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Am. J. Respir. Crit. Care Med., Volume 165, Number 4, February 2002, 508-513

Screening for Lung Cancer with Low-Dose Spiral Computed Tomography

STEPHEN J. SWENSEN, JAMES R. JETT, JEFF A. SLOAN, DAVID E. MIDTHUN, THOMAS E. HARTMAN, ANNE-MARIE SYKES, GREGORY L. AUGHENBAUGH, FRANK E. ZINK, SHAUNA L. HILLMAN, GAYLE R. NOETZEL, RANDOLPH S. MARKS, AMY C. CLAYTON, and PETER C. PAIROLERO

Department of Radiology, the Division of Pulmonary and Critical Care Medicine and Internal Medicine, the Section of Biostatistics, the Cancer Center Statistics Unit, the Division of Medical Oncology, the Department of Laboratory Medicine and Pathology, and the Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota

Studies suggest that screening with spiral computed tomography can detect lung cancers at a smaller size and earlier stage than chest radiography can. To evaluate low-radiation-dose spiral computed tomography and sputum cytology in screening for lung cancer, we enrolled 1,520 individuals aged 50 yr or older who had smoked 20 pack-years or more in a prospective cohort study. One year after baseline scanning, 2,244 uncalcified lung nodules were identified in 1,000 participants (66%). Twenty-five cases of lung cancer were diagnosed (22 prevalence, 3 incidence). Computed tomography alone detected 23 cases; sputum cytology alone detected 2 cases. Cell types were: squamous cell, 6; adenocarcinoma or bronchioalveolar, 15; large cell, 1; small cell, 3. Twenty-two patients underwent curative surgical resection. Seven benign nodules were resected. The mean size of the non-small cell cancers detected by computed tomography was 17 mm (median, 13 mm). The postsurgical stage was IA, 13; IB, 1; IIA, 5; IIB, 1; IIIA, 2; limited, 3. Twelve (57%) of the 21 non-small cell cancers detected by computed tomography were stage IA at diagnosis. Computed tomography can detect early-stage lung cancers. The rate of benign nodule detection is high.




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