Published ahead of print on July 17, 2008, doi:10.1164/rccm.200802-336OC Am. J. Respir. Crit. Care Med., Volume 178, Number 9, November 2008, 956-961 A more recent version of this article appeared on November 1, 2008
Submitted on February 25, 2008 The Pittsburgh Lung Screening Study (PLuSS): Outcomes within 3 years of a first CT ScanDavid O Wilson1*,1 Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 2 Department of Epidemiology, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 3 Department of Radiology, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 4 Heart, Lung, Esophageal Surgery Institute, Department of Surgery, University of Pittsburgh Cancer Institute and University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 5 Department of Pharmacology, University of Pittsburgh, Pittsburgh, PA, USA * To whom correspondence should be addressed. E-mail: wilsondo{at}upmc.edu.
Objective: To report findings from initial and one-year repeat screening low-radiation-dose computed tomography (CT) of the chest and three-year outcomes for 50 to 79 year-old current and ex-smokers in the Pittsburgh Lung Screening Study (PLuSS). Methods: Notified of findings on screening CT, subjects received diagnostic advice from both study and personal physicians. Tracking subjects for up to three years since initial screening, we obtained medical records to document diagnostic procedures, lung cancer diagnoses, and deaths. Results: 3,642 and 3,423 subjects had initial and repeat screening. 1,477 (40.6% of 3,624) were told about non-calcified lung nodules on the initial screening and, before repeat screening, 821 (55.6% of 1,477, 22.5% of 3,642) obtained one or more subsequent diagnostic imaging studies (CT, positron emission tomography - PET, or PET-CT). Tracking identified 80 subjects with lung cancer, including 53 subjects with tumor seen at initial screening. In all, 36 subjects (1.0% of the 3,642 screened), referred for abnormalities on either the initial or repeat screening, had a major thoracic surgical procedure (thoracotomy, video-assisted thoracoscopic surgery - VATS, median sternotomy, or mediastinoscopy) leading to a non-cancer final diagnosis. Out of 82 subjects with thoracotomy or VATS to exclude malignancy in a lung nodule, 28 (34.1%) received a non-cancer final diagnosis. Forty of 69 (58%) subjects with non-small cell lung cancer had stage I disease at diagnosis. Conclusions: Though leading to the discovery of early stage lung cancer, CT screening also led to many diagnostic follow-up procedures, including major thoracic surgical procedures with non-cancer outcomes. Key words: lung cancer screening
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