Journal of thoracic imaging
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Globally, lung cancer is the leading cause of cancer death and is a major public health problem. Because lung cancer is usually diagnosed at an advanced stage, survival is generally poor. In recent decades, clinical advances have not led to marked improvements in outcomes. ⋯ Compared with NLST/USPSTF criteria, selection of individuals for screening using high-quality risk models should lead to fewer individuals being screened, more cancers being detected, and fewer false positives. More lives will be saved with greater cost-effectiveness. In this paper, we review methodological background for prediction modeling, existing lung cancer risk prediction models and some of their findings, and current issues in lung cancer risk prediction modeling and discuss future research.
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Lung cancer is the leading cause of cancer death in the United States and worldwide. However, among the top 4 deadliest cancers, lung cancer is the only one not subject to routine screening. Optimism for an effective lung cancer-screening examination soared after the release of the National Lung Screening Trial results in November 2011. ⋯ However, the momentum for LDCT screening slowed in April 2014 when the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) panel concluded that there was not enough evidence to justify the annual use of LDCT scans for the detection of early lung cancer. This article briefly reviews the epidemiology of lung cancer, the National Lung Screening Trial study results, and the growing national endorsement of LDCT from a variety of key stakeholder organizations. We subsequently analyze and offer our evidence-based counterpoints to the major assumptions underlying the MEDCAC decision.
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The National Lung Cancer Screening Trial (NLST) found a reduction in lung cancer mortality in high-risk patients aged 55 to 74 who were screened with low-dose computed tomography (LDCT) rather than chest x-ray. This reduction was 20% after 6.5 years and 16% after 7.5 years, with a 6.7% reduction in all-cause mortality after 6.5 years. ⋯ Data that support and refute the advocacy position regarding Medicare coverage for LDCT screening are presented. The likely benefits and risks for Medicare patients are discussed in the context of NLST data, other research findings, comparisons between NLST patients and Medicare patients of the same age and smoking histories, and Medicare policies.
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To compare the success rates, complication rates, and radiation doses of conventional computed tomography (CCT) versus computed tomography with fluoroscopy (CTF) during image-guided percutaneous needle biopsies of intrathoracic lesions. ⋯ CCT and CTF are both valuable tools for intrathoracic biopsy. CTF improves technical and core-needle biopsy success at the expense of higher radiation doses to the patient. Operator confidence with CCT and CTF in light of lesion characteristics should guide the choice to select one over the other.