Five-year lung cancer screening experience: CT appearance, growth rate, location, and histologic features of 61 lung cancers

Rebecca M. Lindell, Thomas E. Hartman, Stephen J. Swensen, James R. Jett, David Eric Midthun, Henry D. Tazelaar, Jayawant Mandrekar

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Abstract

Purpose: To retrospectively evaluate the computed tomography (CT)-determined size, morphology, location, morphologic change, and growth rate of incidence and prevalence lung cancers detected in high-risk individuals who underwent annual chest CT screening for 5 years and to evaluate the histologic features and stages of these cancers. Materials and Methods: The study was institutional review board approved and HIPAA compliant. Informed consent was waived. CT scans of 61 cancers (24 in men, 37 in women; age range, 53-79 years; mean, 65 years) were retrospectively reviewed for cancer size, morphology, and location. Forty-eight cancers were assessed for morphologic change and volume doubling time (VDT), which was calculated by using a modified Schwartz equation. Histologic sections were retrospectively reviewed. Results: Mean tumor size was 16.4 mm (range, 5.5-52.5 mm.). Most common CT morphologic features were as follows: for bronchioloalveolar carcinoma (BAC) (n = 9), ground-glass attenuation (n = 6, 67%) and smooth (n = 3, 33%), irregular (n = 3, 33%), or speculated (n = 3, 33%) margin; for non-BAC adenocarcinomas (n = 25), semisolid (n = 11, 44%) or solid (n = 12, 48%), attenuation and irregular margin (n = 14, 56%); for squamous cell carcinoma (n = 14), solid attenuation (n = 12, 86%) and irregular margin (n = 10, 71%); for small cell or mixed small and large cell neuroendocrine carcinoma (n = 7), solid attenuation (n = 6, 86%) and irregular margin (n = 5, 71%); for non-small cell carcinoma not otherwise specified (n = 5), solid attenuation (n = 4, 80%) and irregular margin (n = 3, 60%); and for large cell carcinoma (n = 1), solid attenuation and speculated shape (n = 1, 100%). Attenuation most often (in 12 of 21 cases) increased. Margins most often (in 16 of 20 cases) became more irregular or spiculated. Mean VDT was 518 days. Thirteen of 48 cancers had a VDT longer than 400 days; 11 of these 13 cancers were in women. Conclusion: Overdiagnosis, especially in women, may be a substantial concern in lung cancer screening.

Original languageEnglish (US)
Pages (from-to)555-562
Number of pages8
JournalRadiology
Volume242
Issue number2
DOIs
StatePublished - Feb 2007

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Early Detection of Cancer
Lung Neoplasms
Tomography
Growth
Neoplasms
Large Cell Carcinoma
Bronchiolo-Alveolar Adenocarcinoma
Health Insurance Portability and Accountability Act
Carcinoma
Neuroendocrine Carcinoma
Research Ethics Committees
Informed Consent
Glass
Squamous Cell Carcinoma
Adenocarcinoma
Thorax
Incidence

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

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Five-year lung cancer screening experience : CT appearance, growth rate, location, and histologic features of 61 lung cancers. / Lindell, Rebecca M.; Hartman, Thomas E.; Swensen, Stephen J.; Jett, James R.; Midthun, David Eric; Tazelaar, Henry D.; Mandrekar, Jayawant.

In: Radiology, Vol. 242, No. 2, 02.2007, p. 555-562.

Research output: Contribution to journalArticle

Lindell, Rebecca M. ; Hartman, Thomas E. ; Swensen, Stephen J. ; Jett, James R. ; Midthun, David Eric ; Tazelaar, Henry D. ; Mandrekar, Jayawant. / Five-year lung cancer screening experience : CT appearance, growth rate, location, and histologic features of 61 lung cancers. In: Radiology. 2007 ; Vol. 242, No. 2. pp. 555-562.
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abstract = "Purpose: To retrospectively evaluate the computed tomography (CT)-determined size, morphology, location, morphologic change, and growth rate of incidence and prevalence lung cancers detected in high-risk individuals who underwent annual chest CT screening for 5 years and to evaluate the histologic features and stages of these cancers. Materials and Methods: The study was institutional review board approved and HIPAA compliant. Informed consent was waived. CT scans of 61 cancers (24 in men, 37 in women; age range, 53-79 years; mean, 65 years) were retrospectively reviewed for cancer size, morphology, and location. Forty-eight cancers were assessed for morphologic change and volume doubling time (VDT), which was calculated by using a modified Schwartz equation. Histologic sections were retrospectively reviewed. Results: Mean tumor size was 16.4 mm (range, 5.5-52.5 mm.). Most common CT morphologic features were as follows: for bronchioloalveolar carcinoma (BAC) (n = 9), ground-glass attenuation (n = 6, 67{\%}) and smooth (n = 3, 33{\%}), irregular (n = 3, 33{\%}), or speculated (n = 3, 33{\%}) margin; for non-BAC adenocarcinomas (n = 25), semisolid (n = 11, 44{\%}) or solid (n = 12, 48{\%}), attenuation and irregular margin (n = 14, 56{\%}); for squamous cell carcinoma (n = 14), solid attenuation (n = 12, 86{\%}) and irregular margin (n = 10, 71{\%}); for small cell or mixed small and large cell neuroendocrine carcinoma (n = 7), solid attenuation (n = 6, 86{\%}) and irregular margin (n = 5, 71{\%}); for non-small cell carcinoma not otherwise specified (n = 5), solid attenuation (n = 4, 80{\%}) and irregular margin (n = 3, 60{\%}); and for large cell carcinoma (n = 1), solid attenuation and speculated shape (n = 1, 100{\%}). Attenuation most often (in 12 of 21 cases) increased. Margins most often (in 16 of 20 cases) became more irregular or spiculated. Mean VDT was 518 days. Thirteen of 48 cancers had a VDT longer than 400 days; 11 of these 13 cancers were in women. Conclusion: Overdiagnosis, especially in women, may be a substantial concern in lung cancer screening.",
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T2 - CT appearance, growth rate, location, and histologic features of 61 lung cancers

AU - Lindell, Rebecca M.

AU - Hartman, Thomas E.

AU - Swensen, Stephen J.

AU - Jett, James R.

AU - Midthun, David Eric

AU - Tazelaar, Henry D.

AU - Mandrekar, Jayawant

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N2 - Purpose: To retrospectively evaluate the computed tomography (CT)-determined size, morphology, location, morphologic change, and growth rate of incidence and prevalence lung cancers detected in high-risk individuals who underwent annual chest CT screening for 5 years and to evaluate the histologic features and stages of these cancers. Materials and Methods: The study was institutional review board approved and HIPAA compliant. Informed consent was waived. CT scans of 61 cancers (24 in men, 37 in women; age range, 53-79 years; mean, 65 years) were retrospectively reviewed for cancer size, morphology, and location. Forty-eight cancers were assessed for morphologic change and volume doubling time (VDT), which was calculated by using a modified Schwartz equation. Histologic sections were retrospectively reviewed. Results: Mean tumor size was 16.4 mm (range, 5.5-52.5 mm.). Most common CT morphologic features were as follows: for bronchioloalveolar carcinoma (BAC) (n = 9), ground-glass attenuation (n = 6, 67%) and smooth (n = 3, 33%), irregular (n = 3, 33%), or speculated (n = 3, 33%) margin; for non-BAC adenocarcinomas (n = 25), semisolid (n = 11, 44%) or solid (n = 12, 48%), attenuation and irregular margin (n = 14, 56%); for squamous cell carcinoma (n = 14), solid attenuation (n = 12, 86%) and irregular margin (n = 10, 71%); for small cell or mixed small and large cell neuroendocrine carcinoma (n = 7), solid attenuation (n = 6, 86%) and irregular margin (n = 5, 71%); for non-small cell carcinoma not otherwise specified (n = 5), solid attenuation (n = 4, 80%) and irregular margin (n = 3, 60%); and for large cell carcinoma (n = 1), solid attenuation and speculated shape (n = 1, 100%). Attenuation most often (in 12 of 21 cases) increased. Margins most often (in 16 of 20 cases) became more irregular or spiculated. Mean VDT was 518 days. Thirteen of 48 cancers had a VDT longer than 400 days; 11 of these 13 cancers were in women. Conclusion: Overdiagnosis, especially in women, may be a substantial concern in lung cancer screening.

AB - Purpose: To retrospectively evaluate the computed tomography (CT)-determined size, morphology, location, morphologic change, and growth rate of incidence and prevalence lung cancers detected in high-risk individuals who underwent annual chest CT screening for 5 years and to evaluate the histologic features and stages of these cancers. Materials and Methods: The study was institutional review board approved and HIPAA compliant. Informed consent was waived. CT scans of 61 cancers (24 in men, 37 in women; age range, 53-79 years; mean, 65 years) were retrospectively reviewed for cancer size, morphology, and location. Forty-eight cancers were assessed for morphologic change and volume doubling time (VDT), which was calculated by using a modified Schwartz equation. Histologic sections were retrospectively reviewed. Results: Mean tumor size was 16.4 mm (range, 5.5-52.5 mm.). Most common CT morphologic features were as follows: for bronchioloalveolar carcinoma (BAC) (n = 9), ground-glass attenuation (n = 6, 67%) and smooth (n = 3, 33%), irregular (n = 3, 33%), or speculated (n = 3, 33%) margin; for non-BAC adenocarcinomas (n = 25), semisolid (n = 11, 44%) or solid (n = 12, 48%), attenuation and irregular margin (n = 14, 56%); for squamous cell carcinoma (n = 14), solid attenuation (n = 12, 86%) and irregular margin (n = 10, 71%); for small cell or mixed small and large cell neuroendocrine carcinoma (n = 7), solid attenuation (n = 6, 86%) and irregular margin (n = 5, 71%); for non-small cell carcinoma not otherwise specified (n = 5), solid attenuation (n = 4, 80%) and irregular margin (n = 3, 60%); and for large cell carcinoma (n = 1), solid attenuation and speculated shape (n = 1, 100%). Attenuation most often (in 12 of 21 cases) increased. Margins most often (in 16 of 20 cases) became more irregular or spiculated. Mean VDT was 518 days. Thirteen of 48 cancers had a VDT longer than 400 days; 11 of these 13 cancers were in women. Conclusion: Overdiagnosis, especially in women, may be a substantial concern in lung cancer screening.

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