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Emily Bartlett
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MA10 - Emerging Technologies for Lung Cancer Detection (ID 129)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Screening and Early Detection
- Presentations: 1
- Now Available
- Moderators:Fabrizio Bianchi, Marcelo Sanchez
- Coordinates: 9/08/2019, 15:15 - 16:45, Dublin (1997)
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MA10.10 - Uptake in Lung Cancer Screening – Does CT Location Matter? A Pilot Study Comparison of a Mobile and Hospital Based CT Scanner (Now Available) (ID 2165)
15:15 - 16:45 | Presenting Author(s): Emily Bartlett
- Abstract
- Presentation
Background
Community based lung cancer screening has been proposed as a method of increasing uptake for lung cancer screening by reducing barriers to participation. We report baseline statistics for a lung cancer screening pilot study in which patients were scanned on either a community based mobile CT unit or on a University Hospital based fixed-site CT scanner.
Method
Ever smokers aged 60-75 registered at 17 participating general practitioner practices (GP) in West London were invited for a lung health check at either a mobile unit situated in a supermarket car park or in a hospital site. The location offered was based upon proximity to the participant’s home address. On attendance a lung health check, assessing lung cancer risk, was undertaken. Participants with a LLPv2 score of ≥2.0% and/or PLCOM2012 score of ≥1.51% were offered a same day low dose CT (LDCT) scan. Uptake, attendance and non-attendance (DNA) rates were compared using Chi-squared (χ2) test.
Result
8366 potentially eligible participants were invited for a lung health check appointment; 5135 (61.4%) to the hospital site, and 3231 (38.6%) to the mobile site. 1749/8366 (20.9%) participants responded (males n=954/1749 (54.5%)). 1047/5135 (20.4%) were booked an appointment at the hospital site and 702/3231 (21.7%) at the mobile site (p=0.14). No difference was observed in lung cancer risk between participants at the two sites. Patients at the mobile site were more likely to be ex-smokers (p=0.048). The DNA rate at the hospital site was 96/1047 (9.2%) and at the mobile site was 48/702 (6.8%) (p=0.08). On attendance, 63 patients were ineligible for screening; 52/1749 (3.0%) did not meet the entry criteria and 11/1749 (0.6%) were acutely unwell. Therefore 1542 patients attended and had a risk score calculated and of these 1145/1542 (74.3%) underwent CT. Median [range] risk scores for scanned patients were 1.97 [0-25.34] for PLCOM2012 and 4.71 [0.94-35.92] for LLPv2. Lung cancer was confirmed in 17/1145 (1.5%) participants at baseline. A further 151/1145 (13.2%) participants will undergo interval CT for indeterminate nodules.
Conclusion
There was a small but non-significant increase in participant response rates for the community based mobile site compared to the hospital site CT scanner, but no difference in DNA rates. While community based mobile scanners may provide valuable additional capacity to lung screening programmes, the magnitude of any benefit to participant uptake needs to be balanced against the additional complexity of setting up these stand-alone facilities. Further work is ongoing to understand the interaction between CT location and other factors that influence recruitment, with a view to using effective methods to increase uptake at all sites for future screening invitations.
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P1.11 - Screening and Early Detection (ID 177)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.11-30 - Very Rapid Growth of Small Pulmonary Nodules Predicts Benignity (ID 704)
09:45 - 18:00 | Author(s): Emily Bartlett
- Abstract
Background
Growth of pulmonary nodules on repeat CT is used to identify malignant lesions, although very rapid growth is thought to imply an inflammatory process. Few data exist examining the optimum threshold at which rate of growth predicts a benign aetiology.
Method
Using an institutional CT database of small (<15mm) solid pulmonary nodules (n=784), we identified patients with antecedent (≥30 days prior) thin section (≤2mm) CT imaging and a final diagnosis of primary lung malignancy or a definite benign diagnosis based on pathology or longitudinal CT follow up data (n=137). Enlarging nodules (volume growth >25%) were identified (n=63) using semi-automated volumetry, and the volume doubling time (VDT) calculated. In cases where no nodule existed on the antecedent CT, a volume of 5mm3 was assigned, permitting the calculation of a ‘virtual’ VDT. Comparison of volume doubling time between benign and malignant nodules was made using Wilcoxon signed rank test. A receiver operator curve was constructed, and the optimum threshold of nodule growth rate predictive of benignity was calculated using the methods of Miller.
Result
The final study population consisted of 63 nodules in 57 patients [32/62 (50.8%) malignant, median age 67 years (range 34–85 years), male = 30/57 (52.6%)]. There was no difference in patient age nor in smoking status between groups, although patients with malignant diagnoses significantly more likely to be female (p < 0.001).
The median time between baseline (T1) and antecedent (T0) scans was 260 days (interquartile range 343 days). At baseline (T1), benign lesions (median diameter 10mm, median volume 380 mm3, range 10-4300mm3) were significantly smaller than malignant nodules (median diameter 13mm, median volume 890mm3, range 60-4250 mm3); p = 0.001.
24/31 benign lesions and 3/32 malignant lesions were not visible on the T0 scan, and were assigned a volume of 5mm3. The median benign lesion VDT was 70 days (interquartile range 270 days), malignant median VDT was 188 days (interquartile range 170 days); p = 0.2. The majority of lesions with very rapid growth (VDT < 90 days) were benign diagnoses (n= 17/24 [70.8%]). When examining these rapidly growing nodules, the optimal cut-point of the receiver-operator was a VDT of 50 days, AUC = 0.735. This provided 100% specificity for benign disease.
Conclusion
Our results confirm that very rapid nodule growth predicts benignity; a VDT of <50 days was 100% specific for benignity. Further work is required to validate these findings in other cohorts.
