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CT Screening for Lung Cancer: Diagnoses Resulting from the New York Early Lung Cancer Action Project¹

¹ The complete list of investigators and affiliations is in the Appendix. From the 2004 RSNA Annual Meeting. Received March 14, 2006; revision requested May 17; revision received June 9; accepted July 7; final version accepted September 1. Supported in part by the City of New York Department of Health and Mental Hygiene; Starr Foundation; Empire Blue Cross and Blue Shield; New York Community Trust; New York State Office of Science, Technology, and Academic Research; the Rogers Family Fund; Weill Medical College of Cornell University; Cornell University; and Academic Medical Development Company. Address correspondence to Claudia I. Henschke, PhD, MD, Department of Radiology, New York Presbyterian Hospital–Weill Cornell Medical Center, 525 E 68th St, New York, NY 10021 (e-mail: chensch{at}med.cornell.edu).

Purpose: To evaluate prospectively the diagnostic performance of the New York Early Lung Cancer Action Project (NY-ELCAP) regimen in the diagnosis of early lung cancer at baseline and annual repeat computed tomographic (CT) screenings.

Materials and Methods: Informed consent and institutional review board approval were obtained for this HIPAA-compliant study of baseline and annual repeat low-dose CT screening performed with a common regimen in asymptomatic individuals at 12 institutions in New York State. All 6295 participants were aged 60 years or older, had smoked for at least 10 pack-years, had no prior cancer, had not undergone chest CT in the previous 3 years, and were medically fit to undergo thoracic surgery. Median age was 66 years, and median smoking history was 40 pack-years. The proportion (and 95% exact confidence intervals [CIs]) of subjects with a positive result, as determined by using nodule size; the diagnoses of lung cancer resulting from subsequent work-up; and the distribution by cancer stage and cell type were determined. When relevant, 95% CIs for the proportions were calculated.

Results: Initial CT imaging led to recommendations for further work-up in 14.4% (95% CI: 13.5%, 15.3%) of the 6295 baseline screenings and 6.0% (95% CI: 5.1%, 6.6%) of the 6014 annual repeat screenings. Of 101 patients in whom the diagnosis of lung cancer resulted from baseline screening and three in whom a diagnosis of lung cancer was prompted by symptoms prior to the first scheduled repeat screening, 95 (91.3%) had no clinical evidence of metastases. Of the 20 patients in whom the diagnosis of lung cancer resulted from annual repeat screening, 17 (85%) showed no evidence of metastases. Of the 134 recommended biopsies, 125 (93.3%) resulted in diagnosis of lung cancer or another malignancy, while none of the 24 biopsies performed outside of the recommendation of the regimen resulted in diagnosis of lung cancer.

Conclusion: The NY-ELCAP regimen of screening revealed that annual CT screening for lung cancer resulted in identification of a high proportion of patients with early-stage disease.

© RSNA, 2007

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