Lung Cancer Screening with Low Dose Chest CT in a High Risk Population. Initial Experience and Observations with the First 5,693 Scans Performed
Michael F. Szwerc, Stephanie L. Scarlett, Danielle J. Smith, Richard F. Kucera, Srinivas Annamraju, Jon M. Sweany, Allen M. Rakers.
Excela Heath, Greensburg, PA, USA.
Objective Lung Cancer is responsible for the highest number of cancer related deaths worldwide. Recent clinical trails including the National Lung Screening Trial (NLST) and the NELSON Trial have demonstrated a marked reduction in lung cancer mortality when screening eligible patients with low dose chest computed tomography (LDCT). Despite this, screening rates remain low, especially in underserved populations with significant environmental and occupational exposures. Methods This is a retrospective review of a single institutional experience with 3008 patients who met eligibility criteria and underwent LDCT from January 2016 through July 2019. All scans were interpreted using Lung-RADS and DynaCAD analysis. All Lung-RADS 3 and 4 scans were evaluated by a multidisciplinary team. Data reviewed included Lung -RADS, stage of disease, procedures performed and outcome. Results A total of 5693 scans were performed (3008 new and 2685 follow-up). Initial Lung RADS 1 or 2 scans were found in 2,241 patients( 75%) . Cancer was diagnosed in 67 patients (2.2%) of which Stage I NSCLC was diagnosed in 67% (22 initial, 18 follow-up scans). A total of 174 invasive procedures were performed including 46 anatomic lung resections (91 % robotic) and 6 thymectomies. Conclusion This review demonstrates the ability of regional lung centers to develop LDCT screening programs that can identify and treat patients who have early stage lung cancer. Future analysis should help to clarify if these programs show mortality benefits in line with NLST and NELSON. In addition, LDCT will identify incidental findings that need to be addressed.
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