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Published online before print January 18, 2002, 10.1148/radiol.2223010490
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(Radiology 2002;222:773-781.)
© RSNA, 2002

Thoracic Imaging

Screening for Early Lung Cancer with Low-Dose Spiral CT: Prevalence in 817 Asymptomatic Smokers1

Stefan Diederich, Priv Doz, Dr Med, Dag Wormanns, Dr Med, Michael Semik, Priv Doz, Dr Med, Michael Thomas, Priv Doz, Dr Med, Horst Lenzen, Dipl Ing, Nikolaus Roos, Dr Med and Walter Heindel, Prof Dr Med

1 From the Departments of Clinical Radiology (S.D., D.W., H.L., N.R., W.H.), Thoracic and Cardiovascular Surgery (M.S.), and Hematology/Oncology and Respiratory Medicine (M.T.), University of Münster, Albert-Schweitzer-Strasse 33, D-48129 Münster, Germany. Received February 21, 2001; revision requested March 30; revision received June 13; accepted August 8. Supported by grants from the German Cancer Society (Deutsche Krebshilfe: 70-2021-Di 2 and 70-2501-Di 3) and the Medical Faculty of Münster University (IMF Di-1-4-I/97-22). Address correspondence to S.D. (e-mail: diestef@uni-muenster.de).

PURPOSE: To present prevalence screening data from a nonrandomized screening trial by using low-dose computed tomography (CT) and a simple algorithm based on the size and attenuation of detected nodules to guide diagnostic work-up.

MATERIALS AND METHODS: Eight hundred seventeen asymptomatic volunteers (age range, 40–78 years; median age, 53 years; median tobacco consumption, 45 pack-years) underwent spiral low-dose CT of the chest without contrast material enhancement. We regarded all noncalcified pulmonary nodules greater than 10 mm in diameter as potentially malignant and recommended histologic examination or follow-up after 3, 6, 12, and 24 months to exclude growth. For noncalcified pulmonary nodules of 10 mm or smaller, repeat low-dose CT was recommended to exclude growth.

RESULTS: In 43% (350 of 817) of individuals, 858 noncalcified pulmonary nodules were found. Thirty-two nodules in 29 subjects were larger than 10 mm. Biopsy of 15 lesions revealed lung cancer in 12 lesions in 11 subjects (prevalence for all ages, 1.3% [11 of 817 subjects]; >50 years of age, 2.1% [11 of 519 subjects]; >60 years of age, 3.9% [eight of 206 subjects]), with a high proportion of early tumor stages (seven tumors, stage I; two, stage II; and three, stage III); three lesions were benign. In 17 nodules larger than 10 mm, follow-up with low-dose CT for a minimum of 24 months did not demonstrate growth.

CONCLUSION: Lung cancer screening with low-dose CT demonstrated a prevalence of asymptomatic cancers in 1.3% of a smoking population, including a high proportion of early tumor stages and a 20% (three of 15) rate of invasive procedures for benign lesions.

© RSNA, 2002

Index terms: Cancer screening, 60.12111, 60.12115, 60.12119 • Computed tomography (CT), radiation exposure • Lung neoplasms, CT, 60.12111, 60.12115




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