ARTÍCULO

Improving selection criteria for lung cancer screening. The potential role of emphysema

Autores: Sánchez Salcedo, Pablo Antonio; Wilson, D. O.; De Torres Tajes, Juan Pablo; Weissfeld, J. L.; Berto Botella, Juan Antonio; Campo Ezquibela, Aránzazu; Alcaide Ocaña, Ana Belén; Pueyo Villoslada, Jesús Ciro; Bastarrika Alemáñ, Gorka; Seijo Maceiras, Luis Miguel; Pajares Villandiego, María Josefa; Pio Osés, Rubén; Montuenga Badía, Luis; Zulueta Francés, Javier Joseph
Título de la revista: AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE
ISSN: 1073-449X
Volumen: 191
Número: 8
Páginas: 924 - 931
Fecha de publicación: 2015
Resumen:
Rationale: Lung cancer (LC) screening using low-dose chest computed tomography is now recommended in several guidelines using the National Lung Screening Trial (NLST) entry criteria (age, 55-74; ¿30 pack-years; tobacco cessation within the previous 15 yr for former smokers). Concerns exist about their lack of sensitivity. Objectives: To evaluate the performance of NLST criteria in two different LC screening studies from Europe and the United States, and to explore the effect of using emphysema as a complementary criterion. Methods: Participants from the Pamplona International Early Lung Action Detection Program (P-IELCAP; n = 3,061) and the Pittsburgh Lung Screening Study (PLuSS; n = 3,638) were considered. LC cumulative frequencies, incidence densities, and annual detection rates were calculated in three hypothetical cohorts, including subjects whometNLST criteria alone, those withcomputed tomography-detected emphysema, and those who met NLST criteria and/or had emphysema. Measurements and Main Results: Thirty-six percent and 59% of P-IELCAP and PLuSS participants, respectively, met NLST criteria. Among these, higher LC incidence densities and detection rates were observed. However, applying NLST criteria to our original cohorts would miss asmany as 39% of all LC. Annual screening of subjects meeting either NLST criteria or having emphysema detected most cancers (88% and 95% of incident LC of P-IELCAP and PLuSS, respectively) despite reducing the number of screened participants by as much as 52%. Conclusions: LC screening based solely on NLST criteria could miss a significant number of LC cases. Combining NLST criteria and emphysema to select screening candidates results in higher LC detection rates and a lower number of cancers missed.