Lung Cancer Screening.

Lung cancer screening with low-dose computed tomography (LDCT) reduces lung cancer deaths by early detection. The United States Preventive Services Task Force recommends lung cancer screening with LDCT in adults of age 50 years to 80 years who have at least a 20 pack-year smoking history and are currently smoking or have quit within the past 15 years. The implementation of a lung-cancer-screening program is complex. High-quality screening requires the involvement of a multidisciplinary team. The aim of a screening program is to find balance between mortality reduction and avoiding potential harms related to false-positive findings, overdiagnosis, invasive procedures, and radiation exposure. Components and processes of a high-quality lung-cancer-screening program include the identification of eligible individuals, shared decision-making, performing and reporting LDCT results, management of screen-detected lung nodules and non-nodule findings, smoking cessation, ensuring adherence, data collection, and quality improvement.

The current state of tobacco cessation treatment.

Nicotine addiction and dependence is a chronic relapsing disease driven by addiction to nicotine. Proactive treatment for all tobacco users, regardless of their readiness to quit, is recommended. First-line tobacco cessation medications include nicotine replacement therapy, bupropion, and varenicline. Comprehensive treatment with behavioral interventions and pharmacologic therapy increases success rates of smoking cessation. Although there are many popular alternative treatments, they should not replace or delay the use of known effective therapies.

Lung Cancer Screening.

Lung cancer is the leading cause of US cancer-related deaths. Lung cancer screening with a low radiation dose chest computed tomography scan is now standard of care for a high-risk eligible population. It is imperative for clinicians and surgeons to evaluate the trade-offs of benefits and harms, including the identification of many benign lung nodules, overdiagnosis, and complications. Integration of smoking cessation interventions augments the clinical benefits of screening. Screening programs must develop strategies to manage screening-detected findings to minimize potential harms. Further research should focus on how to improve patient selection, minimize harms, and facilitate access to screening.

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report.

BACKGROUND: The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. METHODS: An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. RESULTS: Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small-cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small-cell lung cancer. CONCLUSIONS: There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report.

BACKGROUND: The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. METHODS: An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. RESULTS: Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer. CONCLUSIONS: There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report.

Background: The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. Materials and Methods: An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. Results: Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer. Conclusion: There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.© 2020 RSNA; The American College of Chest Physicians, published by Elsevier Inc; and The American College of Radiology, published by Elsevier Inc.

Development of a Risk Prediction Model to Estimate the Probability of Malignancy in Pulmonary Nodules Being Considered for Biopsy.

BACKGROUND: Malignancy probability models for pulmonary nodules (PN) are most accurate when used within populations similar to those in which they were developed. Our goal was to develop a malignancy probability model that estimates the probability of malignancy for PNs considered high enough risk to recommend biopsy. METHODS: This retrospective analysis included training and validation datasets of patients with PNs who had a histopathologic diagnosis of malignant or benign. Radiographic and clinical characteristics associated with lung cancer were collected. Univariate logistic regression was used to identify potential predictors. Stepdown selection and multivariate logistic regression were used to build several models, each differing according to available data. RESULTS: Two hundred malignant nodules and 101 benign nodules were used to generate and internally validate eight models. Predictors of lung cancer used in the final models included age, smoking history, upper lobe location, solid and irregular/spiculated nodule edges, emphysema, fluorodeoxyglucose-PET avidity, and history of cancer other than lung. The concordance index (C-index) of the models ranged from 0.75 to 0.81. They were more accurate than the Mayo Clinic model (P < .05 for four of the models), and each had fair to excellent calibration. In an independent sample used for validation, the C-index for our model was 0.67 compared with 0.63 for the Mayo Clinic model. The ratio of malignant to benign nodules within each probability decile showed a greater potential to influence clinical decisions than the Mayo Clinic model. CONCLUSIONS: We developed eight models to help characterize PNs considered high enough risk by a clinician to recommend biopsy. These models may help to guide clinicians' decision-making and be used as a resource for patient communication.

Models to Estimate the Probability of Malignancy in Patients with Pulmonary Nodules.

Pulmonary nodules are a common clinical problem. The goals of their evaluation are to expedite the diagnosis and treatment of patients with malignant nodules and to minimize testing in patients with benign nodules. The approach to lung nodule evaluation is directed by the probability that the nodule is malignant. Estimation of the probability of malignancy can be performed subjectively with intuition and clinical experience or by using validated probability models that combine patient clinical characteristics with nodule imaging features to estimate a probability of malignancy. The accuracy and the generalizability of probability models depend on the clinical profile and the prevalence of malignancy in the population in which they were derived. In this article, we review available validated models to estimate the probability of malignancy in patients with pulmonary nodules and outline how they were derived, their limitations, and how they compare with each other and physician judgment. We conclude with a brief discussion of advances in probability models.