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Published ahead of print on July 25, 2003, doi:10.1164/rccm.200301-144OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 10, November 2003, 1167-1173

A more recent version of this article appeared on November 15, 2003
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Submitted on February 3, 2003
Accepted on July 23, 2003

Lung Cancer Screening: A Different Paradigm

Annette McWilliams1*, John Mayo2, Sharyn MacDonald2, Jean C leRiche1, Branko Palcic1, Eva Szabo3, and Stephen Lam1

1 British Columbia Cancer Agency, Vancouver, BC, Canada, 2 Radiology, Vancouver General Hospital, Vancouver, BC, Canada, 3 Lung and Upper Aerodigestive Cancer Research Group, National Cancer Institute, Division of Cancer Prevention, Bethesda, MD, USA

* To whom correspondence should be addressed. E-mail: amcwilli{at}bccancer.bc.ca.

Thoracic computed tomography (CT) is a sensitive method for detecting early lung cancer, but has a high false-positive rate and is not sensitive for detecting central pre-invasive and micro-invasive cancer. Our hypothesis was that automated quantitative image cytometry (AQC) of sputum cells as the first screening method may improve detection rate by identifying individuals at highest risk for lung cancer. Five hundred and sixty one volunteer current or former smokers >= 50 years of age, with a smoking history of >=30 pack/years, were studied. Among these, 423 were found to have sputum atypia defined as >=5 cells with abnormal DNA content using AQC. Non-calcified pulmonary nodules were found in 46% (261/561). Of the 14 detected cancers, 13 were detected in subjects with sputum atypia; 9 by CT and 4 CIS/micro-invasive cancers by autofluorescence bronchoscopy. One cancer was detected by CT alone. AQC of sputum cells improved the detection rate of lung cancer from 1.8 % to 3.1%. CT scan alone would have missed 29% of the cancers. This screening paradigm shift has the additional potential of reducing the number of initial CT scans by at least 25% with further savings in follow-up investigations and treatment.
Key words: Lung Neoplasms; Tomography, X-ray computed; Bronchoscopy; Diagnostic Imaging; Cytology




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