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Lung Cancer Screening with Low-Dose CT in Brazil: Results of the Initial CT in the Setting of Clinical Practice at a Public Hospital
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A7358 - Lung Cancer Screening with Low-Dose CT in Brazil: Results of the Initial CT in the Setting of Clinical Practice at a Public Hospital
Author Block: F. M. Svartman1, M. M. Leite2, A. G. Sartori2, R. S. Gutierrez3, R. U. Brito2, C. T. Oliveira1, C. F. Andrade4; 1Serviço de Pneumologia, Hospital Nossa Senhora da Conceição e Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil, 2Serviço de Pneumologia, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, 3Serviço de Pneumologia, Hospital Nossa Senhora Da Conceição, Porto Alegre, Brazil, 4Serviço de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
RATIONALE
Lung cancer screening with low-dose CT (LDCT) reduces mortality in high-risk patients, as demonstrated by the National Lung Screening Trial. However, it is not clear if the same results should be expected in clinical practice when screening patients living in low-income areas, with a high prevalence of granulomatous disease and comorbidities.
METHODS
We report the preliminary results of the first round of screening with LDCT in the setting of a pulmonology outpatient clinic within a public hospital in Brazil. Inclusion criteria were: (a) age between 55 and 79 years; (b) a history of at least 30 pack-years of smoking; and (c) current smokers or patients who had been smokers within the previous 15 years. LDCTs results were classified according to the American College of Radiology LUNG-RADS system. A positive screening result was defined as LUNG-RADS 3 or 4. Management of patients with positive screening results was left at the discretion of the attending pulmonologist, but suggestions were made by the radiologist in accordance with LUNG-RADS standards. This report emphasizes outcomes of patients with a first positive LDCT. Records were reviewed in search of diagnostic procedures performed, as well as final diagnosis obtained up to 6 months after the positive baseline LDCT.
RESULTS
Of the 520 patients with a first-round LDCT read and classified, 83 (16%) were considered positive (LUNG-RADS 3, n = 45; LUNG-RADS 4, n = 38). For these 83 patients, follow-up procedures in the next six months included a new CT (n = 39; 47%), bronchoscopy (n = 6; 7%), CT-guided biopsy (n = 8; 10%) thoracic surgery (n = 2; 2.5%) and supraclavicular lymph node biopsy (n =1; 1%). Lung cancer was the final diagnosis in 6 of the 83 patients (positive predictive value = 7%). Staging was as follows: IA (1 patient), IB (1 patient), IIA (1 patient), IIB (1 patient) and IV (2 patients). Culture-proven tuberculosis was the final diagnosis in 2 (2.5%) patients. Importantly, 19 patients (23%) were lost to follow-up or were not submitted to recommended follow-up procedures in the first 6 months after a positive screening result.
CONCLUSIONS
The rate of positive screening results and the positive predictive value for cancer were similar to previous trials and suggest a potential benefit of screening in this population. The high number of patients lost to follow-up is a major concern and is a critical target for improvement of screening programs in clinical practice.
Author Block: F. M. Svartman1, M. M. Leite2, A. G. Sartori2, R. S. Gutierrez3, R. U. Brito2, C. T. Oliveira1, C. F. Andrade4; 1Serviço de Pneumologia, Hospital Nossa Senhora da Conceição e Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil, 2Serviço de Pneumologia, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, 3Serviço de Pneumologia, Hospital Nossa Senhora Da Conceição, Porto Alegre, Brazil, 4Serviço de Cirurgia Torácica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
RATIONALE
Lung cancer screening with low-dose CT (LDCT) reduces mortality in high-risk patients, as demonstrated by the National Lung Screening Trial. However, it is not clear if the same results should be expected in clinical practice when screening patients living in low-income areas, with a high prevalence of granulomatous disease and comorbidities.
METHODS
We report the preliminary results of the first round of screening with LDCT in the setting of a pulmonology outpatient clinic within a public hospital in Brazil. Inclusion criteria were: (a) age between 55 and 79 years; (b) a history of at least 30 pack-years of smoking; and (c) current smokers or patients who had been smokers within the previous 15 years. LDCTs results were classified according to the American College of Radiology LUNG-RADS system. A positive screening result was defined as LUNG-RADS 3 or 4. Management of patients with positive screening results was left at the discretion of the attending pulmonologist, but suggestions were made by the radiologist in accordance with LUNG-RADS standards. This report emphasizes outcomes of patients with a first positive LDCT. Records were reviewed in search of diagnostic procedures performed, as well as final diagnosis obtained up to 6 months after the positive baseline LDCT.
RESULTS
Of the 520 patients with a first-round LDCT read and classified, 83 (16%) were considered positive (LUNG-RADS 3, n = 45; LUNG-RADS 4, n = 38). For these 83 patients, follow-up procedures in the next six months included a new CT (n = 39; 47%), bronchoscopy (n = 6; 7%), CT-guided biopsy (n = 8; 10%) thoracic surgery (n = 2; 2.5%) and supraclavicular lymph node biopsy (n =1; 1%). Lung cancer was the final diagnosis in 6 of the 83 patients (positive predictive value = 7%). Staging was as follows: IA (1 patient), IB (1 patient), IIA (1 patient), IIB (1 patient) and IV (2 patients). Culture-proven tuberculosis was the final diagnosis in 2 (2.5%) patients. Importantly, 19 patients (23%) were lost to follow-up or were not submitted to recommended follow-up procedures in the first 6 months after a positive screening result.
CONCLUSIONS
The rate of positive screening results and the positive predictive value for cancer were similar to previous trials and suggest a potential benefit of screening in this population. The high number of patients lost to follow-up is a major concern and is a critical target for improvement of screening programs in clinical practice.
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