Probability of Cancer in Pulmonary Nodules Detected on First Screening CT

McWilliams, Annette; Tammemägi, M.; Mayo, John R.; Roberts, Heidi C.; Liu, Geoffrey; Soghrati, Kam; Yasufuku, Kazuhiro; Martel, Simon; Laberge, Francis; Gingras, Michel J. P.; Atkar-Khattra, Sukhinder; Berg, Christine D.; Evans, Ken; Finley, Richard J.; Yee, John; English, John; Nasute, Paola; Goffin, John R.; Puksa, Serge; Stewart, Lori; Tsai, Scott S. H.; Johnston, Michael; Manos, Daria; Nicholas, Garth; Goss, Glenwood D.; Seely, Jean M.; Amjadi, Kayvan; Tremblay, Alain; Burrowes, Paul; MacEachern, Paul; Bhatia, Rick; Tsao, Ming‐Sound; Lam, Stephen

doi:10.1056/nejmoa1214726

Cited by 1,074 publications

(1,075 citation statements)

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“…3f for comparison. The diagnosis of subcentimetric nodules is challenging even with standard guidelines [3,13,14]. In the first case, we demonstrated that subcentimetric nodules could be reached with this technique.…”

Section: Discussionmentioning

confidence: 88%

A Novel Method for In Vivo Imaging of Solitary Lung Nodules Using Navigational Bronchoscopy and Confocal Laser Microendoscopy

Hassan¹,

Piton²,

Lachkar³

et al. 2015

Lung

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Solitary pulmonary nodules (SPN) have become increasingly prevalent and diagnostic management remains challenging. We demonstrate a novel technique in which probe-based confocal endomicroscopy (pCLE) could be performed to microimage SPN in vivo and in realtime. Two confocal wavelengths (488 and 660 nm with methylene blue (MB)) were used for elastin network and cellular imaging, respectively using pCLE in conjunction with r-EBUS and virtual navigation. In the first case, the 1-mm Alveoflex Ò was used to image a metastatic melanoma in a subcentimetric nodule in the right middle lobe. In the next case, a malignant 2-cm nodule in the posterior segment of the upper lobe was imaged using the smaller 0.6-mm Cholangioflex Ò . Lastly, we present a benign case revealing confocal characteristics of a nodular lipid pneumonitis. This reports for the first time the feasibility and utility of pCLE in vivo microimaging of SPN using either the Alveoflex or Cholangioflex miniprobes in addition to 660 nm/MB imaging.

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Section: Discussionmentioning

confidence: 88%

A Novel Method for In Vivo Imaging of Solitary Lung Nodules Using Navigational Bronchoscopy and Confocal Laser Microendoscopy

Hassan¹,

Piton²,

Lachkar³

et al. 2015

Lung

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“…Williams, et al (24) analyzed data from two cohorts of participants undergoing low-dose CT screening in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan) and the British Columbia Cancer Agency (BCCA). Outcomes of all nodules were detected on baseline lowdose CT scans.…”

Section: Risk Models To Evaluate "Indeterminate Nodules"mentioning

confidence: 99%

Risk prediction models in lung cancer: The methodology for identifying high risk individuals for future lung cancer computed tomography (CT) screening programs

Field¹,

Marcus²

2015

AACR Education book

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The results of the US National Lung Screening Trial (NLST) were published in 2011 and are considered a landmark event in lung cancer research (1). This randomized study of 53,454 individuals showed that computed tomography (CT) scans are able to reduce lung cancer mortality by 20 percent through early detection, although with important cost and morbidity due to overdiagnosis and treatment of benign nodules. (2) Several European lung cancer screening trials have also been initiated, with the largest being the NELSON trial in the Netherlands (3) and the plan is to pool data from a number of European trials (4). Clearly, screening tools that are able to identify lung cancers at an early stage have much potential to reduce the enormous burden on lung cancer mortality (5). There are now discussions on how implementation may be put in place across the world, within differing health care systems (6). The success of lung cancer screening will be dependent upon identifying populations at sufficient risk in order to maximize the benefit-to-harm ratio of the intervention.The recommendation from the US Preventive Task Forces is based on the US NLST trial, includes screening all individuals between the ages of 55 and 80 with a smoking history of 30 pack-years or more (one pack-year is 20 cigarettes/day for one year or 10 cigarettes/day for two years, etc.) (7). An in-depth analysis of the NLST showed that there were significant differences in the number of lung cancer cases detected based on underlying risk, even though all participants had satisfied the criteria for participation in the study and were considered at high risk: 60 percent of participants at highest risk for lung-cancer death (quintiles 3 through 5) accounted for 88 percent of the prevented deaths, whereas the 20 percent of participants at lowest risk (quintile 1) accounted for only 1 percent of prevented lung-cancer deaths (8). Risk Prediction ModelsThus, accurate selection of high-risk individuals for lung cancer screening requires robust methods for risk prediction (Fig. 1). The discriminative performance of a risk model depends

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“…The Canadian Pulmonary Risk model was developed utilising datasets from the Pan-Canadian Early detection of Lung cancer (PanCan) and validated in the chemoprevention trial dataset at the British Columbian Agency (BCCA) (9).…”

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confidence: 99%