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H.J. De Koning



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    MO11 - Screening and Epidemiology (ID 131)

    • Event: WCLC 2013
    • Type: Mini Oral Abstract Session
    • Track: Imaging, Staging & Screening
    • Presentations: 1
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      MO11.03 - The natural history and screen-detectability of lung cancer: estimates from NLST and the PLCO (ID 2383)

      16:15 - 17:45  |  Author(s): H.J. De Koning

      • Abstract
      • Presentation
      • Slides

      Background
      Implementing effective lung cancer screening programs requires extensive knowledge on the natural history of lung cancer and the sensitivity of the proposed screening modality. Data from the National Lung Cancer Screening Trial (NLST), the Prostate, Lung, Colon and Ovarian Cancer Study (PLCO) and Surveillance Epidemiology and End Result (SEER) data from 2004-2008 are used to investigate the screening sensitivity (by stage and histological type) of Computed Tomography (CT) and chest radiography (CXR) and the mean preclinical sojourn time (MPST) of lung cancer (by gender, stage and histological type).

      Methods
      The MISCAN-Lung model was used to reproduce the lung cancer incidence by method of detection (clinical or screen-detected), gender, histology and stage in both trials, by calibrating screening sensitivity and natural history parameters.

      Results
      Major differences in sensitivity between CT and CXR are estimated for the less advanced stages, for example the sensitivity for stage IA adenocarcinoma is estimated to be 56.63% for CT compared to 16.91% for CXR. The model suggests that the MPST varies by histological type and gender. The largest difference between genders was estimated for adenocarcinoma for which the MPST in pre-clinical stages IA to IV was estimated to be 4.48 years for men compared to 6.01 years for women.

      Conclusion
      This study provides detailed insights in the natural history of lung cancer and the differences in the effectiveness of screening between the NLST and PLCO trials. This knowledge may help to determine effective lung cancer screening programs.

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    PL03 - Presidential Symposium Including Top Rated Abstracts (ID 85)

    • Event: WCLC 2013
    • Type: Plenary Session
    • Track:
    • Presentations: 1
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      PL03.01 - Lung cancer probability in subjects with CT-detected pulmonary nodules (ID 1578)

      08:15 - 09:45  |  Author(s): H.J. De Koning

      • Abstract
      • Slides

      Background
      The main challenge in computed tomography (CT) screening for lung cancer is the high prevalence of pulmonary nodules and the relatively low incidence of lung cancer. Thresholds for nodule size and growth rate, which determine which nodules require additional diagnostic procedures, should be based on the lung cancer probability of the individual.

      Methods
      Diameter, volume and volume-doubling time (VDT) of 9,681 non-calcified nodules detected by CT screening in 7,155 subjects were used to quantify lung cancer probability. Complete coverage on all lung cancer diagnoses was obtained by linkages with the national cancer registry. The nodule management algorithm recommended by the ACCP was evaluated and an improved algorithm, based on lung cancer probability, was proposed.

      Results
      Lung cancer probability was low in subjects with a nodule volume <100mm³ (≤0.7%) or maximum transverse diameter <5mm (≤0.6%) Moreover, probability in these subjects was not significantly different from that in subjects without nodules (0.4%). Lung cancer probability was 0.9-5.8% for nodules with a volume 100-300mm³ or a diameter 5-10mm; the VDT further stratified the probability: 0.0-0.9% for VDTs>600days, 4.0% for VDTs 400-600days and 6.7-25.0% for VDTs<400days. Lung cancer probability was high for participants with nodule volumes ≥300mm³ (8.9-26.1%) or diameters ≥10mm (11.1-26.2%), even with long VDTs. Finally, raising the thresholds for nodule size recommended by the ACCP for an indeterminate result from 4mm to 5mm and for a positive result from 8mm to 10mm, would yield fewer follow-up CT examinations (from 29.8% to 22.2%) and fewer additional diagnostic procedures (from 8.9% to 5.3%) while maintaining the sensitivity at 94.2%.

      Conclusion
      Small nodules (volume <100mm³ or diameter <5mm) are not predictive for lung cancer. Immediate diagnostic evaluation is necessary for subjects with large nodules (volume ≥300mm³ or diameter ≥10mm) and only for subjects with nodules of intermediate size is VDT assessment advocated.

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