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Biomedical subjects

C I Henschke

Publications and source records attributed to C I Henschke.

At least 19 recordsLinked to original sources
PubMed2003

Guidelines for the use of spiral computed tomography in screening for lung cancer.

Screening should be considered in lung cancer, more than any other cancer. Not only is the disease highly fatal, essentially incurable, when diagnosed on the prompting of symptoms and/or clinical signs, but its occurrence is also highly concentrated in identifiably high-risk persons. The degree of usefulness of computed tomography (CT)-based screening for lung cancer must be thought of in reference to a particular, presumably optimal, regimen of pursuing early stage diagnosis. This is an algorithm that begins with the initial test ("screening CT") and ends in either discontinuation of the diagnostic pursuit or in diagnosis of lung cancer. A carefully developed, extensively pilot tested and critically reviewed, updated protocol for CT-based screening for lung cancer is presented here. Its implementation is addressed, together with quality assurance. Finally, the associated curability rate for lung cancer is addressed in the light of what is known or can be surmised from evidence already available. However, recommendation for or against screening requires further information. Principally, the patients risk for lung cancer (in the near future) and the patients life expectancy (when spared of death from lung cancer). These two factors influence when, if ever, to begin screening, and if it is initiated, when to discontinue it. Finally, cost-effectiveness of the screening program should also be considered.

Humans↗
PubMed2001

Early lung cancer action project: initial findings on repeat screenings.

BACKGROUND: The Early Lung Cancer Action Project (ELCAP) was designed to evaluate the usefulness of annual computed tomography (CT) screening for lung carcinoma. With the baseline results having been reported previously, the focus of the current study was on the early results of the repeat screenings. METHODS: A cohort of 1000 high-risk individuals was recruited for baseline and annual repeat CT screening. At last follow-up, a total of 1184 annual repeat screenings had been performed. A positive result from the screening test was defined as newly detected, one to six noncalcified pulmonary nodules with interim growth. The diagnostic workup of the individuals was guided by recommendations supplied by the ELCAP investigators to the collaborating clinicians. RESULTS: Of the 1184 repeat CT screenings, the test result was positive in 30 (2.5%). In 2 of these 30 cases, the individual died (of an unrelated cause) before diagnostic workup and the nodule(s) resolved in another 12 individuals. In the remaining 16 individuals, the absence of further growth was documented by repeat CT in 8 individuals and further growth was documented in the remaining 8 individuals. All eight individuals with further nodular growth underwent biopsy and malignancy was diagnosed in seven. Six of these seven malignancies were nonsmall cell carcinomas (five of which were Stage IA and one of which was Stage IIIA) and the one small cell carcinoma was found to be of limited stage. The median size dimension of these malignancies was 8 mm. In another two subjects, symptoms prompted the interim diagnosis of lung carcinoma. Neither of these malignancies was nodule-associated but rather were endobronchial; one was a Stage IIB nonsmall cell carcinoma and the other was a small cell carcinoma of limited stage. CONCLUSIONS: False-positive screening test results are uncommon and usually manageable without biopsy; compared with no screening, such screenings permit diagnosis at substantially earlier and thus more curable stages. Annual repetition of CT screening is sufficient to minimize symptom-prompted interim diagnoses of nodule-associated malignancies.

Aged↗
PubMed2001

Smoking cessation following CT screening for early detection of lung cancer.

BACKGROUND: This study was conducted to assess the impact of lung cancer screening participation on smoking cessation. METHODS: Individuals (n = 134) who reported active smoking at the time of enrollment in our Early Lung Cancer Action Program (ELCAP) completed a brief, follow-up telephone interview assessing any changes in smoking patterns following lung cancer screening. Using logistic regression, we estimated the probability of decreasing or quitting smoking using each enrollee's background information and computed tomography (CT) scan results. RESULTS: Most survey respondents (74%) agreed that participation in the ELCAP increased their motivation for quitting smoking. In terms of self-reported changes in smoking behavior, 31 (23%) reported that they had quit and 35 (27%) decreased their smoking patterns. Several significant covariates of smoking cessation were identified: perceived benefit of quitting (OR 4.02), cancer anxiety (OR 2.49), younger age (OR 2.47), and abnormal CT finding (1.97). CONCLUSIONS: Our analyses suggest that low-dose helical CT scanning may serve as a strong catalyst for smoking cessation and that delivery of effective smoking cessation interventions along with CT scanning represents a potential opportunity to increase the overall cancer prevention benefit of lung cancer screening.

Aged↗
PubMed2001

A consensus statement of the Society of Thoracic Radiology: screening for lung cancer with helical computed tomography.

This consensus statement by the Society of Thoracic Radiology is a summary of the current understanding of low dose computed tomography (CT) for screening for lung cancer. Lung cancer is the most common fatal malignancy in the industrialized world. Unlike the next three most common cancers, screening for lung cancer is not currently recommended by cancer organizations. Improvements in CT technology make lung screening feasible. Early prevalence data indicate that about two-thirds of lung cancers that are detected by CT screening are at an early stage. Other data support the postulate that patients with lung cancers detected at this early stage have better rates of survival. Whether this will translate into an improved disease specific mortality is yet to be demonstrated. The suggested technical protocols, selection criteria, and method of handling the numerous benign nodules that are detected are discussed. It is the consensus of this committee that mass screening for lung cancer with CT is not currently advocated. Suitable subjects who wish to participate should be encouraged to do so in controlled trials, so that the value of CT screening can be ascertained as soon as possible.

Humans↗
PubMed2001

Early lung cancer action project: annual screening using single-slice helical CT.

The advent of helical CT imaging held promise for the early diagnosis, and thereby, for enhanced curability of lung cancer--a highly fatal disease. In 1993, the Early Lung Cancer Action Project (ELCAP) was initiated and experimentally screened a cohort of 1,000 high-risk persons. Here we summarize the results of the baseline and annual repeat CT screening of these 1,000 subjects. CT-based screening (compared to traditional radiology) was clearly shown to enhance the detection of lung cancer at earlier and more curable stages. A discussion follows of the meaning of the results and possible future screening protocols.

Aged↗
PubMed2001

CT screening for lung cancer: coping with nihilistic recommendations.

The practicing radiologist today is well persuaded that earlier diagnosis of lung cancer can be achieved with traditional-type radiography and especially with modern computed tomography. The practitioner also is confident that intervention in the context of earlier diagnosis is more effective in preventing death due to this otherwise fatal disease. The practitioner is thus inclined to consider such screening in a high-risk person with suitably long life expectancy, especially when asked to provide it. On the other hand, the practitioner is aware of official recommendations against lung cancer screening, said to be based on demonstrated lack of effectiveness of traditional radiographic screening. Some researchers have expressed concerns about screening-associated "overdiagnosis." Given this dilemma, the critically thinking practitioner is concerned to understand the foundation of the official nihilism in evidence and reasoning, as she or he suspects that something may be seriously wrong in this. This article is an attempt to help such a practitioner in this effort--an effort that in the end is rewarded by the comforting realization that the nihilistic recommendations and hesitation-provoking cautions are founded on pseudoevidence and specious reasoning.

Humans↗
PubMed2001

Early lung cancer action project: a summary of the findings on baseline screening.

PURPOSE: The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low radiation dose computed tomography (low-dose CT) in persons at high-risk for lung cancer. METHODS: Since starting in 1993, the ELCAP has enrolled 1,000 asymptomatic persons, 60 years of age or older, with at least 10 pack-years (1 pack per day for 10 years, or 2 packs per day for 5 years) of cigarette smoking, no prior cancer, and medically fit to undergo thoracic surgery. After a structured interview and informed consent, baseline chest radiographs and low-dose CT were obtained on each subject. The diagnostic work-up of screen-detected noncalcified pulmonary nodules (NCN) was guided by ELCAP recommendations which included short-term high-resolution CT follow-up for the smallest nodules. Baseline RESULTS: On low-dose CT at baseline compared to chest radiography, NCN were detected three times as commonly (23% versus 7%), malignancies four times as commonly (2.7% versus 0.7%), and stage I malignancies six times as commonly (2.3% versus 0.4%). Of the 27 CT-detected cancers, 96% (26/27) were resectable; 85% (23/27) were stage I, and 83% (19 of the 23 stage I) were not seen on chest radiography. Following the ELCAP recommendations, biopsies were performed on 28 of the 233 subjects with NCN; 27 had a malignant and one a benign NCN. Another three individuals underwent biopsy outside of the ELCAP recommendations; all had benign NCNS: No one had thoracotomy for a benign nodule. CONCLUSION: Baseline CT screening for lung cancer provides for detecting the disease at earlier and presumably more commonly curable stages in a cost-effective manner.

Clinical Trials as Topic↗
PubMed2000

Early lung cancer action project: overall design and findings from baseline screening.

BACKGROUND: The Early Lung Cancer Action Project (ELCAP) is designed to evaluate baseline and annual repeat screening by low radiation dose computed tomography (low-dose CT) in persons at high-risk for lung cancer. The authors report on the baseline screening experience. For full evaluation of screening, they await the results of annual repeat screening. METHODS: Using a novel non-comparative design, enrollment of 1000 asymptomatic persons, 60 years of age or older, with at least 10 pack-years of cigarette smoking, no prior cancer, and who were medically fit to undergo thoracic surgery was initiated in 1993. After a structured interview and informed consent, chest radiographs (CXR) and low-dose CT were obtained on each subject. The diagnostic workup of screen-detected noncalcified pulmonary nodules (NCNs) was guided by ELCAP recommendations which included short-term high-resolution CT (HRCT) follow-up for the smallest NCNs. RESULTS: On low-dose CT at baseline as compared to CXR, NCNs were detected three times as commonly (23% vs. 7%), malignancies four times as commonly (2.7% vs. 0.7%), Stage I malignancies six times as commonly (2.3% vs. 0.4%). Of the 27 CT-detected cancers, 96% (26/27) were resectable; 85% (23/27) were Stage I, 19 (83%) of the 23 were not seen on CXR. Following the ELCAP recommendations, biopsies were performed on 28 of the 233 subjects with NCNs; 27 had a malignant NCN and one had a benign one. Another three individuals underwent biopsy outside of the ELCAP recommendations, all had benign NCNs. No one had thoracotomy for a benign nodule. CONCLUSIONS: The estimated five-year survival rate of baseline CT-detected malignancies of 60%-80% is a marked improvement over the current rate of 15%. Although false-positive CTs are common, they can be managed with minimal use of invasive diagnostic procedures.

Aged↗
PubMed2000

Special techniques in transthoracic needle biopsy of pulmonary nodules.

We believe that each aspect of the performance of TNB needs to be considered carefully. Meticulous attention to detail allows any nodule in the chest to successfully undergo biopsy. There are techniques of needle tip repositioning that can be quite helpful for obtaining diagnostic material from lung lesions, particularly small nodules. A strong working relationship with pathologists experienced in lung cytology is a vital element of any successful biopsy program. Techniques available to the pathologist allow for quick and decisive determination of the adequacy of the aspirated specimen and help guide the radiologist performing the procedure. Newer cytopathologic techniques help the pathologist make more complex diagnoses from the aspirated material. Finally, techniques used to minimize complications should be considered by the operator before the performance of the biopsy.

Biopsy, Needle↗
PubMed2000

Small solitary pulmonary nodules.

We now are detecting an increasing number of SPN that are difficult to diagnose. Many of the techniques we traditionally have relied on were developed when the average size of detected nodules was larger, and these techniques are of limited diagnostic usefulness for small nodules. In the past, recognition of the need for noninvasive differentiation between benign and malignant nodules led to the development of many useful diagnostic techniques. The ever increasing number of small nodules now being detected will stimulate new approaches. In the future, as in the past, many of these will be based on previously developed concepts. Because a majority of these small nodules will be benign, it will be important to develop reliable methods of determining which patients need further evaluation both from a patient management and cost-effectiveness perspective. Criteria will need to be developed based on the initial CT appearance of the nodule, clinical information about the patient, and subsequent CT using the latest decision analytic techniques and databases. Finally, increased interest in predicting the aggressiveness of a lung cancer, once it has been discovered, could lead to further changes in staging criteria.

Humans↗
PubMed2000

CT screening for lung cancer.

Recommendations against screening for lung cancer were based on the lack of a reduction in mortality of the screened group as compared with the control group in randomized control trials. These results were interpreted as showing that early detection of lung cancer as a result of screening did not decrease the mortality rate compared with detection after presentation of symptoms for the populations being screened. Evidence, however, shows that earlier-stage intervention leads to substantially higher rates of survival. Screening, therefore, is an effective means to prevent deaths from this otherwise fatal disease. This article discusses the evidence of both CT and chest radiograph screening.

Humans↗
PubMed2000

Comparison of biopsy techniques in assessment of solitary pulmonary nodules.

A wide variety of diagnostic tests are available to evaluate solitary pulmonary nodules, ranging from noninvasive to invasive. Given the virulence of lung cancer, those techniques that can provide cytological and pathological information are often chosen. However, the choice of which procedure to perform is complicated by numerous factors, including the sensitivity and specificity of the test, as well as the prevalence of disease. Additional considerations also include complications, availability and expertise in performing procedures, and overall cost of the diagnostic algorithm. Rather than make specific recommendations for diagnostic workup, it is more appropriate to consider that this will vary from institution to institution based on the above factors.

Algorithms↗
PubMed2000

Screening for lung cancer.

Screening for lung cancer has remained controversial since the completion, more than two decades ago, of the three large randomized controlled trials, sponsored by the National Cancer Institute, which led to the recommendation against screening by major medical organizations. Details of the controversy are given, which include concerns about the study design, implementation, and analysis. New evidence about the potential benefit of screening with chest radiography that has emerged since the completion of those trials is reviewed, as well as the results of studies of CT screening for lung cancer.

Humans↗
PubMed2000

Deep venous thrombosis: detection by using indirect CT venography. The Pulmonary Angiography-Indirect CT Venography Cooperative Group.

PURPOSE: To assess the clinical benefits of performing indirect computed tomographic (CT) venography after pulmonary CT angiography to detect deep venous thrombosis (DVT) in patients suspected of having a pulmonary embolism. MATERIALS AND METHODS: The authors prospectively enrolled 541 consecutive patients who underwent pulmonary CT angiography for suspected pulmonary embolism at seven institutions. Using a protocol that optimizes venous enhancement without additional contrast material injection, the authors obtained contiguous images from the pelvis to the popliteal fossa. Ultrasonography (US) also was performed in 116 patients. RESULTS: DVT was found at indirect CT venography in 45 (8%), and pulmonary embolism was found at pulmonary CT angiography in 91 (17%) of 541 patients. Among the 45 patients with DVT, DVT occurred in 16 patients who had no pulmonary embolism at pulmonary CT angiography, which increased the diagnosis of thromboembolic disease by 18%. Among 116 patients who underwent US and indirect CT venography, 15 had DVT at US, and in all 15, DVT also was seen at indirect CT venography. In four additional cases, DVT was seen at only indirect CT venography. CONCLUSION: Among patients suspected to have pulmonary embolism, a substantial number had DVT in the absence of pulmonary embolism. Combined pulmonary CT angiography-indirect CT venography can depict these cases with accuracy comparable to that of US and thus could have a significant effect on patient care.

Adolescent↗
PubMed2000

Small pulmonary nodules: volumetrically determined growth rates based on CT evaluation.

PURPOSE: To determine the accuracy of high-resolution computed tomographic (CT) volumetric measurements of small pulmonary nodules to assess growth and malignancy status. MATERIALS AND METHODS: The accuracy of three-dimensional (3D) image extraction and isotropic resampling techniques was assessed by performing three experiments. The first experiment measured volumes in spherical synthetic nodules of two diameters (3.20 and 3.96 mm), the second measured deformable silicone synthetic nodules prior to and after their shape had been altered markedly, and the third measured nodules of various shapes and sizes. Three-dimensional techniques were used to assess growth in 13 patients for whom the final diagnosis was known and whose initial nodule diameters were less than 10 mm. By using the exponential growth model and the calculated nodule volume at two points in time, the doubling time for each subject was calculated. RESULTS: The three synthetic nodule studies revealed that the volume could be measured accurately to within +/-3%. All five malignant nodules grew, and all had doubling times less than 177 days. Some malignant nodules had asymmetric patterns of growth identified by using the 3D techniques but not the two-dimensional methods. All eight benign nodules had doubling times of 396 days or greater or showed a decrease in volume. CONCLUSION: CT volumetric measurements are highly accurate for determining volume and are useful in assessing growth of small nodules and calculating their doubling times.

Aged↗