Screening for lung cancer with low-dose spiral computed tomography

• Published in: American journal of respiratory and critical care medicine 2002-02, Vol.165 (4), p.508-513
• Main Authors: SWENSEN, Stephen J, JETT, James R, MARKS, Randolph S, CLAYTON, Amy C, PAIROLERO, Peter C, SLOAN, Jeff A, MIDTHUN, David E, HARTMAN, Thomas E, SYKES, Anne-Marie, AUGHENBAUGH, Gregory L, ZINK, Frank E, HILLMAN, Shauna L, NOETZEL, Gayle R
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; False Positive Reactions; Female; Humans; Incidence; Investigative techniques, diagnostic techniques (general aspects); Lung Neoplasms - diagnostic imaging; Lung Neoplasms - epidemiology; Lung Neoplasms - pathology; Lung Neoplasms - prevention & control; Male; Mass Screening; Medical sciences; Middle Aged; Prevalence; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Respiratory system; Smoking; Sputum - cytology; Tomography, X-Ray Computed; United States - epidemiology
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.165.4.2107006

Studies suggest that screening with spiral computed tomography can detect lung cancers at a smaller size and earlier stage than chest radiography can. To evaluate low-radiation-dose spiral computed tomography and sputum cytology in screening for lung cancer, we enrolled 1,520 individuals aged 50 yr or older who had smoked 20 pack-years or more in a prospective cohort study. One year after baseline scanning, 2,244 uncalcified lung nodules were identified in 1,000 participants (66%). Twenty-five cases of lung cancer were diagnosed (22 prevalence, 3 incidence). Computed tomography alone detected 23 cases; sputum cytology alone detected 2 cases. Cell types were: squamous cell, 6; adenocarcinoma or bronchioalveolar, 15; large cell, 1; small cell, 3. Twenty-two patients underwent curative surgical resection. Seven benign nodules were resected. The mean size of the non-small cell cancers detected by computed tomography was 17 mm (median, 13 mm). The postsurgical stage was IA, 13; IB, 1; IIA, 5; IIB, 1; IIIA, 2; limited, 3. Twelve (57%) of the 21 non-small cell cancers detected by computed tomography were stage IA at diagnosis. Computed tomography can detect early-stage lung cancers. The rate of benign nodule detection is high.