Lung cancer screening: from imaging to biomarker

Abstract

Despite several decades of intensive effort to improve the imaging techniques for lung cancer diagnosis and treatment, primary lung cancer is still the number one cause of cancer death in the United States and worldwide. The major causes of this high mortality rate are distant metastasis evident at diagnosis and ineffective treatment for locally advanced disease. Indeed, approximately forty percent of newly diagnosed lung cancer patients have distant metastasis. Currently, the only potential curative therapy is surgical resection of early stage lung cancer. Therefore, early detection of lung cancer could potentially increase the chance of cure by surgery and underlines the importance of screening and detection of lung cancer. In the past fifty years, screening of lung cancer by chest X-Ray (CXR), sputum cytology, computed tomography (CT), fluorescence endoscopy and low-dose spiral CT (LDCT) has not improved survival except for the recent report in 2010 by the National Lung Screening Trial (NLST), which showed a 20 percent mortality reduction in high risk participants screened with LDCT compared to those screened with CXRs. Furthermore, serum biomarkers for detection of lung cancer using free circulating DNA and RNA, exosomal microRNA, circulating tumor cells and various lung cancer specific antigens have been studied extensively and novel screening methods are being developed with encouraging results. The history of lung cancer screening trials using CXR, sputum cytology and LDCT, as well as results of trials involving various serum biomarkers, are reviewed herein.

Public Preferences for Lung Cancer Screening Policies

“…This would entail that a critical part of such an undertaking would be to assess the costs of implementing and running lung cancer screening policies [42]. Because a CT-based national policy may be costly, new less costly modalities such as breath analysis or biomarkers may be advantageous [7,8]. Our study suggests that the perceived value of such screening modalities can be substantial if these could be realized in a primary care setting.…”

“…Most research has been done with respect to imaging-based screening modalities, in which it was found that chest x-ray provided no additional survival benefit over sputum cytology [4] and that low-dose computed tomography (LDCT) reduced cancer-related mortality by 20% compared with chest x-ray [5,6]. Less expensive and more accessible screening modalities are breath or blood biomarkers [7,8]. Nevertheless, because these are early in development there is still insufficient evidence regarding accuracy, standardization, calibration, and method of sample collection.…”

Role of imaging in diagnosis, staging and follow-up of lung cancer

“…Low-dose computed tomography (LDCT) can be used for lung cancer screening. A recent report in 2010 by the National Lung Screening Trial (NLST) showed a 20% mortality reduction in high-risk participants screened with LDCT compared with those screened with chest radiography (CXR) [1]. Multidetector computed tomography (MDCT) is the imaging modality of choice for the initial evaluation of suspected or proven lung cancer.…”

“…One of the major causes of the high mortality rate is distant metastasis at the moment of diagnosis. Approximately 40% of newly diagnosed lung cancer patients have distant metastasis [1]. The imaging approach to lung cancer can be divided into different processes: screening, detection, diagnosis, staging and followup.…”

Advances in the Early Detection of Lung Cancer using Analysis of Volatile Organic Compounds: From Imaging to Sensors

“…Recently, CT was recommended by the National Comprehensive Cancer Network for the screening of lung cancer in high risk groups. However, little evidence supported this recommendation, and lots of problems still exist in the application of this technique (Field et al, 2012;Spiro and Navani., 2012;Tanner et al, 2012;Xiang et al, 2013). Similarly, PET technique also has limitations in detecting and staging lung cancer, including low spatial resolution, and inconspicuous contrast among different tissues, etc (De Wever et al, 2007).…”