Virtual Library

Start Your Search

David R. Baldwin



Author of

  • +

    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
    • +

      P1.11-32 - The UKLS Nodule Risk Model (UKLS-NRM): Utilising Nodule Volumetry (ID 728)

      09:45 - 18:00  |  Author(s): David R. Baldwin

      • Abstract

      Background

      Estimating the clinical probability of malignancy in patients with pulmonary nodules will facilitate early diagnosis, determine optimum patient management strategies and reduce overall costs.

      Currently there are two risk prediction models, which are recommended by BTS; the Brock University model, for nodules ≥300mm3 or ≥8mm diameter, and where the risk is estimated at >10%, the Herder model after PET-CT. However, none of these models employ volumetry and all were developed for use at baseline

      Method

      The UK Lung Cancer Screening (UKLS) trial data were analysed, utilising multivariable logistic regression models to identify independent predictors and develop a parsimonious model to estimate the probability of lung cancer in lung nodules detected at baseline, three month and twelve months repeat screening.

      Result

      figure 2.png1994 UKLS participants had a CT scan; 1013 had a total of 5063 lung nodules and 52 (2.6%) developed lung cancer during a 4 year median follow-up. Covariates that predict lung cancer included: female gender, asthma, bronchitis, asbestos exposure, history of previous cancer, early and late onset of family history of lung cancer, smoking duration, forced vital capacity, nodule type and volume. The final model had excellent discrimination; area under the receiver-operating characteristic curve (AUC [95% CI] = 0.885 [0.880 to 0.889]). Internal validation indicated that the model will discriminate well when applied to new data (optimism-corrected AUC = 0.882 [0.848-.907]). The risk model had a good calibration (goodness-of-fit χ 8.13, P = 0.42).

      Conclusion

      The UKLS Nodule Risk Model (UKLS-NRM) estimates the probability of lung cancer in nodules detected at baseline, three months and twelve months from baseline. The model is based on readily available, strong, and plausible covariates that have been implicated in the aetiology of lung cancer. The application of UKLS-NRM has the potential to be used in both the research and clinical setting.

  • +

    P2.11 - Screening and Early Detection (ID 178)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Screening and Early Detection
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
    • +

      P2.11-07 - Benefits and Harms of Contemporary Lung Cancer Screening: An Infographic to Support Public and Patient Education (ID 1354)

      10:15 - 18:15  |  Author(s): David R. Baldwin

      • Abstract
      • Slides

      Background

      Quantifying and communicating the benefits and harms of low-dose CT (LDCT) lung cancer screening is a complex challenge. Multiple tools have been developed based on the US National Lung Screening Trial (NLST). However, some of these have produced debate and confusion in the public-facing media due to the outdatedness of the NLST protocol and the complexity of the information presented.

      Method

      We developed a new infographic to represent the benefits and harms of contemporary lung screening. We applied the current US nodule management protocol (Lung-RADS v1.0) to the NLST retrospectively. Across the 3 NLST screens and 4 years of follow-up, we used individual-level data to quantify the number of people per 1000 who would have had (a) all normal results (Lung-RADS categories 1 and 2) without lung cancer; (b) any abnormal results (Lung-RADS 3 and 4A/B/X) without lung cancer; (c) invasive diagnostic procedures without lung cancer; and (d) lung cancer diagnosed. We estimated overdiagnosis using the published NLST estimate (18.5%) and reduced the mortality benefit from screening using the reduction in sensitivity from Lung-RADS (13.3%).

      Result

      Applying Lung-RADS to NLST, we found that 779 per 1000 people would have had all normal results, 180 any abnormal results without lung cancer, and 41 lung cancer. Among the 180, 13 would have had an invasive procedure, 0.4 (1 in 2500) a major complication, and 0.2 (1 in 5000) death from any cause within 60 days of the procedure. Finally, among 41 lung cancers, 4 represent overdiagnosis and 3 prevented lung cancer deaths. We compiled these results into an infographic (Figure).

      iarc benefits and harms of lung cancer screening.png

      Conclusion

      Compared with the NLST protocol, modern nodule management reduces harms from screening. Our infographic tool may facilitate communication about lung screening to providers, patients, and the public. It should be updated as additional trial data become available.

      Only Active 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 or select "Add to Cart" and proceed to checkout.

  • +

    S01 - IASLC CT Screening Symposium: Forefront Advances in Lung Cancer Screening (Ticketed Session) (ID 96)

    • Event: WCLC 2019
    • Type: Symposium
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • +

      S01.14 - Lung Cancer MDT (Now Available) (ID 3640)

      07:00 - 12:00  |  Presenting Author(s): David R. Baldwin

      • Abstract
      • Presentation
      • Slides

      Abstract

      The Lung Cancer MDT

      David R Baldwin

      Consultant Respiratory Physician and Honorary Professor of Medicine

      Nottingham University Hospitals and University of Nottingham, UK

      Multidisciplinary Team (MDT) meetings or “Tumour Boards” are increasingly becoming a central component of lung cancer services. Management of lung cancer patients through diagnosis, staging, fitness assessment and treatment is a multidisciplinary endeavour. Good communication between disciplines means that the goal of personalised treatment can be realised because of the complexity of modern management, not least the rapid change in treatments. Many lung cancer services have a meeting of professionals at key points along the clinical pathway that is commonly at the point of decision to treat and where diagnosis and/or staging is complex. There are a number of documents that describe the membership of the MDT and how the meetings should function. Key is that all relevant professional groups are represented and that there is a clear record of the discussion. Despite the widespread adoption of MDT meetings, there remains limited evidence for their effectiveness. This is because the integration of MDTs into the lung cancer services has evolved as management has become increasingly complex. It would be difficult to devise an experiment to test the efficacy of the MDT as they are now so embedded in services.

      With respect to lung cancer screening, it is important that MDTs adhere to guideline-driven management so as to reduce the harms that may accrue. The place of the lung cancer MDT is in relation to a high probability of cancer. In screening it is probably better to have a separate MDT to advise on the management of nodules and incidental findings, again using guideline-driven management. All MDTs should record data for audit, quality improvement and research.

      Only 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.

      Only Active 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 or select "Add to Cart" and proceed to checkout.