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Uraujh Yousaf-Khan
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MA03 - Lung Cancer Screening - Next Step (ID 896)
- Event: WCLC 2018
- Type: Mini Oral Abstract Session
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 10:30 - 12:00, Room 206 AC
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MA03.05 - New Subsolid Pulmonary Nodules in Lung Cancer Screening: The NELSON Trial (ID 11998)
11:00 - 11:05 | Author(s): Uraujh Yousaf-Khan
- Abstract
- Presentation
Background
A central challenge in low-dose computed tomography (LDCT) lung cancer screening is the identification of clinically relevant lung cancer, while preventing overdiagnosis and overtreatment. Subsolid nodules are particularly challenging as they carry a relatively high malignancy rate but possess a slow growth rate. Current guidelines propose a watchful waiting approach with CT surveillance. While new solid nodules after baseline screening have a high lung cancer probability at small size and require lower size cutoff values than baseline nodules, there only is limited evidence on management of new subsolid nodules. Aim of this study was to assess the occurrence and lung cancer frequency of new subsolid nodules and to determine whether a more aggressive follow-up approach is necessary for new subsolid nodules.
a9ded1e5ce5d75814730bb4caaf49419 Method
Within the Dutch-Belgian randomized controlled LDCT lung cancer screening trial (NELSON), 7557 participants underwent baseline screening between April 2004 and December 2006. Three incidence screening rounds took place 1 year, 3 years, and 5.5 years after baseline screening. Participants with new subsolid nodules detected after the baseline screening round were included. A nodule was classified as (pre-)malignancy when it was diagnosed as lung cancer during diagnostic workup including histologic assessment.
4c3880bb027f159e801041b1021e88e8 Result
In the three incidence screening rounds 60 new subsolid nodules not visible in retrospect (43 [72%] part-solid, 17 [28%] nonsolid) were detected in 51 participants (0.7% [51/7295] of participants with at least one incidence screening). Eventually, 6% (3/51) of participants with a new subsolid nodule was diagnosed with a (pre-)malignancy in such a nodule. The (pre-)malignancies were adenocarcinoma (in situ) and diagnostic work-up (referral 950, 364, and 366 days after first detection respectively) showed favorable staging (stage I). Overall, 65% (33/49) of subsolid nodules with follow-up screening were resolving.
8eea62084ca7e541d918e823422bd82e Conclusion
Less than 1% of participants in LDCT lung cancer screening presents with a new subsolid nodule after baseline. Contrary to new solid nodules, new subsolid nodules do not require a more aggressive follow-up approach than baseline nodules.
6f8b794f3246b0c1e1780bb4d4d5dc53Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.
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P1.11 - Screening and Early Detection (Not CME Accredited Session) (ID 943)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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P1.11-06 - Lung Cancer Probability in New Perifissural Nodules Detected in a Lung Cancer Screening Study (ID 13427)
16:45 - 18:00 | Author(s): Uraujh Yousaf-Khan
- Abstract
Background
In incidence lung cancer screening rounds, new lung nodules are a regular finding, with a higher lung cancer probability than baseline nodules. A substantial number of screen-detected nodules is classified as perifissural nodule (PFN). Previous studies showed that baseline PFNs and PFNs in clinical settings represent non-malignant lesions such as intrapulmonary lymph nodes. Whether this is also the case for incident PFNs is unknown. This study evaluates all newly detected nodules in the Dutch-Belgian randomized-controlled NELSON study with respect to perifissural classification and lung cancer probability.
a9ded1e5ce5d75814730bb4caaf49419 Method
All NELSON participants with a new solid nodule detected in screening round 2, 3 or 4 (1, 3, and 5.5 years after baseline, respectively), were enrolled in this substudy. Nodules were classified into three groups: intraparenchymal, vessel attached or fissure attached. Screening CT scans of participants with lung cancer based on a nodule classified as fissure attached, were re-evaluated by two radiologists (4 and 6 years of experience) to check whether this nodule was a typical, atypical or non-PFN. The fissure-attached cancers were matched based on size with benign cases (1:4), and the radiologists were blinded for the final nodule outcome. In case of discrepancy, a third radiologist (13 years of experience) arbitered.
4c3880bb027f159e801041b1021e88e8 Result
1,484 new nodules were detected in the second, third and final NELSON screening round in 949 participants (77.4% male, median age 59 [interquartile range: 55-63]). 1,393 nodules (93.8%) were benign based on 2 year follow-up or pathology; 96 of these (6.9%) were fissure attached. Lung cancer diagnosis was made in 74 new nodules in 74 participants (7.8% of participants with a new nodule). Nine lung cancers (12.1%) were fissure attached and re-evaluated by the radiologists. None of the fissure attached malignant new nodules was classified as a typical or atypical PFN.
8eea62084ca7e541d918e823422bd82e Conclusion
None of the lung cancers that originated from a new nodule in the NELSON study was classified as a typical or atypical PFN. Our results suggest that also in the case of a new PFN, it is highly unlikely that these PFNs will be diagnosed as lung cancer.
6f8b794f3246b0c1e1780bb4d4d5dc53
