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Early detection of lung cancer may be possible with combination of spiral computed tomography and positron emission tomography

Early detection of lung cancer may be possible with a combination of spiral computed tomography and positron emission tomographic scanning, according to preliminary study results reported in the August 23rd issue of the Lancet. The authors suggest that future randomized trials may assess the usefulness of the techniques for widespread population-level screening.

The authors of the European study note that low-dose spiral computed tomography of the chest effectively detects early-stage lung cancer in high-risk individuals; however the high detection rate of benign lesions has been an obstacle to a trial of large-scale screening programs.

In the current study, Ugo Pastorino, MD, Peter Boyle, MD, and their colleagues investigated the effectiveness of yearly spiral computed tomographic scanning and selective use of positron emission scanning (to increase the accuracy of initial findings) in a large population of high-risk volunteers. Over 1000 heavy smokers (minimum consumption 26 cigarettes per day for 37 years) aged 50 years or older underwent annual low-dose spiral computed tomography, with or without positron emission tomography, for 5 years. Lesions up to 5 mm in size were deemed non-suspicious, and screening was repeated after another year.

By the second year of assessment, 22 cases of lung cancer had been diagnosed (11 at baseline, 11 at the beginning of year 2). A total of 440 lung lesions were identified in 298 participants (29 percent), and 95 were recalled for high-resolution contrast computed tomography. Positron emission tomographic scans were positive in 18 of 20 of the identified cancer cases. Removal of malignant tissue was achieved in 95 percent of lung cancer tumors.

Pastorino commented, "We have shown that low-dose spiral computed tomography combined with selective use of positron emission tomography can effectively detect early lung cancer. A more conservative approach to very small computed tomography-detected nodules is justified, and lesions up to 5 mm can be followed up at 12 months without major risks of progression. Although prospective randomized trials are the proper instrument with which to measure the ultimate outcome of any screening policy, pilot studies addressing specific technical issues and methods are of fundamental importance in a phase of accelerated development of imaging and molecular technology, to design the optimum protocol to be tested in large-scale trials."

In an accompanying Commentary, Stefan Diederich, MD, wrote, "The study by Pastorino and colleagues adds an important aspect to the field of lung cancer screening with low-dose computed tomography - that is, simplification of the diagnostic algorithm for nodule classification. More data are required to define the ideal algorithm. Furthermore, prospective randomized trials are underway to analyze whether regular low-dose computed tomography can, in fact, reduce mortality from lung cancer."


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