CT Screening May Detect Early Lung Cancer But Can Lead to Unneeded Surgery

New research indicates that while low-dose CT of the chest can identify lung cancer at an early, more treatable stage, it can also lead to major surgical procedures that uncover no cancer.
The Pittsburgh Lung Screening Study (PLuSS) represents the largest single-institution investigation of CT lung cancer screening in current and former cigarette smokers, according to the report in the November 1st issue of the American Journal of Respiratory and Critical Care Medicine.
The study included 3642 subjects, between 50 and 79 years of age, who were screened with low-radiation-dose CT. Repeat screening at 1 year was performed in 3423 of the subjects. To be eligible for the study, the subjects had to have smoked at least a half pack of cigarettes per day for 25 years or more and have no history of lung cancer.
A noncalcified lung nodule was identified in 40.6% of patients on the initial screening, Dr. David O. Wilson and colleagues, from the University of Pittsburgh, note. Prior to repeat screening, 55.6% of these patients underwent one or more diagnostic imaging studies.
During 3 years of follow-up, 80 subjects were found to have lung cancer, including 53 who had a tumor detected on initial screening.
Overall, 36 subjects (1%) who had an abnormality detected on the initial or repeat CT screen ended up having a major thoracic operation that resulted in a noncancer diagnosis. Of 82 subjects who underwent thoracotomy or video-assisted thorascopic surgery to rule out malignancy, 28 ultimately received a noncancer diagnosis.
Among 69 patients who had non-small cell lung cancer, 40 had stage 1 disease at diagnosis, the report indicates.
"Our challenge is how to reduce major surgery and morbidity from diagnostic procedures triggered by nodule discovery on CT," Dr. York E. Miller, from the University of Colorado, Denver, writes in a related editorial.
"Guidelines for the management of non-calcified pulmonary nodules have been suggested by several groups, with 'watchful waiting' the preferred option in some situations," Dr. Miller adds. These guidelines should be effective in reducing unnecessary surgical procedures if they are adhered to.