.This difference needs to be clearly recognized as it is these annual rounds which allow for identification of small, early, yet aggressive, lung cancers which have high cure rates despite their aggressiveness. The importance of nodule consistency and size are key factors in the regimen. The regimen needs to be continuously updated by incorporating advances in technology and knowledge.Results: The use of the I-ELCAP regimen reduces the workup of participants in the screening program to less than 10% in the baseline round and less than 6% in the annual repeat rounds. By use of this regimen, estimated cure rate of lung cancers diagnosed under screening is 80% or higher in both baseline and annual repeat rounds. Conclusions:The I-ELCAP collaboration provides a new paradigm that answers the 2002 NCI call for multiple approaches to address relevant questions about screening and the Institute of Medicine (IOM) Roundtable on Evidence-based Medicine from the National Academy of Science's call for a "new clinical research paradigm that takes better advantage of data generated in the course of healthcare delivery would speed and improve the development of evidence for real-world decision making".

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“…Indolent pulmonary cancers comprise ground glass opacities (GGO), solid and cystic nodules, the pathological morphology of which is usually a lepidic pattern, as well as carcinoids and scar adenocarcinomas. Farooqi et al (5) reported a case of a 56-year-old male smoker who had a nodule with a cystic airspace and thin wall in the right lower lobe. The patient was followed up for 33 months, at which time the CT scan showed enlarged solid components and a thickened cyst wall.…”

Section: Introductionmentioning

confidence: 99%

Right upper lobectomy performed as dividing posterior ascending artery-bronchus-pulmonary vessels is alternative to primary indolent scar carcinomas

Zhai

Nie

Dong³

et al. 2016

J. Thorac. Dis.

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Lung Cancer Associated With Cystic Airspaces

Abstract: At annual repeat CT screening, the finding of an isolated cystic airspace with increased wall thickness should raise the suspicion of lung cancer.

Cited by 110 publications

References 17 publications

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

The importance of the regimen of screening in maximizing the benefit and minimizing the harms

Right upper lobectomy performed as dividing posterior ascending artery-bronchus-pulmonary vessels is alternative to primary indolent scar carcinomas

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