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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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Keywords: carcinoma; non-small cell lung; cytology; smoking; tomography, x-ray computed
In the United States, lung cancer is the most common fatal malignancy for both men and women. Approximately 175,000 new cases are diagnosed each year, of which 75-80% are non-small cell lung cancer. It is estimated that 1 in 18 women and 1 in 12 men will develop bronchogenic carcinoma in their lifetimes. More than 50% of patients will have distant metastases at diagnosis and only 20-25% will be localized and potentially resectable for cure (1).
The number of deaths from lung cancer exceeds the total combined number of deaths from the next three most common causes of death from cancer: breast, colorectal, and prostate cancers. Screening is recommended for each of these three cancers, and there has been a significant improvement in 5-yr survival over the past 25 yr. Lung cancer survival has not improved.
In the 1970s, the National Cancer Institute supported three mass-screening programs involving the Johns Hopkins University School of Medicine, Memorial Sloan-Kettering Cancer Center, and Mayo Clinic (2). No mortality difference was observed between the screened and the control groups (5), even with extended follow-up through 1996, even though 48% of cancers in the screen arm were early-stage cancers (stages 0, I, and II) (6). As a result of these and other studies, no organizations recommend screening (7).
Investigators have only recently considered the use of low-dose computed tomography for screening (8). These studies have suggested that screening with spiral computed tomography can detect lung cancers at a smaller size (less than 2 cm in diameter) and earlier stage (85-93% stage I) as compared with chest radiography and current clinical practice.
It is unclear whether smaller nodules represent earlier-stage disease and whether detection at an earlier stage improves mortality rates. It is also unclear whether screening with computed tomography creates problems related to overdiagnosis, unnecessary surgical procedure expense, morbidity, and mortality.
To further examine these questions, a study protocol was developed to test the hypothesis that screening with low-dose, fast spiral chest computed tomography in patients at high risk for lung cancer would result in a significant downward shift to stage IA and IB tumors at diagnosis, as compared with previous chest radiograph-based studies (2) and current clinical practice (1).
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Participants were enrolled into the study after written informed consent in response to local and regional television and newspaper coverage that carried information regarding the general outline of the study and eligibility requirements as well as funding of the National Institutes of Health grant. Participants were asymptomatic men and women 50 yr of age or older. Participants had to be current or past (quit less than 10 yr ago) cigarette smokers. A history of cigarette smoking at least 20 pack-years was necessary for entrance into the study. Ineligible were those with a history of any cancer within 5 yr other than nonmelanomatous skin cancer, cervical cancer in situ, or localized prostate cancer. Only mentally competent patients considered healthy enough to undergo pulmonary resection (i.e., patients without congestive heart failure or, in the judgment of the registered-nurse study coordinator, disabling dyspnea at the time of enrollment) were entered into the study. Any patient with a serious illness that decreased life expectancy to less than 5 yr was excluded. This protocol was approved by the Mayo Foundation Institutional Review Board and by the National Cancer Institute.
All participants agreed to undergo a prevalence computed tomography scan and three annual incidence scans. Annual induced sputum samples were obtained for immediate cytologic analysis. Blood was obtained from each participant and stored for subsequent DNA analysis. Spirometry (forced expiratory volume in 1 s) was performed on each participant.
All scans were performed on a multislice spiral computed tomography scanner (LightSpeed Model QX/i, General Electric Medical Systems, Inc., Milwaukee, WI) using the following technique: 5-mm slice width with 3.75-mm reconstruction interval; HS mode; pitch (ratio of table travel per rotation to total beam width), 1.5; exposure time, 0.8 s/rotation; table feed, 30 mm/rotation (37.5 mm/s); 120 kVp; and 40 mA. Effective radiation dose was 0.65 mSv (65 mrem). Follow-up computed tomography was performed at numerous institutions; the technique used was not dictated by the study protocol. It is our understanding that most, if not all, medical centers use standard-dose chest computed tomography with thin sections (1-3 mm) for nodule analysis.
All computed tomography images were viewed in cine-mode formats at a computer workstation by one of four investigator radiologists (T.E.H., S.J.S., G.L.A., A.M.S.). Images were viewed at standard lung, soft tissue, and bone windows.
The location and size of each uncalcified nodule were tabulated. A nodule was considered to be uncalcified if it did not contain benign-pattern calcification (diffuse, central, laminated, chondroid). All nodules identified in the baseline year were considered prevalence nodules. All nodules identified on the first annual computed tomography examination were considered incidence nodules regardless of whether they were present in retrospect on the baseline examination.
Computed tomography reports and a letter from a pulmonologist (J.R.J., D.E.M.) were sent to each participant and his or her physician (as designated by the participant). Nodule management recommendations were made to the attending physician based on an untested, internally developed management algorithm for indeterminate lung nodules (Figure 1).
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From January 20, 1999, to December 15, 1999, 1,520 participants were enrolled and underwent the baseline prevalence computed tomography scan. Enrollment was denied to 421 applicants because they did not meet the eligibility criteria. The reasons for ineligibility were insufficient smoking history, 198; not interested in study after informed consent, 84; history of cancer within 5 yr, 37; congestive heart failure, 18; age, 31; enrollment in a conflicting research study, 4; respiratory insufficiency, 7; and miscellaneous health or personal situations, 42. Of the 1,511 living participants, 1,464 (97%) have returned for the first of their three annual incidence scans, which were performed within a 1-mo window on either side of their 1-yr anniversary. The 1,520 participants comprised 785 men and 735 women; 1,508 (99%) were white and 12 were African American, Native American, or Hispanic. Of the 1,520 participants, 742 (49%) were previous Mayo Clinic patients; the remaining patients were new to Mayo Clinic. All were 50 yr old or older (mean age, 59 yr; range, 50-85 yr). Sixty-one percent were current smokers; 39% were former smokers. The median number of pack-years was 45 (range, 20-230 pack-years).
Nine participants died after enrollment. One of the nine deaths was related to lung cancer (small cell lung cancer). Other causes of death were heart disease (three participants), laryngeal cancer, esophageal cancer, pancreatic cancer, lymphoma, and suicide. The man who committed suicide had a 2-mm lung nodule not thought to be cancer and a 4-cm abdominal aortic aneurysm. None of the nine deaths was related to surgery for either benign or malignant nodules.
One or more uncalcified prevalent lung nodules were prospectively identified in 782 participants (51%). The nodules were distributed in size and number as follows: < 4 mm: 307 (39%); 4- 7 mm: 391 (50%); 8-20 mm: 76 (10%); > 20 mm: 8 (1%).
During interpretation of the first annual incidence scan, additional nodules were retrospectively diagnosed on the baseline scan in 375 (26%) of 1,464 participants. In 231 participants (62% of these 375 participants), the diameter of the retrospectively identified nodules was less than 4 mm, in 137 (37%) it was 4-7 mm, and in 6 (2%) it was 8-20 mm.
A total of 2,053 nodules were present on the prevalence scan. On the first annual incidence scan, 195 (9%) had resolved, 36 (2%) had been surgically removed (some patients had more than one nodule removed per operation), 86 (4%) had increased in size, 79 (4%) had decreased in size, and 1,657 (81%) were stable.
Of the 1,464 participants, 191 (13%) had incidence nodules detected on their first annual scan that were not present in retrospect on the baseline scan. In 70 participants (37% of these 191 participants), the diameter of these incidence nodules was less than 4 mm, in 102 (53%) it was 4-7 mm, in 16 (8%) it was 8-20 mm, and in 3 (2%) it was more than 20 mm.
A total of 2,244 uncalcified prevalence and incidence lung nodules have been identified. In 1,000 (66%) of 1,520 participants, one or more lung nodules have been identified. In addition, 31 participants at baseline and 10 at the first annual scan had more than six nodules. We did not record the number of nodules if it was more than six.
To date, we have documented 25 primary lung cancers (1.7% of 1,464 participants; 1.1% of 2,244 nodules): 22 were non-small cell carcinomas, and 3 were limited-stage small cell carcinomas (Table 1 and Figure 2); 22 were prevalence lung cancers, and 3 were incidence lung cancers; 23 were diagnosed with computed tomography alone, and 2 (1 prevalence and 1 incidence) were diagnosed with sputum cytology alone. The incidence small cell cancer detected by sputum cytology alone was present in retrospect on computed tomography. By cell type, 6 cancers were squamous cell, 15 were adenocarcinoma/ bronchioloalveolar carcinoma, 1 was large cell, and 3 were small cell. The mean size of the non-small cell lung cancers detected by computed tomography was 17 mm.
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Potentially curative pulmonary resection was performed in 22 participants, pulmonary lobectomy in 20, segmentectomy in 1, and wedge excision in 1. The postsurgical cancer stage was IA in 13 participants, IB in 1, IIA in 5, IIB in 1, IIIA in 2, and limited small cell in 3. Seven patients underwent removal of a benign disease, 6 with a wedge excision, and 1 with a lobectomy. Five of the 7 patients had radiologic evidence of nodule growth. The diagnoses (1 patient had 2 nodules) were inflammatory changes, 2 patients; granuloma, 2; hamartoma, 1; scarring, 1; pulmonary embolus, 1; and squamous metaplasia, 1. All remaining nodules are being managed with observation at 3-, 6-, or 12-mo intervals and are considered radiologically indeterminate. Although we have recommendations for every nodule based on size, decisions regarding management are in the hands of the attending local physician and the patient and are not dictated by the study protocol.
Of the 1,520 participants enrolled, 210 (14%) had incidental nonpulmonary computed tomography findings of significance (Table 2). Ancillary nonpulmonary computed tomography findings were considered clinically "significant" if they required further evaluation (e.g., adrenal mass) or had substantive clinical implications (e.g., renal cell carcinoma). These included 2 bronchial carcinoid tumors, 4 renal cell carcinomas, 3 breast cancers, 2 lymphomas, 2 gastric tumors, and 1 pheochromocytoma. One patient with a small pancreatic adenocarcinoma was identified in retrospect.
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Chest radiographs were not prospectively studied. Nine of the 21 participants with cancers detected by computed tomography had a chest radiograph within 1 mo of the computed tomography scan on which the cancer was detected. On five of the nine radiographs, the cancer was prospectively identified.
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The prevalence and first incidence year results of our prospective cohort trial indicate that computed tomography can identify small and early-stage lung cancers. The mean size of the non-small cell lung cancers detected by computed tomography was 17 mm. Most (57%) of the non-small lung cancers detected by computed tomography were stage IA. The 5-yr survival rate after resection of stage IA non-small cell lung cancer ranges from 62% to 82% (15).
Low-dose computed tomography screening for lung cancer offers the possibility of reducing mortality through early detection. It is clearly unproven, and existing data do not justify its widespread use in the general population beyond scientific studies. Potential for bias exists in phase II (single-arm) studies. From our data, it is not clear whether there has been a stage shift. The relatively high percentage of stage IA non-small cell lung cancers detected with computed tomography could reflect any combination of selection, length, overdiagnosis, and lead-time biases. To demonstrate a stage shift, one must show not only an increase in early-stage disease but also a concomitant decrease in late-stage disease. Furthermore, our study is biased by the exclusion of patients with a history of cancer and those not healthy enough to undergo lung resection. Further study is needed to confirm the role that these biases may have in the promising results we and others have observed.
False-Positive Rates
After 2 yr of study, we have found 2,244 uncalcified lung nodules in 66% of our 1,520 screened participants. We estimate that approximately 98% of these are falsely positive findings (1). Assuming that our 13% incidence rate of indeterminate lung nodules continues, almost all patients will have at least one false-positive examination result after only a few years of screening. Henschke and coworkers (11) found nodules in approximately 25% of screened participants, but they used computed tomography techniques (10-mm-thick sections and film [not workstation] viewing) that should allow detection of fewer small nodules (24). They also studied a population that may be expected to have a lower prevalence of fungal granulomas. However, none of the 2,244 lung nodules was calcified on 5-mm sections, and we do not have evidence from this study that a large proportion were granulomas. In fact, only two of the eight benign nodules removed were granulomas.
Radiologically indeterminate benign lung nodules are considered a falsely positive finding of lung cancer. False-positive results are a significant concern. After several annual screening examinations with computed tomography, almost all of the patients in our cohort will need one or more follow-up examinations with computed tomography for indeterminate nodules or ancillary findings. The potential harm includes financial and emotional costs. The morbidity and mortality associated with radiation, biopsy, and surgical procedures must be considered. Morbidity and mortality considerations are particularly disconcerting in cases of benign lesions and overdiagnosed cancers. Clinicians currently lack the ability to determine which cancers will be lethal and which ones are the result of overdiagnosis (6, 25). "Overdiagnosis" includes cases of slow-growing, relatively indolent lung cancers (e.g., some cases of bronchioloalveolar and adenocarcinoma) that a patient dies with and not from. The issue of competing risks (e.g., heart disease, stroke, chronic obstructive pulmonary disease) is an important consideration that must be analyzed in the context of the overall efficacy of this screening examination.
In both the United States and Europe, approximately half of the patients undergoing surgical biopsy of an indeterminate lung nodule subsequently received a diagnosis that the nodule was benign (26). A benign biopsy rate of 50% would be extraordinarily costly and carry with it morbidity and mortality that would preclude use of this screening technique. In our series, seven participants underwent surgical biopsy of indeterminate lung nodules that subsequently were diagnosed as benign. Our proposed lung nodule management algorithm (Figure 1) is designed to expedite surgery for lung cancer and minimize intervention for benign nodules (30). However, a substantial concern is that surgery for benign nodules could dramatically increase when this screening technique is released into practice.
Twenty-six percent of participants had nodules that were missed on the baseline scan. This is a high false-negative rate. Although most of these nodules were quite small, it may be an inherent problem with human observation (34). We did not measure intraobserver or interobserver variability. This is a limitation of our study and an important issue in radiologic screening procedures. Computer-aided detection programs may be helpful in lowering the false-negative rate. Periodic screening, perhaps on an annual basis, will mitigate the downside of missing relatively small and slow-growing cancers.
Incidental Findings
Fourteen percent of our participants had incidental nonpulmonary findings of clinical significance (Table 2). It is possible that these findings enhance the potential value of computed tomography screening for lung cancer. Some of the findings we defined as clinically significant led to potentially life-saving surgery or chemotherapy because of early detection, when the patient was asymptomatic. These findings included aortic aneurysm, renal cell carcinoma, bronchial carcinoid, breast cancer, gastric cancer, pheochromocytoma, and lymphoma. (Note that we excluded all bronchial carcinoids from the lung cancer list.) It is also possible that for some individuals, incidental findings only add cost, anxiety, and even morbidity and mortality. Low specificity and high cost for evaluation of false-positive cases are important issues that clearly require further study.
In this cohort, we are exploring the possibility of using computed tomography to screen systematically for signs of heart disease (coronary artery calcification) (35), stroke (carotid artery calcification) (36), emphysema (presence and quantification) (37), osteoporosis (quantitative computed tomography bone mineral densitometry) (38), and risk of cardiovascular disease, non-insulin-dependent diabetes mellitus, and hypertension (visceral fat ratio) (39). Low-dose computed tomography has the potential to be used as a comprehensive screening tool for many of the most common causes of death.
Conclusion
Given the data from single-arm studies performed in Japan and the United States, it is plausible that earlier detection of lung cancer by computed tomography may result in decreased mortality. Earlier detection of lung cancer does not necessarily translate into decreased mortality, however. We raise concerns regarding a very high false-positive rate. The observed low specificity of this proposed screening examination could render it prohibitively expensive. Determination of improved disease-specific mortality and cost effectiveness will likely be needed for computed tomography to be widely accepted and reimbursed as a screening technique in lung cancer. This should require a prospective randomized controlled study.
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Correspondence and requests for reprints should be addressed to Dr. S. J. Swensen, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail: schwartz.roberta{at}mayo.edu
(Received in original form July 3, 2001 and accepted in revised form November 29, 2001).
Nothing in this publication implies that Mayo Foundation endorses any products mentioned in this manuscript.Acknowledgments: Supported by the National Cancer Institute CA 79935-01 and Mayo Foundation.
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References |
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1. Greenlee RT, Murray T, Bolden S, Wingo PA. Cancer statistics, 2000. CA Cancer J Clin 2000; 50: 7-33 [Abstract].
2. Frost JK, Ball WC, Levin ML, Tockman MS, Baker RR, Carter D, Eggleston JC, Erozan YS, Gupta PK, Khouri NF, et al . . Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Johns Hopkins study. Am Rev Respir Dis 1984; 130: 549-554 [Medline].
3. Flehinger BJ, Melamed MR, Zaman MB, Heelan RT, Perchick WB, Martini N. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Memorial Sloan-Kettering study. Am Rev Respir Dis 1984; 130: 555-560 [Medline].
4. Fontana RS, Sanderson DR, Taylor WF, Woolner LB, Miller WE, Muhm JR, Uhlenhopp MA. Early lung cancer detection: results of the initial (prevalence) radiologic and cytologic screening in the Mayo Clinic study. Am Rev Respir Dis 1984; 130: 561-565 [Medline].
5. Fontana RS, Sanderson DR, Woolner LB, Taylor WF, Miller WE, Muhm JR. Lung cancer screening: the Mayo program. J Occup Med 1986; 28: 746-750 [Medline].
6.
Marcus PM,
Bergstralh EJ,
Fagerstrom RM,
Williams DE,
Fontana R,
Taylor WF,
Prorok PC.
Lung cancer mortality in the Mayo Lung Project:
impact of extended follow-up.
J Natl Cancer Inst
2000;
92:
1308-1316
7. Eddy DM. Screening for lung cancer. Ann Intern Med 1989; 111: 232-237 .
8. Diederich S, Lenzen H, Puskas Z, Koch AT, Yelbuz TM, Eameri M, Roos N, Peters PE. Low-dose computed tomography of the thorax. Experimental and clinical investigations [German]. Radiologe 1996; 36: 475-482 [Medline].
9. Henschke CI, Miettinen OS, Yankelevitz DF, Libby DM, Smith JP. Radiographic screening for cancer. Proposed paradigm for requisite research. Clin Imaging 1994; 18: 16-20 [Medline].
10.
Kaneko M,
Eguchi K,
Ohmatsu H,
Kakinuma R,
Naruke T,
Suemasu K,
Moriyama N.
Peripheral lung cancer: screening and detection with
low-dose spiral CT versus radiography.
Radiology
1996;
201:
798-802
11. Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP, McGuinness G, Miettinen OS, Libby DM, Pasmantier MW, Koizumi J, Altorki NK, et al . . Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet 1999; 354: 99-105 [Medline].
12. Sone S, Takashima S, Li F, Yang Z, Honda T, Maruyama Y, Hasegawa M, Yamanda T, Kubo K, Hanamura K, et al . . Mass screening for lung cancer with mobile spiral computed tomography scanner. Lancet 1998; 351: 1242-1245 [Medline].
13. Sone S, Li F, Yang ZG, Maruyama Y, Hasegawa M, Wang JC, Kawakami S, Honda T. Characteristics of small lung cancers invisible on conventional chest radiography and detected by population based screening using spiral CT. Br J Radiol 2000; 73: 137-145 [Abstract].
14. Ohmatsu H, Kakinuma R, Kaneko M, Moriyama N, Kusumoto M, Eguchi K. Successful lung cancer screening with low-dose helical CT in addition to chest x-ray and sputum cytology: the comparison of two screening period with or without helical CT [abstract]. Radiology 2000;217(Suppl):242.
15. Flehinger BJ, Melamed MR. Current status of screening for lung cancer. Chest Surg Clin North Am 1994; 4: 1-15 [Medline].
16.
Mountain CF.
Revisions in the International System for Staging Lung
Cancer.
Chest
1997;
111:
1710-1717
17.
Flehinger BJ,
Kimmel M,
Melamed MR.
The effect of surgical treatment
on survival from early lung cancer. Implications for screening.
Chest
1992;
101:
1013-1018
18. Mountain CF. A new international staging system for lung cancer. Chest 1986;89(Suppl 4):225S-233S.
19. Mountain CF. Prognostic implications of the International Staging System for Lung Cancer. Semin Oncol 1988; 15: 236-245 [Medline].
20. Pairolero PC, Williams DE, Bergstralh EJ, Piehler JM, Bernatz PE, Payne WS. Postsurgical stage I bronchogenic carcinoma: morbid implications of recurrent disease. Ann Thorac Surg 1984; 38: 331-338 [Abstract].
21.
Martini N,
Bains MS,
Burt ME,
Zakowski MF,
McCormack P,
Rusch VW,
Ginsberg RJ.
Incidence of local recurrence and second primary
tumors in resected stage I lung cancer.
J Thorac Cardiovasc Surg
1995;
109:
120-129
22.
Harpole DH,
Herndon JE,
Wolfe WG,
Iglehart JD,
Marks JR.
A prognostic model of recurrence and death in stage I non-small cell lung
cancer utilizing presentation, histopathology, and oncoprotein expression.
Cancer Res
1995;
55:
51-56
23. Gail MH, Eagan RT, Feld R, Ginsberg R, Goodell B, Hill L, Holmes EC, Lukeman JM, Mountain CF, Oldham RK, et al . . Prognostic factors in patients with resected stage I non-small cell lung cancer. A report from the Lung Cancer Study Group. Cancer 1984; 54: 1802-1813 [Medline].
24.
Tillich M,
Kammerhuber F,
Reittner P,
Riepl T,
Stoeffler G,
Szolar DH.
Detection of pulmonary nodules with helical CT: comparison of cine
and film-based viewing.
AJR Am J Roentgenol
1997;
169:
1611-1614
25. Sagawa M, Tsubono Y, Saito Y, Sato M, Tsuji I, Takahashi S, Usuda K, Tanita T, Kondo T, Fujimura S. A case-control study for evaluating the efficacy of mass screening program for lung cancer in Miyagi Prefecture, Japan. Cancer 2001; 92: 588-594 [Medline].
26.
Bernard A.
Resection of pulmonary nodules using video-assisted thoracic surgery. The Thorax Group.
Ann Thorac Surg
1996;
61:
202-204
27. Mack MJ, Hazelrigg SR, Landreneau RJ, Acuff TE. Thoracoscopy for the diagnosis of the indeterminate solitary pulmonary nodule. Ann Thorac Surg 1993; 56: 825-830 [Abstract].
28. Siegelman SS, Zerhouni EA, Leo FP, Khouri NF, Stitik FP. CT of the solitary pulmonary nodule. AJR 1980; 135: 1-13 [Abstract].
29. Keagy BA, Starek PJ, Murray GF, Battaglini JW, Lores ME, Wilcox BR. Major pulmonary resection for suspected but unconfirmed malignancy. Ann Thorac Surg 1984; 38: 314-316 [Abstract].
30. Viggiano RW, Swensen SJ, Rosenow EC. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med 1992; 13: 83-95 [Medline].
31. Swensen SJ, Jett JR, Payne WS, Viggiano RW, Pairolero PC, Trastek VF. An integrated approach to evaluation of the solitary pulmonary nodule. Mayo Clin Proc 1990; 65: 173-186 [Medline].
32.
Swensen SJ,
Brown LR,
Colby TV,
Weaver AL,
Midthun DE.
Lung
nodule enhancement at CT: prospective findings.
Radiology
1996;
201:
447-455
33.
Swensen SJ,
Silverstein MD,
Ilstrup DM,
Schleck CD,
Edell ES.
The
probability of malignancy in solitary pulmonary nodules. Application
to small radiologically indeterminate nodules.
Arch Intern Med
1997;
157:
849-855
34.
Kakinuma R,
Ohmatsu H,
Kaneko M,
Eguchi K,
Naruke T,
Nagai K,
Nishiwaki Y,
Suzuki A,
Moriyama N.
Detection failures in spiral CT screening
for lung cancer: analysis of CT findings.
Radiology
1999;
212:
61-66
35.
Rumberger JA,
Simons DB,
Fitzpatrick LA,
Sheedy PF,
Schwartz RS.
Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study.
Circulation
1995;
92:
2157-2162
36.
Doris I,
Dobranowski J,
Franchetto AA,
Jaeschke R.
The relevance of
detecting carotid artery calcification on plain radiograph.
Stroke
1993;
24:
1330-1334
37.
Müller NL,
Staples CA,
Miller RR,
Abboud RT.
"Density mask." An
objective method to quantitate emphysema using computed tomography.
Chest
1988;
94:
782-787
38. Weigert JM. QCT, the most accurate method of measuring bone mineral density? J Bone Miner Res 1997; 12: 1954-1955 [Medline].
39.
Caprio S,
Hyman LD,
McCarthy S,
Lange R,
Bronson M,
Tamborlane WV.
Fat distribution and cardiovascular risk factors in obese adolescent girls:
importance of the intraabdominal fat depot.
Am J Clin Nutr
1996;
64:
12-17
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C. R. Sander, A. A. Pathan, N. E. R. Beveridge, I. Poulton, A. Minassian, N. Alder, J. Van Wijgerden, A. V. S. Hill, F. V. Gleeson, R. J. O. Davies, et al. Safety and Immunogenicity of a New Tuberculosis Vaccine, MVA85A, in Mycobacterium tuberculosis-infected Individuals Am. J. Respir. Crit. Care Med., April 15, 2009; 179(8): 724 - 733. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Tao, D. S. Gierada, F. Zhu, T. K. Pilgram, J. H. Wang, and K. T. Bae Automated Matching of Pulmonary Nodules: Evaluation in Serial Screening Chest CT Am. J. Roentgenol., March 1, 2009; 192(3): 624 - 628. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Budoff Ethical Issues Related to Lung Nodules on Cardiac CT Am. J. Roentgenol., March 1, 2009; 192(3): W146 - W146. [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Xu, H. J. van der Zaag-Loonen, M. Oudkerk, Y. Wang, R. Vliegenthart, E. T. Scholten, J. Verschakelen, M. Prokop, H. J. de Koning, and R. J. van Klaveren Smooth or Attached Solid Indeterminate Nodules Detected at Baseline CT Screening in the NELSON Study: Cancer Risk during 1 Year of Follow-up Radiology, January 1, 2009; 250(1): 264 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. McWilliams and J. Mayo Computed Tomography-detected Noncalcified Pulmonary Nodules: A Review of Evidence for Significance and Management Proceedings of the ATS, December 15, 2008; 5(9): 900 - 904. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. K. Gill, M. F. Vazquez, A. Kramer, M. Hames, L. Zhang, K. Heselmeyer-Haddad, T. Ried, K. Shilo, C. Henschke, D. Yankelevitz, et al. The Use of Genetic Markers to Identify Lung Cancer in Fine Needle Aspiration Samples Clin. Cancer Res., November 15, 2008; 14(22): 7481 - 7487. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. O. Wilson, J. L. Weissfeld, C. R. Fuhrman, S. N. Fisher, P. Balogh, R. J. Landreneau, J. D. Luketich, and J. M. Siegfried The Pittsburgh Lung Screening Study (PLuSS): Outcomes within 3 Years of a First Computed Tomography Scan Am. J. Respir. Crit. Care Med., November 1, 2008; 178(9): 956 - 961. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Umemura, N. Fujimoto, A. Hiraki, K. Gemba, N. Takigawa, K. Fujiwara, M. Fujii, H. Umemura, M. Satoh, M. Tabata, et al. Aberrant promoter hypermethylation in serum DNA from patients with silicosis Carcinogenesis, September 1, 2008; 29(9): 1845 - 1849. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. McMahon, C. Y. Kong, B. E. Johnson, M. C. Weinstein, J. C. Weeks, K. M. Kuntz, J.-A. O. Shepard, S. J. Swensen, and G. S. Gazelle Estimating Long-term Effectiveness of Lung Cancer Screening in the Mayo CT Screening Study Radiology, July 1, 2008; 248(1): 278 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. R. Washko, E. Hoffman, and J. J. Reilly Radiographic Evaluation of the Potential Lung Volume Reduction Surgery Candidate Proceedings of the ATS, May 1, 2008; 5(4): 421 - 426. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Jett and D. E. Midthun Commentary: CT Screening for Lung Cancer--Caveat Emptor Oncologist, April 1, 2008; 13(4): 439 - 444. [Full Text] [PDF]
|
|
|
|
|
|
D. S. Gierada, T. K. Pilgram, M. Ford, R. M. Fagerstrom, T. R. Church, H. Nath, K. Garg, and D. C. Strollo Lung Cancer: Interobserver Agreement on Interpretation of Pulmonary Findings at Low-Dose CT Screening Radiology, December 1, 2007; 246(1): 265 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. W. Lee, M. Kim, D. S. Gierada, and K. T. Bae Performance of a Computer-Aided Program for Automated Matching of Metastatic Pulmonary Nodules Detected on Follow-Up Chest CT Am. J. Roentgenol., November 1, 2007; 189(5): 1077 - 1081. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Fasola, O. Belvedere, M. Aita, T. Zanin, A. Follador, P. Cassetti, S. Meduri, V. De Pangher, G. Pignata, V. Rosolen, et al. Low-Dose Computed Tomography Screening for Lung Cancer and Pleural Mesothelioma in an Asbestos-Exposed Population: Baseline Results of a Prospective, Nonrandomized Feasibility Trial An Alpe-Adria Thoracic Oncology Multidisciplinary Group Study (ATOM 002) Oncologist, October 1, 2007; 12(10): 1215 - 1224. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. Wahidi, J. A. Govert, R. K. Goudar, M. K. Gould, and D. C. McCrory Evidence for the Treatment of Patients With Pulmonary Nodules: When Is It Lung Cancer?: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 94S - 107S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. K. Gould, J. Fletcher, M. D. Iannettoni, W. R. Lynch, D. E. Midthun, D. P. Naidich, and D. E. Ost Evaluation of Patients With Pulmonary Nodules: When Is It Lung Cancer?: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 108S - 130S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H Bolte, C Riede, S Muller-Hulsbeck, S Freitag-Wolf, G Kohl, T Drews, M Heller, and J Bieder Precision of computer-aided volumetry of artificial small solid pulmonary nodules in ex vivo porcine lungs Br. J. Radiol., June 1, 2007; 80(954): 414 - 421. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Dubey and C. A. Powell Update in Lung Cancer 2006 Am. J. Respir. Crit. Care Med., May 1, 2007; 175(9): 868 - 874. [Full Text] [PDF]
|
|
|
|
|
|
S. B. Markowitz, A. Miller, J. Miller, A. Manowitz, S. Kieding, L. Sider, and A. Morabia Ability of Low-Dose Helical CT To Distinguish Between Benign and Malignant Noncalcified Lung Nodules Chest, April 1, 2007; 131(4): 1028 - 1034. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
New York Early Lung Cancer Action Project Investig CT Screening for Lung Cancer: Diagnoses Resulting from the New York Early Lung Cancer Action Project Radiology, April 1, 2007; 243(1): 239 - 249. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Loewen, N. Natarajan, D. Tan, E. Nava, D. Klippenstein, M. Mahoney, M. Cummings, and M. Reid Autofluorescence bronchoscopy for lung cancer surveillance based on risk assessment Thorax, April 1, 2007; 62(4): 335 - 340. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. B. Bach, J. R. Jett, U. Pastorino, M. S. Tockman, S. J. Swensen, and C. B. Begg Computed Tomography Screening and Lung Cancer Outcomes JAMA, March 7, 2007; 297(9): 953 - 961. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Mujoomdar, J. H. M. Austin, R. Malhotra, C. A. Powell, G. D. N. Pearson, M. C. Shiau, and H. Raftopoulos Clinical Predictors of Metastatic Disease to the Brain from Non-Small Cell Lung Carcinoma: Primary Tumor Size, Cell Type, and Lymph Node Metastases Radiology, March 1, 2007; 242(3): 882 - 888. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M McMahon and D. C Christiani Computed tomography screening for lung cancer BMJ, February 10, 2007; 334(7588): 271 - 271. [Full Text] [PDF]
|
|
|
|
|
|
S. G Spiro Screening for lung cancer: yet another problem Thorax, February 1, 2007; 62(2): 105 - 106. [Full Text] [PDF]
|
|
|
|
|
|
C. Black, R. de Verteuil, S. Walker, J. Ayres, A. Boland, A. Bagust, and N. Waugh Population screening for lung cancer using computed tomography, is there evidence of clinical effectiveness? A systematic review of the literature Thorax, February 1, 2007; 62(2): 131 - 138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. F. Redente, D. J. Orlicky, R. J. Bouchard, and A. M. Malkinson Tumor Signaling to the Bone Marrow Changes the Phenotype of Monocytes and Pulmonary Macrophages during Urethane-Induced Primary Lung Tumorigenesis in A/J Mice Am. J. Pathol., February 1, 2007; 170(2): 693 - 708. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Lindell, T. E. Hartman, S. J. Swensen, J. R. Jett, D. E. Midthun, H. D. Tazelaar, and J. N. Mandrekar Five-year Lung Cancer Screening Experience: CT Appearance, Growth Rate, Location, and Histologic Features of 61 Lung Cancers Radiology, February 1, 2007; 242(2): 555 - 562. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. A Silvestri, P. J Nietert, J. Zoller, C. Carter, and D. Bradford Attitudes towards screening for lung cancer among smokers and their non-smoking counterparts Thorax, February 1, 2007; 62(2): 126 - 130. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. A. Silvestri Screening for lung cancer in a high-risk group: but I still haven't found what I'm looking for... Eur. Respir. J., January 1, 2007; 29(1): 6 - 7. [Full Text] [PDF]
|
|
|
|
|
|
T. Vierikko, R. Jarvenpaa, T. Autti, P. Oksa, M. Huuskonen, S. Kaleva, J. Laurikka, S. Kajander, K. Paakkola, S. Saarelainen, et al. Chest CT screening of asbestos-exposed workers: lung lesions and incidental findings Eur. Respir. J., January 1, 2007; 29(1): 78 - 84. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Hunt, M. Siva, R. Southon, and T. Treasure Does lung cancer screening with low-dose computerised tomography (LDCT) improve disease-free survival? Interactive CardioVascular and Thoracic Surgery, October 1, 2006; 5(5): 612 - 615. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Mascalchi, G. Belli, M. Zappa, G. Picozzi, M. Falchini, R. D. Nave, G. Allescia, A. Masi, A. L. Pegna, N. Villari, et al. Risk-benefit analysis of X-ray exposure associated with lung cancer screening in the Italung-CT trial. Am. J. Roentgenol., August 1, 2006; 187(2): 421 - 429. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. C. Black Randomized Clinical Trials for Cancer Screening: Rationale and Design Considerations for Imaging Tests J. Clin. Oncol., July 10, 2006; 24(20): 3252 - 3260. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-P. Revel, A. Merlin, S. Peyrard, R. Triki, S. Couchon, G. Chatellier, and G. Frija Software volumetric evaluation of doubling times for differentiating benign versus malignant pulmonary nodules. Am. J. Roentgenol., July 1, 2006; 187(1): 135 - 142. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Das, A. K. Ng, C. C. Earle, P. M. Mauch, and K. M. Kuntz Computed tomography screening for lung cancer in Hodgkin's lymphoma survivors: decision analysis and cost-effectiveness analysis Ann. Onc., May 1, 2006; 17(5): 785 - 793. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. K. Ganti and J. L. Mulshine Lung cancer screening. Oncologist, May 1, 2006; 11(5): 481 - 487. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. R. Goodman, M. Gulsun, L. Washington, P. G. Nagy, and K. L. Piacsek Inherent Variability of CT Lung Nodule Measurements In Vivo Using Semiautomated Volumetric Measurements. Am. J. Roentgenol., April 1, 2006; 186(4): 989 - 994. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Khokhar, A Vickers, M S Moore, S Mironov, D E Stover, and M B Feinstein Significance of non-calcified pulmonary nodules in patients with extrapulmonary cancers Thorax, April 1, 2006; 61(4): 331 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Pajares, I. Zudaire, M. D. Lozano, J. Agorreta, G. Bastarrika, W. Torre, A. Remirez, R. Pio, J. J. Zulueta, and L. M. Montuenga Molecular profiling of computed tomography screen-detected lung nodules shows multiple malignant features. Cancer Epidemiol. Biomarkers Prev., February 1, 2006; 15(2): 373 - 380. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R MacRedmond, G McVey, M Lee, R W Costello, D Kenny, C Foley, P M Logan, and on behalf of the PALCAD investigators Screening for lung cancer using low dose CT scanning: results of 2 year follow up Thorax, January 1, 2006; 61(1): 54 - 56. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F V Gleeson Is screening for lung cancer using low dose spiral CT scanning worthwhile? Thorax, January 1, 2006; 61(1): 5 - 7. [Full Text] [PDF]
|
|
|
|
|
|
F. Li, H. Arimura, K. Suzuki, J. Shiraishi, Q. Li, H. Abe, R. Engelmann, S. Sone, H. MacMahon, and K. Doi Computer-aided Detection of Peripheral Lung Cancers Missed at CT: ROC Analyses without and with Localization Radiology, November 1, 2005; 237(2): 684 - 690. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. B. Flieder, J. L. Port, R. J. Korst, P. J. Christos, M. A. Levin, D. E. Becker, and N. K. Altorki Tumor Size Is a Determinant of Stage Distribution in T1 Non-Small Cell Lung Cancer Chest, October 1, 2005; 128(4): 2304 - 2308. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Novello, C. Fava, P. Borasio, L. Dogliotti, G. Cortese, B. Crida, G. Selvaggi, P. Lausi, M. P. Brizzi, P. Sperone, et al. Three-year findings of an early lung cancer detection feasibility study with low-dose spiral computed tomography in heavy smokers Ann. Onc., October 1, 2005; 16(10): 1662 - 1666. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G. Spiro and G. A. Silvestri One Hundred Years of Lung Cancer Am. J. Respir. Crit. Care Med., September 1, 2005; 172(5): 523 - 529. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Lindell, T. E. Hartman, S. J. Swensen, J. R. Jett, D. E. Midthun, M. A. Nathan, and V. J. Lowe Lung Cancer Screening Experience: A Retrospective Review of PET in 22 Non-Small Cell Lung Carcinomas Detected on Screening Chest CT in a High-Risk Population Am. J. Roentgenol., July 1, 2005; 185(1): 126 - 131. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Jett Limitations of Screening for Lung Cancer with Low-Dose Spiral Computed Tomography Clin. Cancer Res., July 1, 2005; 11(13): 4988s - 4992s. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Bastarrika, M. J. Garcia-Velloso, M. D. Lozano, U. Montes, W. Torre, N. Spiteri, A. Campo, L. Seijo, A. B. Alcaide, J. Pueyo, et al. Early Lung Cancer Detection Using Spiral Computed Tomography and Positron Emission Tomography Am. J. Respir. Crit. Care Med., June 15, 2005; 171(12): 1378 - 1383. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Das, A. K. Ng, M. A. Stevenson, and P. M. Mauch Clinical course of thoracic cancers in Hodgkin's disease survivors Ann. Onc., May 1, 2005; 16(5): 793 - 797. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Lenox To Screen or Not To Screen Chest, April 1, 2005; 127(4): 1091 - 1092. [Full Text] [PDF]
|
|
|
|
|
|
J. P. Wisnivesky, D. Yankelevitz, and C. I. Henschke Stage of Lung Cancer in Relation to Its Size: Part 2. Evidence Chest, April 1, 2005; 127(4): 1136 - 1139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. Strauss, L. Dominioni, J. R. Jett, M. Freedman, and F. W. Grannis Jr Como International Conference Position Statement: Lung Cancer Screening for Early Diagnosis 5 Years After The 1998 Varese Conference Chest, April 1, 2005; 127(4): 1146 - 1151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. J. Swensen, J. R. Jett, T. E. Hartman, D. E. Midthun, S. J. Mandrekar, S. L. Hillman, A.-M. Sykes, G. L. Aughenbaugh, A. O. Bungum, and K. L. Allen CT Screening for Lung Cancer: Five-year Prospective Experience Radiology, April 1, 2005; 235(1): 259 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Fujiwara, N. Fujimoto, M. Tabata, K. Nishii, K. Matsuo, K. Hotta, T. Kozuki, M. Aoe, K. Kiura, H. Ueoka, et al. Identification of Epigenetic Aberrant Promoter Methylation in Serum DNA Is Useful for Early Detection of Lung Cancer Clin. Cancer Res., February 1, 2005; 11(3): 1219 - 1225. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K Doi Current status and future potential of computer-aided diagnosis in medical imaging Br. J. Radiol., January 1, 2005; 78(suppl_1): S3 - s19. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Bach, E. B. Elkin, U. Pastorino, M. W. Kattan, A. I. Mushlin, C. B. Begg, and D. M. Parkin Benchmarking Lung Cancer Mortality Rates in Current and Former Smokers Chest, December 1, 2004; 126(6): 1742 - 1749. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Li, M. Aoyama, J. Shiraishi, H. Abe, Q. Li, K. Suzuki, R. Engelmann, S. Sone, H. MacMahon, and K. Doi Radiologists' Performance for Differentiating Benign from Malignant Lung Nodules on High-Resolution CT Using Computer-Estimated Likelihood of Malignancy Am. J. Roentgenol., November 1, 2004; 183(5): 1209 - 1215. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Mayo, K.-I. Kim, S. L. S. MacDonald, T. Johkoh, P. Kavanagh, H. O. Coxson, and S. Vedal Reduced Radiation Dose Helical Chest CT: Effect on Reader Evaluation of Structures and Lung Findings Radiology, September 1, 2004; 232(3): 749 - 756. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Crestanello, M. S. Allen, J. R. Jett, S. D. Cassivi, F. C. Nichols III, S. J. Swensen, C. Deschamps, and P. C. Pairolero Thoracic surgical operations in patients enrolled in a computed tomographic screening trial J. Thorac. Cardiovasc. Surg., August 1, 2004; 128(2): 254 - 259. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. Borczuk, L. Shah, G. D. N. Pearson, K. L. Walter, L. Wang, J. H. M. Austin, R. A. Friedman, and C. A. Powell Molecular Signatures in Biopsy Specimens of Lung Cancer Am. J. Respir. Crit. Care Med., July 15, 2004; 170(2): 167 - 174. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Gohagan, P. Marcus, R. Fagerstrom, P. Pinsky, B. Kramer, and P. Prorok Baseline Findings of a Randomized Feasibility Trial of Lung Cancer Screening With Spiral CT Scan vs Chest Radiograph: The Lung Screening Study of the National Cancer Institute Chest, July 1, 2004; 126(1): 114 - 121. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. G. Jennings, H. T. Winer-Muram, R. D. Tarver, and M. O. Farber Lung Tumor Growth: Assessment with CT--Comparison of Diameter and Cross-sectional Area with Volume Measurements Radiology, June 1, 2004; 231(3): 866 - 871. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. L. Humphrey, S. Teutsch, and M. Johnson Lung Cancer Screening with Sputum Cytologic Examination, Chest Radiography, and Computed Tomography: An Update for the U.S. Preventive Services Task Force Ann Intern Med, May 4, 2004; 140(9): 740 - 753. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Endo, Y. Kotani, M. Satouchi, Y. Takada, T. Sakamoto, N. Tsubota, and H. Furukawa CT Fluoroscopy-Guided Bronchoscopic Dye Marking for Resection of Small Peripheral Pulmonary Nodules Chest, May 1, 2004; 125(5): 1747 - 1752. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-P. Revel, A. Bissery, M. Bienvenu, L. Aycard, C. Lefort, and G. Frija Are Two-dimensional CT Measurements of Small Noncalcified Pulmonary Nodules Reliable? Radiology, May 1, 2004; 231(2): 453 - 458. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.-P. Revel, C. Lefort, A. Bissery, M. Bienvenu, L. Aycard, G. Chatellier, and G. Frija Pulmonary Nodules: Preliminary Experience with Three-dimensional Evaluation Radiology, May 1, 2004; 231(2): 459 - 466. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Miller, S. Markowitz, A. Manowitz, and J. A. Miller Lung Cancer Screening Using Low-Dose High-Resolution CT Scanning in a High-Risk Workforce: 3,500 Nuclear Fuel Workers in Three US States Chest, May 1, 2004; 125(5_suppl): 152S - 153S. [Full Text] [PDF]
|
|
|
|
|
|
G. Loewen, M. Reid, D. Tan, D. Klippenstein, E. Nava, R. Natarajan, and M. Mahoney Bimodality Lung Cancer Screening in High-Risk Patients: A Preliminary Report Chest, May 1, 2004; 125(5_suppl): 163S - 164S. [Full Text] [PDF]
|
|
|
|
|
|
D. M. Libby, J. P. Smith, N. K. Altorki, M. W. Pasmantier, D. Yankelevitz, and C. I. Henschke Managing the Small Pulmonary Nodule Discovered by CT Chest, April 1, 2004; 125(4): 1522 - 1529. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R MacRedmond, P M Logan, M Lee, D Kenny, C Foley, and R W Costello Screening for lung cancer using low dose CT scanning Thorax, March 1, 2004; 59(3): 237 - 241. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Awai, K. Murao, A. Ozawa, M. Komi, H. Hayakawa, S. Hori, and Y. Nishimura Pulmonary Nodules at Chest CT: Effect of Computer-aided Diagnosis on Radiologists' Detection Performance Radiology, February 1, 2004; 230(2): 347 - 352. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Means-Markwell, R. I. Linnoila, J. Williams, P. A. Janne, F. Kaye, K. O'Neil, and B. E. Johnson Prospective Study of the Airways and Pulmonary Parenchyma of Patients at Risk for a Second Lung Cancer Clin. Cancer Res., December 1, 2003; 9(16): 5915 - 5921. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Sidransky, R. Irizarry, J. A. Califano, X. Li, H. Ren, N. Benoit, and L. Mao Serum Protein MALDI Profiling to Distinguish Upper Aerodigestive Tract Cancer Patients From Control Subjects J Natl Cancer Inst, November 19, 2003; 95(22): 1711 - 1717. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. McWilliams, J. Mayo, S. MacDonald, J. C. leRiche, B. Palcic, E. Szabo, and S. Lam Lung Cancer Screening: A Different Paradigm Am. J. Respir. Crit. Care Med., November 15, 2003; 168(10): 1167 - 1173. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Fenton and R. A. Deyo Patient Self-Referral for Radiologic Screening Tests: Clinical and Ethical Concerns J Am Board Fam Med, November 1, 2003; 16(6): 494 - 501. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Watanabe, A. Ishizaka, E. Ikeda, A. Ohashi, and K. Kobayashi Contributions of bronchoscopic microsampling in the supplemental diagnosis of small peripheral lung carcinoma Ann. Thorac. Surg., November 1, 2003; 76(5): 1668 - 1672. [Abstract] [Full Text] [PDF]
|
|
|
|
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J. P. Ko, H. Rusinek, E. L. Jacobs, J. S. Babb, M. Betke, G. McGuinness, and D. P. Naidich Small Pulmonary Nodules: Volume Measurement at Chest CT--Phantom Study Radiology, September 1, 2003; 228(3): 864 - 870. [Abstract] [Full Text] [PDF]
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J. R. Mayo, J. Aldrich, and N. L. Muller Radiation Exposure at Chest CT: A Statement of the Fleischner Society Radiology, July 1, 2003; 228(1): 15 - 21. [Abstract] [Full Text] [PDF]
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 D. Ost, A. M. Fein, and S. H. Feinsilver The Solitary Pulmonary Nodule N. Engl. J. Med., June 19, 2003; 348(25): 2535 - 2542. [Full Text] [PDF]
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H. Kimura, N. Iwai, S. Ando, K. Kakizawa, N. Yamamoto, H. Hoshino, and T. Anayama A prospective study of indications for mediastinoscopy in lung cancer with CT findings, tumor size, and tumor markers Ann. Thorac. Surg., June 1, 2003; 75(6): 1734 - 1739. [Abstract] [Full Text] [PDF]
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S. Takashima, S. Sone, F. Li, Y. Maruyama, M. Hasegawa, and M. Kadoya Indeterminate Solitary Pulmonary Nodules Revealed at Population-Based CT Screening of the Lung: Using First Follow-Up Diagnostic CT to Differentiate Benign and Malignant Lesions Am. J. Roentgenol., May 1, 2003; 180(5): 1255 - 1263. [Abstract] [Full Text] [PDF]
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P. B. Bach, M. W. Kattan, M. D. Thornquist, M. G. Kris, R. C. Tate, M. J. Barnett, L. J. Hsieh, and C. B. Begg Variations in Lung Cancer Risk Among Smokers J Natl Cancer Inst, March 19, 2003; 95(6): 470 - 478. [Abstract] [Full Text] [PDF]
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J. M. Reich Lung Cancer Screening: Contumacy vs Mendacity Chest, March 1, 2003; 123(3): 963 - 964. [Full Text] [PDF]
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 L. G. Ford, L. M. Minasian, W. McCaskill-Stevens, E. D. Pisano, D. Sullivan, and R. A. Smith Prevention and Early Detection Clinical Trials: Opportunities for Primary Care Providers and Their Patients CA Cancer J Clin, March 1, 2003; 53(2): 82 - 101. [Abstract] [Full Text]
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S. J. Swensen, J. R. Jett, T. E. Hartman, D. E. Midthun, J. A. Sloan, A.-M. Sykes, G. L. Aughenbaugh, and M. A. Clemens Lung Cancer Screening with CT: Mayo Clinic Experience Radiology, March 1, 2003; 226(3): 756 - 761. [Abstract] [Full Text] [PDF]
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M. J. Tobin Chronic Obstructive Pulmonary Disease, Pollution, Pulmonary Vascular Disease, Transplantation, Pleural Disease, and Lung Cancer in AJRCCM 2002 Am. J. Respir. Crit. Care Med., February 1, 2003; 167(3): 356 - 370. [Full Text] [PDF]
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K.-c. Chang and C.-c. Leung Computed tomography is reasonably reliable for screening lung cancer Am. J. Respir. Crit. Care Med., February 1, 2003; 167(3): 473 - 473. [Full Text] [PDF]
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P. J. Mahadevia, L. A. Fleisher, K. D. Frick, J. Eng, S. N. Goodman, and N. R. Powe Lung Cancer Screening With Helical Computed Tomography in Older Adult Smokers: A Decision and Cost-effectiveness Analysis JAMA, January 15, 2003; 289(3): 313 - 322. [Abstract] [Full Text] [PDF]
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M. Decramer and C. Roussos Early detection: introduction Eur. Respir. J., January 1, 2003; 21(39_suppl): 1S - 2s. [Full Text] [PDF]
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S.G. Spiro Surgery for nonsmall cell lung cancer: can improvements be made? Eur. Respir. J., January 1, 2003; 21(39_suppl): 52S - 56s. [Abstract] [Full Text] [PDF]
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