Mortality outcomes of low-dose computed tomography screening for lung cancer in urban China:a decision analysis and implications for practice

Background: Mortality outcomes in trials of low-dose computed tomography(CT) screening for lung cancer are inconsistent. This study aimed to evaluate whether CT screening in urban areas of China could reduce lung cancer mortality and to investigate the factors that associate with the screening effect.Methods: A decision tree model with three scenarios(low-dose CT screening, chest X-ray screening, and no screening) was developed to compare screening results in a simulated Chinese urban cohort(100,000 smokers aged45-80 years). Data of participant characteristics were obtained from national registries and epidemiological surveys for estimating lung cancer prevalence. The selection of other tree variables such as sensitivities and specificities of low-dose CT and chest X-ray screening were based on literature research. Differences in lung cancer mortality(primary outcome), false diagnoses, and deaths due to false diagnosis were calculated. Sensitivity analyses were performed to identify the factors that associate with the screening results and to ascertain worst and optimal screening effects considering possible ranges of the variables.Results: Among the 100,000 subjects, there were 448,541, and 591 lung cancer deaths in the low-dose CT, chest X-ray, and no screening scenarios, respectively(17.2% reduction in low-dose CT screening over chest X-ray screening and 24.2% over no screening). The costs of the two screening scenarios were 9387 and 2497 false diagnoses and 7and 2 deaths due to false diagnosis among the 100,000 persons, respectively. The factors that most influenced death reduction with low-dose CT screening over no screening were lung cancer prevalence in the screened cohort, lowdose CT sensitivity, and proportion of early-stage cancers among low-dose CT detected lung cancers. Considering all possibilities, reduction in deaths(relative numbers) with low-dose CT screening in the worst and optimal cases were16(5.4%) and 288(40.2%) over no screening, respectively.Conclusions: In terms of mortality outcomes, our findings favor conducting low-dose CT screening in urban China.However, approaches to reducing false diagnoses and optimizing important screening conditions such as enrollment criteria for screening are highly needed.

Histogram analysis of apparent diffusion coefficient predicts response to radiofrequency ablation in hepatocellular carcinoma

Objective: The aim of this study was to predict tumor progression in patients with hepatocellular carcinoma(HCC) treated with radiofrequency ablation(RFA) using histogram analysis of apparent diffusion coefficients(ADC).Methods: Breath-hold diffusion weighted imaging(DWI) was performed in 64 patients(33 progressive and 31 stable) with biopsy-proven HCC prior to RFA. All patients had pre-treatment magnetic resonance imaging(MRI)and follow-up computed tomography(CT) or MRI. The ADC values(ADC_(10), ADC_(30_, ADC_(median) and ADC_(max))were obtained from the histogram's 10 th, 30 th, 50 th and 100 th percentiles. The ratios of ADC_(10), ADC_(30_,ADCmedian and ADCmax to the mean non-lesion area-ADC(RADC_(10), RADC_(30_, RADC_(median), and RADC_(max)) were calculated. The two patient groups were compared. Key predictive factors for survival were determined using the univariate and multivariate analysis of the Cox model. The Kaplan-Meier survival analysis was performed, and pairs of survival curves based on the key factors were compared using the log-rank test.Results: The ADC_(30_, ADCmedian, ADCmax, RADC_(30_, RADC_(median), and RADC_(max) were significantly larger in the progressive group than in the stable group(P<0.05). The median progression-free survival(PFS) was 22.9 months for all patients. The mean PFS for the stable and progressive groups were 47.7±1.3 and 9.8±1.3 months,respectively. Univariate analysis indicated that RADC_(10), RADC_(30_, and RADC_(median) were significantly correlated with the PFS [hazard ratio(HR)=31.02, 43.84, and 44.29, respectively, P<0.05 for all]. Multivariate analysis showed that RADCmedian was the only independent predictor of tumor progression(P=0.04). And the cutoff value of RADC_(median) was 0.71.Conclusions: Pre-RFA ADC histogram analysis might serve as a useful biomarker for predicting tumor progression and survival in patients with HCC treated with RFA.

中国城市人群低剂量计算机断层扫描筛查肺癌的死亡率结果:决策分析和实践意义

背景与目的不同低剂量计算机断层扫描(computed tomography,CT)筛查肺癌试验得出的死亡率结果不一致。本研究旨在评价中国城市CT筛查是否能够降低肺癌死亡率,并探讨影响筛查效果的因素。方法建立了3种场景(低剂量CT筛查、胸部X线筛查和无筛查)的决策树模型来比较模拟的中国城市人群(100,000例年龄45–80岁的吸烟者)的筛查结果。从国家登记和流行病学调查中获得了参与者特征数据并估算了肺癌患病比例。根据文献调研选择了低剂量CT和胸部X线筛查的灵敏度和特异度等其他树变量。计算了3种筛查方法间肺癌死亡率(主要结局)、误诊和误诊导致死亡的差异。通过敏感性分析找出了与筛查结果相关的因素,并确定了在变量可能范围内的最差和最优筛查效果。结果 100,000例研究对象中,低剂量CT、胸部X线和无筛查场景分别有448例、541例和591例肺癌死亡(低剂量CT筛查比胸部X线筛查死亡人数减少17.2%,比无筛查减少24.2%)。100,000例研究对象中,2种筛查场景的代价分别为9387例和2497例误诊及7例和2例误诊导致的死亡。低剂量CT筛查比无筛查的死亡数降低,影响最大的因素是筛查人群的肺癌患病比例、低剂量CT的灵敏度和低剂量CT检出肺癌中早期癌的比例。综合了所有可能性,低剂量CT筛查肺癌的死亡人数(相对数)在最坏和最好情况下分别比无筛查降低了16例(5.4%)和288例(40.2%)。结论就死亡率结局而言,我们的研究结果支持在中国城市人群中进行低剂量CT筛查。然而,急需策略来减少误诊和优化纳入标准等重要筛查条件。

Reduction of the Radiation Dose by Decreasing the Tube Current without Degradation of Low-Contrast Detectability on Abdominal Multi-Detector Row CT: A Phantom-Based Study

As use of the lowest acceptable radiation dose during routine diagnostic imaging is important, we determined the optimal tube current without degradation of low-contrast detectability on abdominal multi-detector row CT (MDCT). CT scanning was performed with a Catphan&#174;?500 phantom. The optimal tube current was 300 mA on 64-MDCT and 160 mA on 8-MDCT, with a fixed voltage of 120 kV. Reduction of the radiation dose in abdominal CT scanning by lowering the tube current proved to be feasible.