Four-Year Results of Low-Dose CT Screening and Nodule Management in the ITALUNG Trial

• Published in: Journal of thoracic oncology Vol. 8; no. 7; pp. 866 - 875
• Main Authors: Pegna, Andrea Lopes, Picozzi, Giulia, Falaschi, Fabio, Carrozzi, Laura, Falchini, Massimo, Carozzi, Francesca Maria, Pistelli, Francesco, Comin, Camilla, Deliperi, Annalisa, Grazzini, Michela, Innocenti, Florio, Maddau, Cristina, Vella, Alessandra, Vaggelli, Luca, Paci, Eugenio, Mascalchi, Mario
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2013; International Association for the Study of Lung Cancer
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - surgery; Aged; Biopsy, Fine-Needle; Cancer; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - surgery; Case-Control Studies; Computed tomography; Early Detection of Cancer; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Lung Neoplasms - diagnosis; Lung Neoplasms - surgery; Lymph Nodes - pathology; Lymph Nodes - surgery; Male; Middle Aged; Neoplasm Staging; Nuclear medicine; Positron-Emission Tomography; Prognosis; Pulmonary biopsy; Radiopharmaceuticals; Small Cell Lung Carcinoma - diagnosis; Small Cell Lung Carcinoma - surgery; Time Factors; Tomography, X-Ray Computed; Nuclear medicine; Computed tomography; Pulmonary biopsy; Cancer
• ISSN: 1556-0864; 1556-1380; 1556-1380
• DOI: 10.1097/JTO.0b013e31828f68d6

Recruitment and nodule management are critical issues of lung cancer screening with low-dose computed tomography (LDCT). We report subjects’ compliance and results of LDCT screening and management protocol in the active arm of the ITALUNG trial. Three thousand two hundred six smokers or former smokers invited by mail were randomized to receive four annual LDCT (n = 1613) or usual care (n = 1593). Management protocol included follow-up LDCT, 2-[18F]fluoro-2-deoxy-D glucose positron emission tomography (FDG-PET), and CT-guided fine-needle aspiration biopsy (FNAB). One thousand four hundred six subjects (87%) underwent baseline LDCT, and 1263 (79%) completed four screening rounds. LDCT was positive in 30.3% of the subjects at baseline and 15.8% subsequently. Twenty-one lung tumors in 20 subjects (1.5% detection) were found at baseline, and 20 lung tumors in 18 subjects (0.5% detection) in subsequent screening rounds. Ten of 18 prevalent (55%) and 13 of 17 incident (76%) non–small-cell cancers were in stage I. Interval growth enabled diagnosis of lung cancer in 16 subjects (42%), but at least one follow-up LDCT was obtained in 741 subjects (52.7%) over the screening period. FDG-PET obtained in 6.5% of subjects had 84% sensitivity and 90% specificity for malignant lesions. FNAB obtained in 2.4% of subjects showed 90% sensitivity and 88% specificity. Positivity of both FDG-PET and FNAB invariably predicted malignancy. Surgery for benign lesions was performed on four subjects (10% of procedures) but followed protocol violations on three subjects. High-risk subjects recruited by mail who entered LDCT screening showed a high and stable compliance. Efficacy of screening is, however, weakened by low detection rate and specificity. Adhesion to management protocol might lessen surgery for benign lesions.