Association of Oncogene Driver Mutations with Recurrence and Survival in Stage I Nonsmall Cell Lung Cancer.

Background: Stage I nonsmall cell lung cancer (NSCLC) is primarily treated with surgical resection and has a favorable prognosis with an expected recurrence rate of 30%. New methods to risk stratify patients with stage I NSCLC are needed to help select those that might benefit from more active surveillance or adjuvant therapy.

Methods: We analyzed clinical data from 1330 patients (1469 tumors) with NSCLC and correlated it with next-generation sequencing (NGS).

Imatinib Treatment of Lymphangiomatosis (Generalized Lymphatic Anomaly).

Lymphangiomatosis (eg, generalized lymphatic anomaly) is an abnormal proliferation of lymphatic endothelial cells. It is often a childhood disease, but it may present in adulthood by infiltrating organs and cause obstruction, bleeding, or disruption of lymphatic flow. Pulmonary involvement may be mild or cause diffuse interstitial lung disease, airway obstruction, hemoptysis, chylothorax, chylopericardium, and culminate in respiratory failure.

Surgical lung biopsy in adult respiratory distress syndrome: a meta-analysis.

Background: Adult respiratory distress syndrome (ARDS) has a high mortality rate and consumes considerable health care resources. It is not clear whether specimens obtained from open lung biopsy (OLB) in ARDS provide a specific diagnosis, alter therapy, or affect outcome. This meta-analysis attempts to determine whether OLB is safe, provides a specific diagnosis, changes therapy, or affects survival.

Outcomes of unresected ground-glass nodules with cytology suspicious for adenocarcinoma.

Background: Five-year survival rates for resected stage I adenocarcinoma approach 100%. Given previous studies describing the prolonged indolent natural history of ground-glass lesions suspicious for early adenocarcinoma, our purpose in this study was to determine if outcomes were different among patients who were observed for radiographic and biopsy suspected early adenocarcinoma compared with those who were resected immediately.

Methods: We identified 63 patients with no prior history of lung adenocarcinoma who had undergone computer tomography-guided fine-needle aspiration of ground-glass opacities with cytology concerning for new early adenocarcinoma between January 2002 and December 2011.

Lung cancer associated with cystic airspaces.

Objective: The objectives of this study were to determine the frequency of lung cancers associated with a discrete cystic airspace and to characterize the morphologic and pathologic features of the cancer and the cystic airspace.

Materials And Methods: We reviewed all diagnosed cases of lung cancer resulting from baseline screening (n=595) and annual screening (n=111) in the International Early Lung Cancer Action Program to identify those abutting or in the wall of a cystic airspace. We also reviewed the pathologic specimens.

Radiographic and clinical characterization of false negative results from CT-guided needle biopsies of lung nodules.

Introduction: Computed tomography-guided transthoracic fine-needle aspiration (FNA) is a highly sensitive technique for diagnosing malignancy in pulmonary nodules; however, there is great uncertainty regarding the reliability of a benign result. The goal of this study was to characterize the clinical, radiologic, and technical variables associated with a false negative result.

Methods: We performed a consecutive series review of patients who had an initial benign result from an FNA between January 2002 and December 2004.

Lung cancers diagnosed at annual CT screening: volume doubling times.

Purpose: To empirically address the distribution of the volume doubling time (VDT) of lung cancers diagnosed in repeat annual rounds of computed tomographic (CT) screening in the International Early Lung Cancer Action Program (I-ELCAP), first and foremost with respect to rates of tumor growth but also in terms of cell types.

Materials And Methods: All CT screenings in I-ELCAP from 1993 to 2009 were performed according to HIPAA-compliant protocols approved by the institutional review boards of the collaborating institutions. All instances of first diagnosis of primary lung cancer after a negative screening result 7-18 months earlier were identified, with symptom-prompted diagnoses included.

Emphysema scores predict death from COPD and lung cancer.

Objective: Our objective was to assess the usefulness of emphysema scores in predicting death from COPD and lung cancer.

Methods: Emphysema was assessed with low-dose CT scans performed on 9,047 men and women for whom age and smoking history were documented. Each scan was scored according to the presence of emphysema as follows: none, mild, moderate, or marked.

Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease.

Purpose: To assess the usefulness of ordinal scoring of the visual assessment of coronary artery calcification (CAC) on low-dose computed tomographic (CT) scans of the chest in the prediction of cardiovascular death.

Materials And Methods: All participants consented to low-dose CT screening according to an institutional review board-approved protocol. The amount of CAC was assessed on ungated low-dose CT scans of the chest obtained between June 2000 and December 2005 in a cohort of 8782 smokers aged 40-85 years.

Elevated carcinoembryonic antigen and sarcoidosis masquerading as metastatic colon cancer.

When patients with colorectal cancer are monitored after resection of primary or metastatic disease, an elevated carcinoembryonic antigen (CEA) level is usually an indicator of recurrent disease. Positron emission tomography (PET) scans are often used to locate the site of recurrences when computed tomography scans do not show the presence of disease. This case highlights an important cause of a falsely elevated CEA with abnormal PET imaging.

Survival of patients with stage I lung cancer detected on CT screening.

Background: The outcome among patients with clinical stage I cancer that is detected on annual screening using spiral computed tomography (CT) is unknown.

Methods: In a large collaborative study, we screened 31,567 asymptomatic persons at risk for lung cancer using low-dose CT from 1993 through 2005, and from 1994 through 2005, 27,456 repeated screenings were performed 7 to 18 months after the previous screening. We estimated the 10-year lung-cancer-specific survival rate among participants with clinical stage I lung cancer that was detected on CT screening and diagnosed by biopsy, regardless of the type of treatment received, and among those who underwent surgical resection of clinical stage I cancer within 1 month.

CT screening for lung cancer: the value of short-term CT follow-up.

Background: Although CT screening for lung cancer results in a diagnosis of stage I > 80% of the time, benign noncalcified nodules are also found. We recognized that some nodules appeared to represent infectious bronchopneumonia or other inflammatory processes, as they resolved on follow-up CT, sometimes after antibiotic therapy. To determine the extent to which short-term CT radiographic follow-up might shorten the workup of nodules, we reviewed our experience with baseline and annual repeat CT screenings performed subsequent to the original Early Lung Cancer Action Project series.

Managing the small pulmonary nodule discovered by CT.

Objectives: To review the Early Lung Cancer Action Project experience and the medical literature from 1993 to 2003 on detection of the small, noncalcified pulmonary nodule by CT in order to formulate a management algorithm for these nodules.

Design: Prospective noncomparative study of smokers without prior malignancy and a review of the medical literature of CT screening of lung cancer.

Interventions: Chest CT and, where appropriate, CT observation for nodule growth, antibiotics, CT-guided fine-needle aspiration (FNA) biopsy, fiberoptic bronchoscopy, and video-assisted thoracoscopic surgery (VATS).

CT screening for lung cancer: suspiciousness of nodules according to size on baseline scans.

Purpose: To assess the frequency with which a particular, possibly optimal work-up of noncalcified nodules less than 5.0 mm in diameter identified on initial computed tomographic (CT) images at baseline screening leads to a diagnosis of malignancy prior to first annual repeat screening, compared with a possibly optimal work-up of larger nodules.

Materials And Methods: Two series of baseline CT screenings in high-risk people were retrospectively reviewed.

Overdiagnosis in chest radiographic screening for lung carcinoma: frequency.

Background: The pattern of results in the Mayo Lung Project (MLP), which is the basis for the prevailing recommendations against radiographic screening for lung carcinoma, has led to the assertion that up to 50% of the diagnosed cases of early-stage disease in that trial may have represented overdiagnosed, indolent cases. This finding suggests the possibility of such a high frequency of overdiagnosis in chest radiographic lung carcinoma screening in general. In the current study, the authors analyzed data from the MLP and its counterpart study at Memorial Sloan-Kettering Cancer Center (MSK) to estimate the frequency of overdiagnosis in these studies.

Mammographic screening: no reliable supporting evidence?

Much confusion is being generated by the conclusion of a recent review that "there is no reliable evidence that screening for breast cancer reduces mortality." In that review, however, there was no appreciation of the appropriate mortality-related measure of screening's usefulness; and correspondingly, there was no estimation of the magnitude of this measure. We take this measure to be the proportional reduction in case-fatality rate, and studied its magnitude on the basis of the only valid and otherwise suitable trial.