Thoracic surgical operations in patients enrolled in a computed tomographic screening trial

Juan A. Crestanello, Mark S. Allen, James R. Jett, Stephen D. Cassivi, Francis C. Nichols, Stephen J. Swensen, Claude Deschamps, Peter C. Pairolero

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Abstract

Objective Screening for lung cancer with computed tomography may detect cancers at an earlier stage but may also result in overdiagnosis. We reviewed the thoracic surgical operations performed on patients enrolled in our computed tomographic screening program. Methods From January 1999 through December 2002, screening computed tomography for lung cancer was performed annually on 1520 participants. All participants were at least 50 years old and smoked more than 20 pack/y. We found 3130 indeterminate pulmonary nodules in 1112 participants (73%). Fifty-five participants (3.6%) underwent 60 thoracic operations for a variety of indications. The medical records of these 55 patients were reviewed. Results Indications for operation included suspicious pulmonary nodules, mediastinal adenopathy, and a spontaneous pneumothorax. Operations performed included a lobectomy in 37 cases, wedge resection in 11, segmentectomy in 6, video-assisted thoracoscopic surgical talc pleurodesis in 1, bilobectomy in 2, mediastinoscopy in 2, and anterior mediastinotomy in 1. Benign disease was found in 10 patients (18.1%), and lung cancer was found in 45 (81.9%), 2 of whom had metachronous lung cancers. Cell types were adenocarcinoma in 15 cancers, bronchioloalveolar cell carcinoma in 13, squamous cell in 13, carcinoid in 2, small cell in 2, and large cell and undifferentiated non-small cell in 1 case each. Twenty-eight cancers were classified as stage IA, 4 as IB, 4 as IIA, 1 as IIB, 4 as IIIA, 3 as IIIB, 1 as IV, and 2 as limited small cell carcinoma. Complications occurred in 27% of patients. Operative mortality was 1.7%. Conclusion Computed tomographic screening finds a large number of indeterminate pulmonary nodules in smokers 50 years old or older, most of which are observed and not operated on. Although 47 cancers were detected thus far in this highly selected group of patients, this represents only 1.5% of the pulmonary nodules identified.

Original languageEnglish (US)
Pages (from-to)254-259
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume128
Issue number2
DOIs
StatePublished - Aug 2004

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Thorax
Lung Neoplasms
Lung
Neoplasms
Tomography
Pleurodesis
Bronchiolo-Alveolar Adenocarcinoma
Mediastinoscopy
Talc
Small Cell Carcinoma
Segmental Mastectomy
Carcinoid Tumor
Pneumothorax
Medical Records
Adenocarcinoma
Epithelial Cells
Mortality

Keywords

  • 10

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Crestanello, J. A., Allen, M. S., Jett, J. R., Cassivi, S. D., Nichols, F. C., Swensen, S. J., ... Pairolero, P. C. (2004). Thoracic surgical operations in patients enrolled in a computed tomographic screening trial. Journal of Thoracic and Cardiovascular Surgery, 128(2), 254-259. https://doi.org/10.1016/j.jtcvs.2004.02.017

Thoracic surgical operations in patients enrolled in a computed tomographic screening trial. / Crestanello, Juan A.; Allen, Mark S.; Jett, James R.; Cassivi, Stephen D.; Nichols, Francis C.; Swensen, Stephen J.; Deschamps, Claude; Pairolero, Peter C.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 128, No. 2, 08.2004, p. 254-259.

Research output: Contribution to journalArticle

Crestanello, JA, Allen, MS, Jett, JR, Cassivi, SD, Nichols, FC, Swensen, SJ, Deschamps, C & Pairolero, PC 2004, 'Thoracic surgical operations in patients enrolled in a computed tomographic screening trial', Journal of Thoracic and Cardiovascular Surgery, vol. 128, no. 2, pp. 254-259. https://doi.org/10.1016/j.jtcvs.2004.02.017
Crestanello, Juan A. ; Allen, Mark S. ; Jett, James R. ; Cassivi, Stephen D. ; Nichols, Francis C. ; Swensen, Stephen J. ; Deschamps, Claude ; Pairolero, Peter C. / Thoracic surgical operations in patients enrolled in a computed tomographic screening trial. In: Journal of Thoracic and Cardiovascular Surgery. 2004 ; Vol. 128, No. 2. pp. 254-259.
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abstract = "Objective Screening for lung cancer with computed tomography may detect cancers at an earlier stage but may also result in overdiagnosis. We reviewed the thoracic surgical operations performed on patients enrolled in our computed tomographic screening program. Methods From January 1999 through December 2002, screening computed tomography for lung cancer was performed annually on 1520 participants. All participants were at least 50 years old and smoked more than 20 pack/y. We found 3130 indeterminate pulmonary nodules in 1112 participants (73{\%}). Fifty-five participants (3.6{\%}) underwent 60 thoracic operations for a variety of indications. The medical records of these 55 patients were reviewed. Results Indications for operation included suspicious pulmonary nodules, mediastinal adenopathy, and a spontaneous pneumothorax. Operations performed included a lobectomy in 37 cases, wedge resection in 11, segmentectomy in 6, video-assisted thoracoscopic surgical talc pleurodesis in 1, bilobectomy in 2, mediastinoscopy in 2, and anterior mediastinotomy in 1. Benign disease was found in 10 patients (18.1{\%}), and lung cancer was found in 45 (81.9{\%}), 2 of whom had metachronous lung cancers. Cell types were adenocarcinoma in 15 cancers, bronchioloalveolar cell carcinoma in 13, squamous cell in 13, carcinoid in 2, small cell in 2, and large cell and undifferentiated non-small cell in 1 case each. Twenty-eight cancers were classified as stage IA, 4 as IB, 4 as IIA, 1 as IIB, 4 as IIIA, 3 as IIIB, 1 as IV, and 2 as limited small cell carcinoma. Complications occurred in 27{\%} of patients. Operative mortality was 1.7{\%}. Conclusion Computed tomographic screening finds a large number of indeterminate pulmonary nodules in smokers 50 years old or older, most of which are observed and not operated on. Although 47 cancers were detected thus far in this highly selected group of patients, this represents only 1.5{\%} of the pulmonary nodules identified.",
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AB - Objective Screening for lung cancer with computed tomography may detect cancers at an earlier stage but may also result in overdiagnosis. We reviewed the thoracic surgical operations performed on patients enrolled in our computed tomographic screening program. Methods From January 1999 through December 2002, screening computed tomography for lung cancer was performed annually on 1520 participants. All participants were at least 50 years old and smoked more than 20 pack/y. We found 3130 indeterminate pulmonary nodules in 1112 participants (73%). Fifty-five participants (3.6%) underwent 60 thoracic operations for a variety of indications. The medical records of these 55 patients were reviewed. Results Indications for operation included suspicious pulmonary nodules, mediastinal adenopathy, and a spontaneous pneumothorax. Operations performed included a lobectomy in 37 cases, wedge resection in 11, segmentectomy in 6, video-assisted thoracoscopic surgical talc pleurodesis in 1, bilobectomy in 2, mediastinoscopy in 2, and anterior mediastinotomy in 1. Benign disease was found in 10 patients (18.1%), and lung cancer was found in 45 (81.9%), 2 of whom had metachronous lung cancers. Cell types were adenocarcinoma in 15 cancers, bronchioloalveolar cell carcinoma in 13, squamous cell in 13, carcinoid in 2, small cell in 2, and large cell and undifferentiated non-small cell in 1 case each. Twenty-eight cancers were classified as stage IA, 4 as IB, 4 as IIA, 1 as IIB, 4 as IIIA, 3 as IIIB, 1 as IV, and 2 as limited small cell carcinoma. Complications occurred in 27% of patients. Operative mortality was 1.7%. Conclusion Computed tomographic screening finds a large number of indeterminate pulmonary nodules in smokers 50 years old or older, most of which are observed and not operated on. Although 47 cancers were detected thus far in this highly selected group of patients, this represents only 1.5% of the pulmonary nodules identified.

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