The 2021 USPSTF lung cancer screening guidelines: a new frontier

Potter, Alexandra L.; Bajaj, Simar S.; Yang, Chi‐Fu Jeffrey

doi:10.1016/s2213-2600(21)00210-1

Cited by 38 publications

(35 citation statements)

References 6 publications

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“…The National Lung Screening Trial (NLST) reported a reduction in lung cancer mortality with chest computed tomography (CT) screening in the participants with high cancer risk [2]. Since 2013, the Preventive Services Task Force (USPSTF) has recommended low-dose computed tomography for lung cancer screening [3]. With the increased application of chest CT for lung cancer screening, pure ground-glass nodules (pGGNs) were frequently found [4].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Invasive Adenocarcinomas among Pure Ground-Glass Nodules Less Than 2 cm in Diameter

Hsu

Huang

Pan

et al. 2021

Cancers

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Benign lesions, atypical adenomatous hyperplasia (AAH), and malignancies such as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IA) may feature a pure ground-glass nodule (pGGN) on a thin-slide computed tomography (CT) image. According to the World Health Organization (WHO) classification for lung cancer, the prognosis of patients with IA is worse than those with AIS and MIA. It is relatively risky to perform a core needle biopsy of a pGGN less than 2 cm to obtain a reliable pathological diagnosis. The early and adequate management of patients with IA may provide a favorable prognosis. This study aimed to disclose suggestive signs of CT to accurately predict IA among the pGGNs. A total of 181 pGGNs of less than 2 cm, in 171 patients who had preoperative CT-guided localization for surgical excision of a lung nodule between December 2013 and August 2019, were enrolled. All had CT images of 0.625 mm slice thickness during CT-guided intervention to confirm that the nodules were purely ground glass. The clinical data, CT images, and pathological reports of those 171 patients were reviewed. The CT findings of pGGNs including the location, the maximal diameter in the long axis (size-L), the maximal short axis diameter perpendicular to the size-L (size-S), and the mean value of long and short axis diameters (size-M), internal content, shape, interface, margin, lobulation, spiculation, air cavity, vessel relationship, and pleural retraction were recorded and analyzed. The final pathological diagnoses of the 181 pGGNs comprised 29 benign nodules, 14 AAHs, 25 AISs, 55 MIAs, and 58 IAs. Statistical analysis showed that there were significant differences among the aforementioned five groups with respect to size-L, size-S, and size-M (p = 0.029, 0.043, 0.025, respectively). In the univariate analysis, there were significant differences between the invasive adenocarcinomas and the non-invasive adenocarcinomas with respect to the size-L, size-S, size-M, lobulation, and air cavity (p = 0.009, 0.016, 0.008, 0.031, 0.004, respectively) between the invasive adenocarcinomas and the non-invasive adenocarcinomas. The receiver operating characteristic (ROC) curve of size for discriminating invasive adenocarcinoma also revealed similar area under curve (AUC) values among size-L (0.620), size-S (0.614), and size-M (0.623). The cut-off value of 7 mm in size-M had a sensitivity of 50.0% and a specificity of 76.4% for detecting IAs. In the multivariate analysis, the presence of air cavity was a significant predictor of IA (p = 0.042). In conclusion, the possibility of IA is higher in a pGGN when it is associated with a larger size, lobulation, and air cavity. The air cavity is the significant predictor of IA.

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Section: Introductionmentioning

confidence: 99%

Predictors of Invasive Adenocarcinomas among Pure Ground-Glass Nodules Less Than 2 cm in Diameter

Hsu

Huang

Pan

et al. 2021

Cancers

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“…Still, such studies will have to be carefully designed since scanners with a lower resolution might miss some features of EGFR mutations. International guidelines suggest that low-dose spiral CT screening should be carried out in high-risk groups[ 22 , 33 - 35 ]. Still, low-dose CT is only suitable for routine screening in high-risk groups.…”

Section: Discussionmentioning

confidence: 99%

“…Still, low-dose CT is only suitable for routine screening in high-risk groups. Once suspicious lesions are found during screening, routine HRCT examination should be performed to enable a more detailed assessment of lesions[ 22 , 33 - 35 ]. The present study only included patients who underwent HRCT as confirmation of regular lung cancer screening.…”

Section: Discussionmentioning

confidence: 99%

High-resolution computed tomography findings independently predict epidermal growth factor receptor mutation status in ground-glass nodular lung adenocarcinoma

Zhu¹,

Xu²,

Zhang³

et al. 2021

WJCC

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BACKGROUND For lung adenocarcinoma with epidermal growth factor receptor (EGFR) gene mutation, small molecule tyrosine kinase inhibitors are more effective. Some patients could not obtain enough histological specimens for EGFR gene mutation detection. Specific imaging features can predict EGFR mutation status to a certain extent. AIM To assess the associations of EGFR mutations with high-resolution computerized tomography (HRCT) features in ground-glass nodular lung adenocarcinoma. METHODS This study retrospectively assessed patients with ground-glass nodular lung adenocarcinoma diagnosed between January 2011 and March 2017. EGFR gene mutations in exons 18-21 were detected. The patients were classified into mutant EGFR and wild-type groups, and general data and HRCT image characteristics were assessed. RESULTS Among 98 patients, 31 (31.6%) and 67 (68.4%) had mutated and wild-type EGFR in exons 18-21, respectively. Gender, age, smoking history, location of lesions, morphology, edges, borders, pleural indentations, and associations of nodules with bronchus and blood vessels were comparable in both groups (all P > 0.05). Patients with mutant EGFR had larger nodules than those with the wild-type (17.19 ± 6.79 and 14.37 ± 6.30 mm, respectively; P = 0.047). Meanwhile, the vacuole/honeycomb sign was more frequent in the mutant EGFR group ( P = 0.011). The logistic regression prediction model included the combination of nodule size and vacuole/honeycomb sign (OR = 1.120, 95%CI: 1.023-1.227, P = 0.014) revealed a sensitivity of 83.9%, a specificity of 52.2% and an AUC of 0.698 (95%CI: 0.589-0.806; P = 0.002). CONCLUSION Nodule size and vacuole/honeycomb features could independently predict EGFR mutation status in ground-glass nodular lung adenocarcinoma.

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“…Albeit with a very different time-course, these three chronic respiratory diseases (COPD, ILAs, IPF) manifest clinically with a very similar pattern, i.e., progressive dyspnea that is often underestimated because it is considered a physiologic effect of aging and smoking, with episodes of exacerbations of dyspnea and, in different proportions, other respiratory symptoms (cough, sputum, and wheezing). They are almost invariably diagnosed in elderly smokers and are associated with an increased risk of lung cancer, multimorbidity, and mortality, with mortality being higher and sooner in IPF [12,36,37].…”

Section: Idiopathic Pulmonary Fibrosismentioning

confidence: 99%

“…These chronic diseases also often manifest with progressive dyspnea and episodes of exacerbations of dyspnea [36]. Aging and smoking are also associated with an increased risk of lung cancer, which is also associated with these chronic respiratory diseases [37].…”

Section: Idiopathic Pulmonary Fibrosismentioning

confidence: 99%

COPD, Pulmonary Fibrosis and ILAs in Aging Smokers: The Paradox of Striking Different Responses to the Major Risk Factors

Beghè

Cerri

Fabbri

et al. 2021

IJMS

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Aging and smoking are associated with the progressive development of three main pulmonary diseases: chronic obstructive pulmonary disease (COPD), interstitial lung abnormalities (ILAs), and idiopathic pulmonary fibrosis (IPF). All three manifest mainly after the age of 60 years, but with different natural histories and prevalence: COPD prevalence increases with age to >40%, ILA prevalence is 8%, and IPF, a rare disease, is 0.0005–0.002%. While COPD and ILAs may be associated with gradual progression and mortality, the natural history of IPF remains obscure, with a worse prognosis and life expectancy of 2–5 years from diagnosis. Acute exacerbations are significant events in both COPD and IPF, with a much worse prognosis in IPF. This perspective discusses the paradox of the striking pathological and pathophysiologic responses on the background of the same main risk factors, aging and smoking, suggesting two distinct pathophysiologic processes for COPD and ILAs on one side and IPF on the other side. Pathologically, COPD is characterized by small airways fibrosis and remodeling, with the destruction of the lung parenchyma. By contrast, IPF almost exclusively affects the lung parenchyma and interstitium. ILAs are a heterogenous group of diseases, a minority of which present with the alveolar and interstitial abnormalities of interstitial lung disease.

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The 2021 USPSTF lung cancer screening guidelines: a new frontier

Cited by 38 publications

References 6 publications

Predictors of Invasive Adenocarcinomas among Pure Ground-Glass Nodules Less Than 2 cm in Diameter

Predictors of Invasive Adenocarcinomas among Pure Ground-Glass Nodules Less Than 2 cm in Diameter

High-resolution computed tomography findings independently predict epidermal growth factor receptor mutation status in ground-glass nodular lung adenocarcinoma

COPD, Pulmonary Fibrosis and ILAs in Aging Smokers: The Paradox of Striking Different Responses to the Major Risk Factors

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