Published ahead of print on March 24, 2005, doi:10.1164/rccm.200411-1479OC
Am. J. Respir. Crit. Care Med., Volume 171, Number 12, June 2005, 1378-1383
A more recent version of this article appeared on June 15, 2005
Submitted on November 5, 2004
Accepted on March 18, 2005
Early Lung Cancer Detection using Spiral Computed Tomography and Positron Emission Tomography
Gorka Bastarrika1, Maria Jose Garcia-Velloso2, Maria Dolores Lozano3, Usua Montes4, Wenceslao Torre5, Natalia Spiteri5, Arantza Campo4, Luis Seijo4, Ana Belen Alcaide4, Jesus Pueyo1, David Cano1, Isabel Vivas1, Octavio Cosin1, Pablo Dominguez1, Patricia Serra2, Jose A Richter2, Luis Montuenga6, and Javier J Zulueta4*
1 Department of Radiology, Clinica Universitaria, Pamplona, Navarra, Spain,
2 Department of Nuclear Medicine, Clinica Universitaria, Pamplona, Navarra, Spain,
3 Department of Pathology, Clinica Universitaria, Pamplona, Navarra, Spain,
4 Department of Pulmonary Medicine, Clinica Universitaria, Pamplona, Navarra, Spain,
5 Department of Thoracic Surgery, Clinica Universitaria, Pamplona, Navarra, Spain,
6 Department of Histology and Pathology, Universidad de Navarra School of Medicine, Center for Applied Medical Research (CIMA), Pamplona, Navarra, Spain; Division of Oncology, Universidad de Navarra School of Medicine, Center for Applied Medical Research (CIMA), Pamplona, Navarra, Spain
* To whom correspondence should be addressed. E-mail: jzulueta{at}unav.es.
Rationale: Lung cancer screening using CT is effective in detecting lung cancer in early stages. Concerns regarding false positive rates and unnecessary invasive procedures have been raised. Objective: To study the efficiency of a lung cancer screening protocol using spiral CT and FDG-PET. Methods: High risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for non-calcified nodules of  5 mm, and FDG-PET was done for nodules 10 mm or smaller (> 7mm) growing nodules. Results: 911 individuals completed a baseline CT study and 424 at least one annual follow-up study. Of the former, 14% had non-calcified nodules 5 mm, and 3.6% had nodules 10mm. Eleven non-small cell- (NSCLC) and 1 small cell (SCLC) lung cancers were diagnosed in the baseline study (prevalence rate of 1.32%), and 2 NSCLC in the annual study (incidence rate of 0.47%). All NSCLC (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 out of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69%, 91%, 90% and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%. Conclusion: A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions.
Key words: lung neoplasm, smoking, COPD, pulmonary nodule
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