USPSTF2013 versus PLCOm2012 lung cancer screening eligibility criteria (International Lung Screening Trial): interim analysis of a prospective cohort study.

BACKGROUND: Lung cancer is a major health problem. CT lung screening can reduce lung cancer mortality through early diagnosis by at least 20%. Screening high-risk individuals is most effective. Retrospective analyses suggest that identifying individuals for screening by accurate prediction models is more efficient than using categorical age-smoking criteria, such as the US Preventive Services Task Force (USPSTF) criteria. This study prospectively compared the effectiveness of the USPSTF2013 and PLCOm2012 model eligibility criteria. METHODS: In this prospective cohort study, participants from the International Lung Screening Trial (ILST), aged 55-80 years, who were current or former smokers (ie, had ≥30 pack-years smoking history or ≤15 quit-years since last permanently quitting), and who met USPSTF2013 criteria or a PLCOm2012 risk threshold of at least 1·51% within 6 years of screening, were recruited from nine screening sites in Canada, Australia, Hong Kong, and the UK. After enrolment, patients were assessed with the USPSTF2013 criteria and the PLCOm2012 risk model with a threshold of at least 1·70% at 6 years. Data were collected locally and centralised. Main outcomes were the comparison of lung cancer detection rates and cumulative life expectancies in patients with lung cancer between USPSTF2013 criteria and the PLCOm2012 model. In this Article, we present data from an interim analysis. To estimate the incidence of lung cancers in individuals who were USPSTF2013-negative and had PLCOm2012 of less than 1·51% at 6 years, ever-smokers in the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) who met these criteria and their lung cancer incidence were applied to the ILST sample size for the mean follow-up occurring in the ILST. This trial is registered at ClinicalTrials.gov, NCT02871856. Study enrolment is almost complete. FINDINGS: Between June 17, 2015, and Dec 29, 2020, 5819 participants from the International Lung Screening Trial (ILST) were enrolled on the basis of meeting USPSTF2013 criteria or the PLCOm2012 risk threshold of at least 1·51% at 6 years. The same number of individuals was selected for the PLCOm2012 model as for the USPSTF2013 criteria (4540 [78%] of 5819). After a mean follow-up of 2·3 years (SD 1·0), 135 lung cancers occurred in 4540 USPSTF2013-positive participants and 162 in 4540 participants included in the PLCOm2012 of at least 1·70% at 6 years group (cancer sensitivity difference 15·8%, 95% CI 10·7-22·1%; absolute odds ratio 4·00, 95% CI 1·89-9·44; p<0·0001). Compared to USPSTF2013-positive individuals, PLCOm2012-selected participants were older (mean age 65·7 years [SD 5·9] vs 63·3 years [5·7]; p<0·0001), had more comorbidities (median 2 [IQR 1-3] vs 1 [1-2]; p<0·0001), and shorter life expectancy (13·9 years [95% CI 12·8-14·9] vs 14·8 [13·6-16·0] years). Model-based difference in cumulative life expectancies for those diagnosed with lung cancer were higher in those who had PLCOm2012 risk of at least 1·70% at 6 years than individuals who were USPSTF2013-positive (2248·6 years [95% CI 2089·6-2425·9] vs 2000·7 years [1841·2-2160·3]; difference 247·9 years, p=0·015). INTERPRETATION: PLCOm2012 appears to be more efficient than the USPSTF2013 criteria for selecting individuals to enrol into lung cancer screening programmes and should be used for identifying high-risk individuals who benefit from the inclusion in these programmes. FUNDING: Terry Fox Research Institute, The UBC-VGH Hospital Foundation and the BC Cancer Foundation, the Alberta Cancer Foundation, the Australian National Health and Medical Research Council, Cancer Research UK and a consortium of funders, and the Roy Castle Lung Cancer Foundation for the UK Lung Screen Uptake Trial.

Post-CT-guided lung biopsy optimisation of the observation period by identifying patients at risk of delayed pneumothorax.

INTRODUCTION: Identify the risk factors for delayed pneumothorax after lung biopsy. METHODS: A retrospective study of 355 CT-guided lung biopsies was performed at Fiona Stanley Hospital, Western Australia over 42 months. A comprehensive range of patient, lesion and procedural variables were recorded. All post-procedural complications including time, size of pneumothorax and post-biopsy radiographs were reviewed. Lasso logistic regression model was utilised to determine factors predicting patient complications. RESULTS: A total of 167 patients (47%) developed a pneumothorax, in which 34% were significant, requiring longer observation or drain insertion. The majority of pneumothoraces occurred within the first hour (86%), with 90% detected at the time of the procedure. Then, 12% were detected more than 3 h post-procedure, of which 8 patients (5%) had a significant delayed pneumothorax. Factors increasing the likelihood of significant pneumothorax include the length of lung traversed, smaller nodule size, surrounding emphysema, increased age and lateral patient position with the lesion in the non-dependent aspect. Increasing patient age, longer length of lung traversed and smaller nodule diameter increase the risk of delayed onset of pneumothorax (more than 3 h). CONCLUSION: The results of this study align with other studies indicating it is safe to discharge stable patients within an hour post-lung biopsy. However, specific risk factors, including age, small lesion size and deep lesions, may identify patients who could benefit from a longer observation period.

Air trapping in small airway diseases: A review of imaging technique and findings with an overview of small airway diseases.

Air trapping is a common finding radiologists encounter on CT imaging of the thorax. This term is used when there are geographic areas of differing attenuation within the lung parenchyma. Most commonly, this is the result of abnormal retention of air due to complete or partial airway obstruction from small airway pathologies. Perfusional differences due to underlying vascular diseases could also result in these appearances, and hence, inspiratory and full expiratory phase CT studies are required to accurately diagnose air trapping. It is important to note that this can occasionally be present in healthy patients. Multiple diseases are associated with air trapping. Determining the aetiology relies on accurate patient history and concomitant findings on CT. There is currently no consensus on accurate assessment of the severity of air trapping. The ratio of mean lung density between expiration and inspiration on CT and the change in lung volume have demonstrated a positive correlation with the presence of small airway disease. Treatment and resultant patient outcome depend on the underlying aetiology, and hence, radiologists need to be familiar with the common causes of air trapping. This paper outlines the most common disease processes leading to air trapping, including Constrictive bronchiolitis, Hypersensitivity pneumonitis, DIPNECH, and Post-infectious (Swyer-James/Macleod). Various diseases result in the air trapping pattern seen on the expiratory phase CT scan of the thorax. Combining patient history with other concomitant imaging findings is essential for accurate diagnosis and to further guide management.

Lung cancer reported as a benign lesion due to low-dose chest computed tomography artefact: A case report.

CT imaging for lung cancer screening requires low dose technique. Low dose CT chest imaging is associated with an increased risk of artefacts, such as increased noise. We present a case where an artefact from the low dose technique lead to a lung cancer being erroneously reported as a benign hamartoma.