Lung cancer screening 3

801 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
801
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
9
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Lung cancer screening 3

  1. 1. Ahmed Zeeneldin
  2. 2. ¨ High risk population ¡ Heavy smoker or former smoker (quit within last 15 years) ú Smoked 30 pack years equivalent to 1 pack /day x 30 years ¡ Age: 55 to 74 years¨ Randomized to: ¡ low-dose helical CT OR ¡ standard chest X-ray¨ Duration: yearly x 3 years and follow up for 5 years¨ Positive cases are further verified¨ Endpoint: death from lung cancer
  3. 3. Process and outcomes in the NLST. Radiology doi:10.1148/radiol.10091808©2010 by Radiological Society of North America
  4. 4. ¨ Started 2002¨ Accrued 53 000 in 33 sites in USA over 20 months¨ DSMB stopped the trial in October 2010
  5. 5. Spiral CT Chest xray PNumbers 26500 26500No of cases ? ?Lung cancer mortality 354 442 <0.05RR of lung cancer death 0.8 (20% lower) 1All-cause mortality 7% lowerPositive findings on imaging during study 24% 7%False positives 95-98% 93-96%Compliance 91%
  6. 6. ¨ Primary Prevention: ¡ Prevent initial disease occurrence¨ Secondary Prevention: ¡ Detect the disease early in the asymptomatic stage¨ Tertiary Prevention: ¡ Prevent re-occurrence and complications and disability and improve QOL
  7. 7. ¨ High risk groups: ¡ Heavy cigarette smokers¨ Asymptomatic
  8. 8. ¨ Primary Prevention: ú Anti-smoking measures bilat mastectomy ú HBV vaccination ú HPV vaccination¨ Secondary Prevention: ú Breast cancer screening ú HCC screening¨ Tertiary Prevention: ú Proper treatments ú Adj Tam in breast cancer
  9. 9. Lung cancer¨ Clinical exam: X ¡ BSE, CBE ¡ DRE¨ Lab tests: X ¡ Serum biomarkers: ú PSA ú AFP ¡ Cytology¨ Radiology: YES ¡ Mammography - Chest X-ray XXXX ¡ TRUS - CT chest ¡ ABD US - MRI?¨ Other: XXX ¡ Colonoscpoy - Bronchoscopy
  10. 10. A. ConventionalB. Spiral (low dose helical): ¡ scans the entire chest in about 7-15 seconds during a single, breath-hold. The CT scanner rotates around the person, who is lying still on a table as the table passes through the center of the scanner.
  11. 11. ¨ Lead time bias¨ Length bias¨ Overdiagnosis bias
  12. 12. ¨ Survival is the time from Diagnosis to death¨ It is longer if cancer is detected early by screening¨ Lead time= screening survival – symptom survival¨ To avoid it measure mortality
  13. 13. ¨ Indolent cancers have long preclinical phase and more amenable to early detection
  14. 14. ¨ Diagnosis and treatment of non-fatal disease
  15. 15. ¨ High risk population ¡ Heavy smoker or former smoker (quit within last 15 years) ¡ Age: 55 to 74 years¨ Randomized to: ¡ low-dose helical CT OR ¡ standard chest X-ray¨ Duration: yearly x 3 years and follow up for 5 years¨ Positive cases are further verified¨ Endpoint: death from lung cancer
  16. 16. Process and outcomes in the NLST. Radiology doi:10.1148/radiol.10091808©2010 by Radiological Society of North America
  17. 17. ¨ Started 2002¨ Accrued 53 000 in 33 sites in USA over 20 months¨ DSMB stopped the trial in October 2010
  18. 18. Spiral CT Chest xray PNumbers 26500 26500Lung cancer mortality 354 442 <0.05Mortality /100 000 245 308RR 0.8 (20% lower) 1All-cause mortality 7% lowerPositive findings on imaging during study 24% 7%False positives 95-98% 93-96%Compliance 91%
  19. 19. ¨ Who is at high risk?¨ Age?¨ Schedule?¨ Compliance?¨ False positive rates?¨ Stop or not to stop smoking?
  20. 20. Lung cancer No lung cancer (cases) (non-cases)Spiral CT mass True positive (TP) False positive (FP) PPV: 5% 95% TP/test positiveSpiral CT no mass False negative (FN) True negative (TN) NPV: TN/test negative Test Sensitivity: Test Specificity: TP/cases TN/non-cases
  21. 21. ¨ Positivity rate or prevalence of positivity = Total positives / Total tested x 100 49.70%¨¨ Negativity rate or prevalenve of negativity = Total negatives / Total tested x 100 50.30%¨¨ Rate of Disagreement = (False positives + False negatives) / Total tested x 100 8.73%¨¨ Rate of Agreement = (True positives + True negatives) / Total tested x 100 91.27%¨¨ Sensitivity = True positives / Total positives x 100 84.85%¨¨ Specificity = True negatives / Total negatives x 100 97.60%¨¨ Predictive value positivity = True positives / Tested positive x 100 97.22%¨¨ Predictive value negativity = True negatives / Tested negative x 100 86.70%
  22. 22. ¨ Females: ¡ Breast ¡ Cervix¨ Males: ¡ Prostate¨ Both sexes: ¡ Colorectal ¡ Lung ¡ ? HCC in Egypt in high risk groups

×