According to three-year outcomes data released this month by the Pittsburgh Lung Screening Study (PLuSS), although CT screening is leading to the discovery of early stage lung cancer, it has also led to many diagnostic follow-up procedures, including major thoracic surgical procedures with non-cancer outcomes.
The PLuSS results, published in the November issue of the American Journal of Respiratory and Critical Care Medicine, reported findings from initial and one-year repeat screening low-radiation-dose CT of the chest and three-year outcomes for 50- to 79-year-old current and ex-smokers.
A cohort of 3,642 and 3,423 subjects had initial and repeat screening, respectively. A total of 1,477 were told about noncalcified lung nodules on the initial screening and, before repeat screening, 55.6 percent of this subgroup obtained one or more subsequent diagnostic imaging studies (CT, PET or PET/CT).
Tracking identified 80 subjects with lung cancer, including 53 subjects with tumor seen at initial screening. In all, 1 percent of the total cohort referred for abnormalities on either the initial or repeat screening, had a major thoracic surgical procedure leading to a non-cancer final diagnosis.
Out of 82 subjects with thoracotomy or video-assisted thoracoscopic surgery to exclude malignancy in a lung nodule, 34.1 percent received a non-cancer final diagnosis. Overall, the researchers found that 58 percent of the subjects with non–small cell lung cancer had stage I disease at diagnosis.
Commenting on the results, York E. Miller, MD, from the University Colorado, Denver, said that the challenge for healthcare providers utilizing CT lung screening “is how to avoid major surgery and illness from interventions triggered by nodule discovery on CT.”