Coronary artery calcium score on low-dose computed tomography for lung cancer screening

AIM: To evaluate the feasibility of coronary artery calcium score(CACS) on low-dose non-gated chest CT(ngCCT).METHODS: Sixty consecutive individuals(30 males; 73 ± 7 years) scheduled for risk stratification by means of unenhanced ECG-triggered cardiac computed to-mography(gCCT) underwent additional unenhanced ngCCT. All CT scans were performed on a 64-slice CT scanner(Somatom Sensation 64 Cardiac, Siemens, Germany). CACS was calculated using conventional methods/scores(Volume, Mass, Agatston) as previ-ously described in literature. The CACS value obtained were compared. The Mayo Clinic classification was used to stratify cardiovascular risk based on Agatston CACS. Differences and correlations between the two methods were compared. A P-value < 0.05 was considered sig-nificant.RESULTS: Mean CACS values were significantly higher for gCCT as compared to ngCCT(Volume: 418 ± 747 vs 332 ± 597; Mass: 89 ± 151 vs 78 ± 141; Agatston: 481 ± 854 vs 428 ± 776; P < 0.05). The correlation between the two values was always very high(Volume: r = 0.95; Mass: r = 0.97; Agatston: r = 0.98). Of the 6 patients with 0 Agatston score on gCCT, 2(33%) showed an Agatston score > 0 in the ngCCT. Of the 3 patients with 1-10 Agatston score on gCCT, 1(33%) showed an Agatston score of 0 in the ngCCT. Overall, 23(38%) patients were reclassified in a different car-diovascular risk category, mostly(18/23; 78%) shifting to a lower risk in the ngCCT. The estimated radiation dose was significantly higher for gCCT(DLP 115.8 ± 50.7 vs 83.8 ± 16.3; Effective dose 1.6 ± 0.7 mSv vs 1.2 ± 0.2 mSv; P < 0.01).CONCLUSION: CACS assessment is feasible on ngCCT; the variability of CACS values and the associated re-stratification of patients in cardiovascular risk groups should be taken into account.

Lung cancer screening, what has changed after the latest evidence?

Lung cancer(LC)is still one of the most frequent cancers with a high related mortality.Their prognosis is directly proportional to the stage at the time of diagnosis.Seventy percent are currently diagnosed in advanced or locally advanced stage(higher than stage III),making a cure unlikely for the majority of patients.Developments in LC treatment are significant however they do not seem to be enough to reverse the current situation,at least,in a short period of time.Despite recent advances in treatment,primary prevention and early diagnosis appear to be the key to reduce the incidence and mortality of this disease.Many countries have developed LC screening programs based on the results of clinical trials published in recent years.The aim of this paper is to review the latest results of the NEderlands Leuvens Longkanker Screenings Onderzoek and compare them with the findings of the National Lung Screening Trial.We address the question whether it is necessary to continue discussing the evidence regarding LC screening.In both trials,there is a clear impact on LC mortality but,with a modest reduction in over all mortality.Undoubtedly,the benefit of screening can be expected to grow as low-dose computed tomographys are performed over longer periods of time.

Early screening of lung cancers:an effort arduous but worthwhile

Cancers are a concerning health catastrophe worldwide that may become the end of lifetime for many of us--they overwhelmingly exhaust medical resources, lead to huge economic burdens, and separate people from their beloved ones. Fewer and fewer insurance agencies are willing to include primary cancers on their general health insurance plan, just because cancers have been so flummoxingly usual in our daily life that many primary cancer claims would give rise to much less profits.

Lung cancer risk score for ever and never smokers in China

Background:Most lung cancer risk prediction models were developed in European and North-American cohorts of smokers aged≥55 years,while less is known about risk profiles in Asia,especially for never smokers or individuals aged<50 years.Hence,we aimed to develop and validate a lung cancer risk estimate tool for ever and never smokers across a wide age range.Methods:Based on the China Kadoorie Biobank cohort,we first systematically selected the predictors and explored the nonlinear association of predictors with lung cancer risk using restricted cubic splines.Then,we separately developed risk prediction models to construct a lung cancer risk score(LCRS)in 159,715 ever smokers and 336,526 never smokers.The LCRS was further validated in an independent cohort over a median follow-up of 13.6 years,consisting of 14,153 never smokers and 5,890 ever smokers.Results:A total of 13 and 9 routinely available predictors were identified for ever and never smokers,respectively.Of these predictors,cigarettes per day and quit years showed nonlinear associations with lung cancer risk(Pnon-linear<0.001).The curve of lung cancer incidence increased rapidly above 20 cigarettes per day and then was relatively flat until approximately 30 cigarettes per day.We also observed that lung cancer risk declined sharplywithin the first 5 years of quitting,and then continued to decrease but at a slower rate in the subsequent years.The 6-year area under the receiver operating curve for the ever and never smokers’models were respectively 0.778 and 0.733 in the derivation cohort,and 0.774 and 0.759 in the validation cohort.In the validation cohort,the 10-year cumulative incidence of lung cancerwas 0.39%and 2.57%for ever smokers with low(<166.2)and intermediate-high LCRS(≥166.2),respectively.Never smokers with a high LCRS(≥21.2)had a higher 10-year cumulative incidence rate than those with a low LCRS(<21.2;1.05%vs.0.22%).An online risk evaluation tool(LCKEY;http://ccra.njmu.edu.cn/lckey/web)was developed to facilitate the use of LCRS.Conclusions:The LCRS can be an effective risk assessment tool designed for ever and never smokers aged 30 to 80 years.

Exploring potential of different X-ray imaging methods for early-stage lung cancer detection

Purpose To explore the potential of X-ray imaging for early-stage lung cancer screening and to help finding an optimal lung cancer screening method.Methods Experimentally and simulatively comparing performances of different X-ray techniques(absorption-contrast imaging and phase-contrast imaging)for model lung cancer samples.Results Absorption imaging shows performance equal to or better than that of low-radiation dose.Conclusion Absorption imaging is still the most promising imaging method for early lung cancer detection.