Journal of thoracic imaging
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Spontaneous regression of lung cancer is a rare phenomenon. We described a case of lung adenocarcinoma size reduction during steroid therapy. ⋯ Steroid use might have diminished the inflammatory response around the lung cancer, resulting in the apparent shrinkage of the lung cancer. This phenomenon is a potential pitfall in lung cancer diagnosis.
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Recent studies have supported the use of low-dose computed tomography (LDCT) of the chest as a screening tool for lung cancer. Several professional organizations have now included LDCT screening in high-risk populations in their guidelines. The United States Preventive Services Task Force has added LDCT to its lung cancer-screening guidelines as of December 2013. ⋯ The American College of Radiology-Society of Thoracic Radiology collaboration and the National Comprehensive Cancer Care Network recently provided some guidelines for LDCT utilization for lung cancer screening. There are several scanning and image reconstruction techniques that can be used for reducing radiation dose in LDCT lung cancer screening. This review article presents protocols and guidelines for use of LDCT in lung cancer screening and describes our early experience in implementing LDCT at our institution.
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Lung cancer is the leading cause of cancer-related death worldwide. In 2011, the largest lung cancer screening trial worldwide, the US National Lung Screening Trial, published a 20% decrease in lung cancer-specific mortality in the computed tomography (CT)-screened group, compared with the group screened by chest x-ray. On the basis of this trial, different US guidelines recently have recommended CT lung cancer screening. ⋯ In Europe, several lung cancer screening trials are ongoing. It is planned to pool the results of the lung cancer screening trials in European randomized lung cancer CT screening (EUCT). By pooling of the data, EUCT hopes to be able to provide additional information for the discussion of some important issues regarding the implementation of lung cancer screening by low-dose CT, including: the determination of the optimal screen population, the comparison between a volume-based and diameter-based nodule management protocol, and the determination of optimal screen intervals.
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The National Lung Screening Trial (NLST) demonstrated that screening with low-dose CT versus chest radiography reduced lung cancer mortality by 16% to 20%. More recently, a cost-effectiveness analysis (CEA) of CT screening for lung cancer versus no screening in the NLST was performed. ⋯ In this paper, I review the methods and assumptions used to obtain the base case estimate of $81,000 per quality-adjusted life-year gained. In addition, I show how this estimate varied widely among different subsets and when some of the base case assumptions were changed and speculate on the cost-effectiveness of CT screening for lung cancer outside the NLST.
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Pulmonary nodules are commonly detected in computed tomography (CT) chest screening of a high-risk population. The specific visual or quantitative features on CT or other modalities can be used to characterize the likelihood that a nodule is benign or malignant. Visual features on CT such as size, attenuation, location, morphology, edge characteristics, and other distinctive "signs" can be highly suggestive of a specific diagnosis and, in general, be used to determine the probability that a specific nodule is benign or malignant. ⋯ Imaging analytics can objectively and reproducibly quantify nodule features on CT, nuclear medicine, and magnetic resonance imaging. Some quantitative techniques show great promise in helping to differentiate benign from malignant lesions or to stratify the risk of aggressive versus indolent neoplasm. In this article, we (1) summarize the visual characteristics, descriptors, and signs that may be helpful in management of nodules identified on screening CT, (2) discuss current quantitative and multimodality techniques that aid in the differentiation of nodules, and (3) highlight the power, pitfalls, and limitations of these various techniques.