- •Foreword
- •Preface
- •Contents
- •About the Editors
- •Contributors
- •1: Tracheobronchial Anatomy
- •Trachea
- •Introduction
- •External Morphology
- •Internal Morphology
- •Mucous Layer
- •Blood Supply
- •Anatomo-Clinical Relationships
- •Bronchi
- •Main Bronchi
- •Bronchial Division
- •Left Main Bronchus (LMB)
- •Right Main Bronchus (RMB)
- •Blood Supply
- •References
- •2: Flexible Bronchoscopy
- •Introduction
- •History
- •Description
- •Indications and Contraindications
- •Absolute Contraindications
- •Procedure Preparation
- •Technique of FB Procedure
- •Complications of FB Procedure
- •Basic Diagnostic Procedures
- •Bronchoalveolar Lavage (BAL)
- •Transbronchial Lung Biopsy (TBLB)
- •Transbronchial Needle Aspiration (TBNA)
- •Bronchial Brushings
- •Advanced Diagnostic Bronchoscopy
- •EBUS-TBNA
- •Ultrathin Bronchoscopy
- •Transbronchial Lung Cryobiobsy (TBLC)
- •Therapeutic Procedures Via FB
- •LASER Bronchoscopy
- •Electrocautery
- •Argon Plasma Coagulation (APC)
- •Cryotherapy
- •Photodynamic Therapy
- •Airway Stent Placement
- •Endobronchial Valve Placement
- •Conclusion
- •References
- •History and Historical Perspective
- •Indications and Contraindications
- •Procedure Description
- •Procedure Planning
- •Target Approximation
- •Sampling
- •Complications
- •Future Directions
- •Summary and Recommendations
- •References
- •4: Rigid Broncoscopy
- •Innovations
- •Ancillary Equipment
- •Rigid Bronchoscopy Applications
- •Laser Bronchoscopy
- •Tracheobronchial Prosthesis
- •Transbronchial Needle Aspiration (TBNA)
- •Rigid Bronchoscope in Other Treatments for Bronchial Obstruction
- •Mechanical Debridement
- •Pediatric Rigid Bronchoscopy
- •Tracheobronchial Dilatation
- •Foreign Bodies Removal
- •Other Indications
- •Complications
- •The Procedure
- •Some Conclusions
- •References
- •History and Historical Perspective
- •Indications and Contraindications
- •Preprocedural Evaluation and Preparation
- •Physical Examination
- •Procedure-Related Indications
- •Application of the Technique
- •Topical Anesthesia
- •Anesthesia of the Nasal Mucosa and Nasopharynx
- •Anesthesia of the Mouth and Oropharynx
- •Superior Laryngeal Nerve Block
- •Recurrent Laryngeal Nerve Block (RLN)
- •Conscious Sedation
- •Monitored Anesthesia Care (MAC)
- •General Anesthesia
- •Monitoring the Depth of Anesthesia
- •Interventional Bronchoscopy Suites
- •Airway Devices
- •Laryngeal Mask Airway (LMA)
- •Endotracheal Tube (ETT)
- •Rigid Bronchoscope
- •Modes of Ventilation
- •Spontaneous Ventilation
- •Assisted Ventilation
- •Noninvasive Positive Pressure Ventilation (NIV)
- •Positive Pressure Controlled Mechanical Ventilation
- •Jet Ventilation
- •Electronic Mechanical Jet Ventilation
- •Postprocedure Care
- •Special Consideration
- •Anesthesia for Peripheral Diagnostic and Therapeutic Bronchoscopy
- •Anesthesia for Interventional Bronchoscopic Procedures During the COVID-19 Pandemic
- •Summary and Recommendations
- •Conclusion
- •References
- •Background
- •Curricular Structure and Delivery
- •What Is a Bronchoscopy Curriculum?
- •Tradition, Teaching Styles, and Beliefs
- •Using Assessment Tools to Guide the Educational Process
- •The Ethics of Teaching
- •When Learners Teach: The Journey from Novice to Mastery and Back Again
- •The Future Is Now
- •References
- •Interventional Procedure
- •Assessment of Flow–Volume Curve
- •Dyspnea
- •Analysis of Pressure–Pressure Curve
- •Conclusions
- •References
- •Introduction
- •Adaptations of the IP Department
- •Environmental Control
- •Personal Protective Equipment
- •Procedure Performance
- •Bronchoscopy in Intubated Patients
- •Other Procedures in IP Unit
- •References
- •Introduction
- •Safety
- •Patient Safety
- •Provider Safety
- •Patient Selection and Screening
- •Lung Cancer Diagnosis and Staging
- •Inpatients
- •COVID-19 Clearance
- •COVID Clearance: A Role for Bronchoscopy
- •Long COVID: A Role for Bronchoscopy
- •Preparing for the Next Pandemic
- •References
- •Historical Perspective
- •Indications and Contraindications
- •Evidence-Based Review
- •Summary and Recommendations
- •References
- •Introduction
- •Clinical Presentation
- •Diagnosis
- •Treatment
- •History and Historical Perspectives
- •Indications and Contraindications
- •Benign and Malignant Tumors
- •Tumors with Uncertain Prognosis
- •Application of the Technique
- •Evidence Based Review
- •Summary and Recommendations
- •References
- •12: Cryotherapy and Cryospray
- •Introduction
- •Historical Perspective
- •Equipment
- •Cryoadhesion
- •Indications
- •Cryorecanalization
- •Cryoadhesion and Foreign Body Removal
- •Cryoadhesion and Mucus Plugs/Blood Clot Retrieval
- •Endobronchial Cryobiopsy
- •Transbronchial Cryobiopsy for Lung Cancer
- •Safety Concerns and Contraindications
- •Cryoablation
- •Indications
- •Evidence
- •Safety Concerns and Contraindications
- •Cryospray
- •Indications
- •Evidence
- •Safety Concerns and Contraindications
- •Advantages of Cryotherapy
- •Limitations
- •Future Research Directions
- •References
- •13: Brachytherapy
- •History and Historical Perspective
- •Indications and Contraindications
- •Application of the Technique
- •Evidence-Based Review
- •Adjuvant Treatment
- •Palliative Treatment
- •Complications
- •Summary and Recommendations
- •References
- •14: Photodynamic Therapy
- •Introduction
- •Photosensitizers
- •First-Generation Photosensitizers
- •M-Tetrahidroxofenil Cloro (mTHPC) (Foscan®)
- •PDT Reaction
- •Tumor Damage Process
- •Procedure
- •Indications
- •Curative PDT Indications
- •Palliative PDT Indications
- •Contraindications
- •Rationale for Use in Early-Stage Lung Cancer
- •Rationale
- •PDT in Combination with Other Techniques for Advanced-Stage Non-small Cell Lung Cancer
- •Commentary
- •Complementary Endoscopic Methods for PDT Applications
- •New Perspectives
- •Other PDT Applications
- •Conclusions
- •References
- •15: Benign Airways Stenosis
- •Etiology
- •Congenital Tracheal Stenosis
- •Iatrogenic
- •Infectious
- •Idiopathic Tracheal Stenosis
- •Distal Bronchial Stenosis
- •Diagnosis Methods
- •Patient History
- •Imaging Techniques
- •Bronchoscopy
- •Pulmonary Function Test
- •Treatment
- •Endoscopic Treatment
- •Dilatation
- •Laser Therapy
- •Stents
- •How to Proceed
- •Stent Placement
- •Placing a Montgomery T Tube
- •The Rule of Twos for Benign Tracheal Stenosis (Fig. 15.23)
- •Surgery
- •Summary and Recommendations
- •References
- •16: Endobronchial Prostheses
- •Introduction
- •Indications
- •Extrinsic Compression
- •Intraluminal Obstruction
- •Stump Fistulas
- •Esophago-respiratory Fistulas (ERF)
- •Expiratory Central Airway Collapse
- •Physiologic Rationale for Airway Stent Insertion
- •Stent Selection Criteria
- •Stent-Related Complications
- •Granulation Tissue
- •Stent Fracture
- •Migration
- •Contraindications
- •Follow-Up and Patient Education
- •References
- •Introduction
- •Overdiagnosis
- •False Positives
- •Radiation
- •Risk of Complications
- •Lung Cancer Screening Around the World
- •Incidental Lung Nodules
- •Management of Lung Nodules
- •References
- •Introduction
- •Minimally Invasive Procedures
- •Mediastinoscopy
- •CT-Guided Transthoracic Biopsy
- •Fluoroscopy-Guided Transthoracic Biopsies
- •US-Guided Transthoracic Biopsy
- •Thoracentesis and Pleural Biopsy
- •Thoracentesis
- •Pleural Biopsy
- •Surgical or Medical Thoracoscopy
- •Image-Guided Pleural Biopsy
- •Closed Pleural Biopsy
- •Image-Guided Biopsies for Extrathoracic Metastases
- •Tissue Acquisition, Handling and Processing
- •Implications of Tissue Acquisition
- •Guideline Recommendations for Tissue Acquisition in Mediastinal Staging
- •Methods to Overcome Challenges in Tissue Acquisition and Genotyping
- •Rapid on-Site Evaluation (ROSE)
- •Sensitive Genotyping Assays
- •Liquid Biopsy
- •Summary, Recommendations and Highlights
- •References
- •History
- •Data Source and Methodology
- •Tumor Size
- •Involvement of the Main Bronchus
- •Atelectasis/Pneumonitis
- •Nodal Staging
- •Proposal for the Revision of Stage Groupings
- •Small Cell Lung Cancer (SCLC)
- •Discussion
- •Methodology
- •T Descriptors
- •N Descriptors
- •M Descriptors
- •Summary
- •References
- •Introduction
- •Historical Perspective
- •Fluoroscopy
- •Radial EBUS Mini Probe (rEBUS)
- •Ultrasound Bronchoscope (EBUS)
- •Virtual Bronchoscopy
- •Trans-Parenchymal Access
- •Cone Beam CT (CBCT)
- •Lung Vision
- •Sampling Instruments
- •Conclusions
- •References
- •History and Historical Perspective
- •Narrow Band Imaging (NBI)
- •Dual Red Imaging (DRI)
- •Endobronchial Ultrasound (EBUS)
- •Optical Coherence Tomography (OCT)
- •Indications and Contraindications
- •Confocal Laser Endomicroscopy and Endocytoscopy
- •Raman Spectrophotometry
- •Application of the Technique
- •Supplemental Technology for Diagnostic Bronchoscopy
- •Evidence-Based Review
- •Summary and Recommendations, Highlight of the Developments During the Last Three Years (2013 on)
- •References
- •Introduction
- •History and Historical Perspective
- •Endoscopic AF-OCT System
- •Preclinical Studies
- •Clinical Studies
- •Lung Cancer
- •Asthma
- •Airway and Lumen Calibration
- •Obstructive Sleep Apnea
- •Future Applications
- •Summary
- •References
- •23: Endobronchial Ultrasound
- •History and Historical Perspective
- •Equipment
- •Technique
- •Indication, Application, and Evidence
- •Convex Probe Ultrasound
- •Equipment
- •Technique
- •Indication, Application, and Evidence
- •CP-EBUS for Malignant Mediastinal or Hilar Adenopathy
- •CP-EBUS for the Staging of Non-small Cell Lung Cancer
- •CP-EBUS for Restaging NSCLC After Neoadjuvant Chemotherapy
- •Complications
- •Summary
- •References
- •Introduction
- •What Is Electromagnetic Navigation?
- •SuperDimension Navigation System (EMN-SD)
- •Computerized Tomography
- •Computer Interphase
- •The Edge Catheter: Extended Working Channel (EWC)
- •Procedural Steps
- •Planning
- •Detecting Anatomical Landmarks
- •Pathway Planning
- •Saving the Plan and Exiting
- •Registration
- •Real-Time Navigation
- •SPiN System Veran Medical Technologies (EMN-VM)
- •Procedure
- •Planning
- •Navigation
- •Biopsy
- •Complications
- •Limitations
- •Summary
- •References
- •Introduction
- •Image Acquisition
- •Hardware
- •Practical Considerations
- •Radiation Dose
- •Mobile CT Studies
- •Future Directions
- •Conclusion
- •References
- •26: Robotic Assisted Bronchoscopy
- •Historical Perspective
- •Evidence-Based Review
- •Diagnostic Yield
- •Monarch RAB
- •Ion Endoluminal Robotic System
- •Summary
- •References
- •History and Historical Perspective
- •Indications and Contraindications
- •General
- •Application of the Technique
- •Preoperative Care
- •Patient’s Position and Operative Field
- •Incision and Initial Dissection
- •Palpation
- •Biopsy
- •Control of Haemostasis and Closure
- •Postoperative Care
- •Complications
- •Technical Variants
- •Extended Cervical Mediastinoscopy
- •Mediastinoscopic Biopsy of Scalene Lymph Nodes
- •Inferior Mediastinoscopy
- •Mediastino-Thoracoscopy
- •Video-Assisted Mediastinoscopic Lymphadenectomy
- •Transcervical Extended Mediastinal Lymphadenectomy
- •Evidence-Based Review
- •Summary and Recommendations
- •References
- •Introduction
- •Case 1
- •Adrenal and Hepatic Metastases
- •Brain
- •Bone
- •Case 1 Continued
- •Biomarkers
- •Case 1 Concluded
- •Case 2
- •Chest X-Ray
- •Computerized Tomography
- •Positive Emission Tomography
- •Magnetic Resonance Imaging
- •Endobronchial Ultrasound with Transbronchial Needle Aspiration
- •Transthoracic Needle Aspiration
- •Transbronchial Needle Aspiration
- •Endoscopic Ultrasound with Needle Aspiration
- •Combined EUS-FNA and EBUS-TBNA
- •Case 2 Concluded
- •Case 3
- •Standard Cervical Mediastinoscopy
- •Extended Cervical Mediastinoscopy
- •Anterior Mediastinoscopy
- •Video-Assisted Thoracic Surgery
- •Case 3 Concluded
- •Case 4
- •Summary
- •References
- •29: Pleural Anatomy
- •Pleural Embryonic Development
- •Pleural Histology
- •Cytological Characteristics
- •Mesothelial Cells Functions
- •Pleural Space Defense Mechanism
- •Pleura Macroscopic Anatomy
- •Visceral Pleura (Pleura Visceralis or Pulmonalis)
- •Parietal Pleura (Pleura Parietalis)
- •Costal Parietal Pleura (Costalis)
- •Pleural Cavity (Cavitas Thoracis)
- •Pleural Apex or Superior Pleural Sinus [12–15]
- •Anterior Costal-Phrenic Sinus or Cardio-Phrenic Sinus
- •Posterior Costal-Phrenic Sinus
- •Cost-Diaphragmatic Sinus or Lateral Cost-Phrenic Sinus
- •Fissures18
- •Pleural Vascularization
- •Parietal Pleura Lymphatic Drainage
- •Visceral Pleura Lymphatic Drainage
- •Pleural Innervation
- •References
- •30: Chest Ultrasound
- •Introduction
- •The Technique
- •The Normal Thorax
- •Chest Wall Pathology
- •Pleural Pathology
- •Pleural Thickening
- •Pneumothorax
- •Pulmonary Pathology
- •Extrathoracic Lymph Nodes
- •COVID and Chest Ultrasound
- •Conclusions
- •References
- •Introduction
- •History of Chest Tubes
- •Overview of Chest Tubes
- •Contraindications for Chest Tube Placement
- •Chest Tube Procedural Technique
- •Special Considerations
- •Pneumothorax
- •Empyema
- •Hemothorax
- •Chest Tube Size Considerations
- •Pleural Drainage Systems
- •History of and Introduction to Indwelling Pleural Catheters
- •Indications and Contraindications for IPC Placement
- •Special Considerations
- •Non-expandable Lung
- •Chylothorax
- •Pleurodesis
- •Follow-Up and IPC Removal
- •IPC-Related Complications and Management
- •Competency and Training
- •Summary
- •References
- •32: Empyema Thoracis
- •Historical Perspectives
- •Incidence
- •Epidemiology
- •Pathogenesis
- •Clinical Presentation
- •Radiologic Evaluation
- •Biochemical Analysis
- •Microbiology
- •Non-operative Management
- •Prognostication
- •Surgical Management
- •Survivorship
- •Summary and Recommendations
- •References
- •Evaluation
- •Initial Intervention
- •Pleural Interventions for Recurrent Symptomatic MPE
- •Especial Circumstances
- •References
- •34: Medical Thoracoscopy
- •Introduction
- •Diagnostic Indications for Medical Thoracoscopy
- •Lung Cancer
- •Mesothelioma
- •Other Tumors
- •Tuberculosis
- •Therapeutic Indications
- •Pleurodesis of Pneumothorax
- •Thoracoscopic Drainage
- •Drug Delivery
- •Procedural Safety and Contraindications
- •Equipment
- •Procedure
- •Pre-procedural Preparations and Considerations
- •Procedural Technique [32]
- •Medical Thoracoscopy Versus VATS
- •Conclusion
- •References
- •Historical Perspective
- •Indications and Contraindications
- •Evidence-Based Review
- •Endobronchial Valves
- •Airway Bypass Tracts
- •Coils
- •Other Methods of ELVR
- •Summary and Recommendations
- •References
- •36: Bronchial Thermoplasty
- •Introduction
- •Mechanism of Action
- •Trials
- •Long Term: Ten-Year Study
- •Patient Selection
- •Bronchial Thermoplasty Procedure
- •Equipment
- •Pre-procedure
- •Bronchoscopy
- •Post-procedure
- •Conclusion
- •References
- •Introduction
- •Bronchoalveolar Lavage (BAL)
- •Technical Aspects of BAL Procedure
- •ILD Cell Patterns and Diagnosis from BAL
- •Technical Advises for Conventional TLB and TLB-C in ILD
- •Future Directions
- •References
- •Introduction
- •The Pediatric Airway
- •Advanced Diagnostic Procedures
- •Endobronchial Ultrasound
- •Virtual Navigational Bronchoscopy
- •Cryobiopsy
- •Therapeutic Procedures
- •Dilation Procedures
- •Thermal Techniques
- •Mechanical Debridement
- •Endobronchial Airway Stents
- •Metallic Stents
- •Silastic Stents
- •Novel Stents
- •Endobronchial Valves
- •Bronchial Thermoplasty
- •Discussion
- •References
- •Introduction
- •Etiology
- •Congenital ADF
- •Malignant ADF
- •Cancer Treatment-Related ADF
- •Benign ADF
- •Iatrogenic ADF
- •Diagnosis
- •Treatment Options
- •Endoscopic Techniques
- •Stents
- •Clinical Results
- •Stent Complications
- •Other Available Stents
- •Other Endoscopic Methods
- •References
- •Introduction
- •Anatomy and Physiology of Swallowing
- •Functional Physiology of Swallowing
- •Epidemiology and Risk Factors
- •Types of Foreign Bodies
- •Organic
- •Inorganic
- •Mineral
- •Miscellaneous
- •Clinical Presentation
- •Acute FB
- •Retained FB
- •Radiologic Findings
- •Bronchoscopy
- •Airway Management
- •Rigid Vs. Flexible Bronchoscopy
- •Retrieval Procedure
- •Instruments
- •Grasping Forceps
- •Baskets
- •Balloons
- •Suction Instruments
- •Ablative Therapies
- •Cryotherapy
- •Laser Therapy
- •Electrocautery and APC
- •Surgical Management
- •Complications
- •Bleeding and Hemoptysis
- •Distal Airway Impaction
- •Iron Pill Aspiration
- •Follow-Up and Sequelae
- •Conclusion
- •References
- •Vascular Origin of Hemoptysis
- •History and Historical Perspective
- •Diagnostic Bronchoscopy
- •Therapeutic Bronchoscopy
- •General Measures
- •Therapeutic Bronchoscopy
- •Evidence-Based Review
- •Summary
- •Recommendations
- •References
- •History
- •“The Glottiscope” (1807)
- •“The Esophagoscope” (1895)
- •The Rigid Bronchoscope (1897–)
- •The Flexible Bronchoscope (1968–)
- •Transbronchial Lung Biopsy (1972) (Fig. 42.7)
- •Laser Therapy (1981–)
- •Endobronchial Stents (1990–)
- •Electromagnetic Navigation (2003–)
- •Bronchial Thermoplasty (2006–)
- •Endobronchial Microwave Therapy (2004–)
- •American Association for Bronchology and Interventional Pulmonology (AABIP) and Journal of Bronchology and Interventional Pulmonology (JOBIP) (1992–)
- •References
- •Index
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Risk of Complications
Lung cancer screening results in a signi cant proportion of invasive procedures including surgery. These are done for both diagnosis and for treatment. In the IELCAP study, the rate of perioperative mortality was 0.5% [14]. However, the surgical mortality rate for major lung surgery across the US is 5% [19]. Major complications after a diagnostic procedure in the NLST occurred in 0.06% of patients with a positive LDCT that did not result in cancer, and 11.2% of those that did result in the diagnosis of cancer [15].
There is consensus among the different guidelines that lung cancer screening should be performed in centers with multidisciplinary lung cancer groups with expertise in minimally invasive diagnostic techniques (endobronchial ultrasound and navigational bronchoscopy), and in treatments with less morbidity, such as VATS, robotic surgery, or SBRT.
Lung Cancer Screening: Eligibility
Criteria
In December of 2013, the United States Preventive Services Task Force (USPSTF) published its rst recommendation in favor of annual lung cancer screening in the US for adults aged 55–80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years [27]. These selection criteria based on age and smoking history are similar to the entry criteria to the NLST, except that in the latter, the age range was between 55 and 74 years [15]. In an updated version in 2021, the USPSTF changed the age range and pack-year eligibility, recommending screening with LDCT in adults aged 50–80 years who have a 20 pack-year history of smoking and currently smoke or have quit within 15 years [28].
Retrospective studies have shown that applying the NLST entry criteria to other lung cancer screening cohorts would have rendered up to 40% of patients who were diagnosed with lung cancer ineligible for screening [29]. Retrospective analyses of lung cancer screening cohorts suggest that
other risk factors for lung cancer may play a role in selecting the right candidates for screening. For example, the presence of emphysema on the baseline LDCT in a screening program is associated with a two to threefold increased risk of a lung cancer diagnosis [29, 30]. Some suggest that entry criteria should be different for the initial screenings than for subsequent annual screenings. More fexible entry criteria in the rst screening may allow for better risk prediction for subsequent annual screening using data obtained on the baseline LDCT (e.g., radiologic emphysema) [29]. The USPSTF acknowledges that other risk factors for lung cancer may play an important role in identifying high risk individuals who can bene t from lung cancer screening but recommends determining risk by age and smoking history because of lack of evidence that risk prediction models would improve outcomes [28].
Lung Cancer Screening Around the World
Almost 10 years after the publication of the initial favorable recommendations, less than 10% of eligible individuals each year in the US undergo lung cancer screening. In Europe, no of cial recommendation for screening had been made up until 2022 when the EU published an of cial report in which it recommends, “extending population-based screening programs to lung and prostate cancer and ensure preparedness for the introduction of new methods” [31]. Croatia is the only European country that has implemented a nation-wide lung cancer screening program [32]. Other countries in the EU are currently analyzing bene ts and risks associated with the implementation of nationwide programs or are designing pilot studies to determine the feasibility of nationwide population-based lung cancer screening programs [33].
Japan was one of the rst countries in the world to conduct research on the use of LDCT for lung cancer screening. In 1993, the Anti-lung Cancer Association, a for pro t organization supported by a government grant, conducted the rst trial exploring LDCT as an alternative to chest-
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X-ray (CXR) for lung cancer screening [34]. Results showed that screening with LDCT is superior to CXR and can detect stage I lung cancer in more than 90% of high-risk individuals diagnosed with the disease [34]. Since, there have been numerous studies con rming the ben- e ts of lung cancer screening using LDCT [5]. By 2009, more than 125,000 individuals had been screened in Japan, with cancer detection rates between 0.15% and 0.33% and stage I diagnoses between 70% and 79% [5]. By 2015, there were 1347 physicians, and 854 centers, certi ed by the Japanese Accreditation Council for Lung Cancer CT Screening to do screening using LDCT [5]. Despite Japan’s pioneering efforts in conducting research and in implementing lung cancer screening, few studies from this country, if any, are included in the discussions about implementation of lung cancer screening programs in Western countries.
Screening with LDCT also started in China many years before the rest of the world. Initial efforts in the early 90s were followed by international collaborations with the groups from I-ELCAP and NELSON [5]. There are currently large ongoing trials exploring LDCT for screening not only lung cancer, but also COPD and cardiovascular diseases [27]. One of these studies, the China National Cancer Early Screening Trial (CHANCES), will randomize 78,500 individuals to explore different aspects of lung and colorectal cancer screening: biomarkers, screening intervals, and mortality rates [5].
South Korea has ongoing pilot programs to assess the feasibility to implement population- based lung cancer screening with LDCT [5]. Australia’s government is engaging and consulting key stakeholders to seek input on key design elements of a potential population based, nationwide, lung cancer screening program [35].
Incidental Lung Nodules
Since the publication of the rst studies on lung cancer screening using LDCT, the number of lung nodules on CT reports has increased notably. One study suggests that most of the increase
is due to more awareness of radiologists, and perhaps also due to improvements in technology [36]. Using natural language processing algorithms to scan free text on radiology reports, researchers analyzed trends in lung nodule detection over a period of 7 years. The study was conducted in a large integrated healthcare system prior to the implementation of lung cancer screening programs, but more than a decade after positive results of several lung cancer screening studies were published. Extrapolating data to the census of the United States, 1.57 million new lung nodules were reported in 2010 [36], more than ten times prior estimates of the prevalence of incidental lung nodules, previously referred to as solitary pulmonary nodules [37]. Furthermore, the incidence of lung nodules detected increased steadily throughout the study duration, from 2006 to 2012 [12]. Approximately 5% of individuals with a new lung nodule were diagnosed with lung cancer [36]. Despite the increase in the number of nodules detected, the incidence of lung cancer diagnosis did not increase in this group of individuals, suggesting the main reasons for the increases in lung nodule incidence are greater awareness of the radiologists and improvements in CT technology. This translates into a higher risk of unnecessary invasive diagnostic and therapeutic procedures. Another concern raised by several studies is an exceedingly high proportion (up to 60%) of patients with lung nodules detected outside of lung cancer screening programs that are lost to follow-up [38]. For this reason, some centers are developing programs aimed at tracking incidental lung nodules and other ndings. In a large healthcare system in southern United States, researchers analyzed the diagnosis of lung cancer through three different pathways: a lung cancer screening program (5659 participants between 2015 and 2021), an incidental lung nodule program (15,461 patients between 2015 and 2021), and a multidisciplinary thoracic oncology program (1766 patients not belonging to any of the other two groups, between 2015 and 2020) [39]. The number of lung cancers diagnosed in each pathway was 156 (3%), 772 (5%), and 1139 (65%), respectively. Moreover, the proportion of patients diagnosed in stage I or II was
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61%, 61%, and 44%, respectively. In comparison to the lung cancer screening pathway, there were more underserved patients belonging to minorities or uninsured in the lung nodule program. Several reports suggest that lung cancer screening using LDCT is being implemented more widely among more affuent and predominantly white individuals. Thus, a program that detects nodules incidentally may be an opportunity, not only to identify more individuals with lung cancer in early stages, but also to overcome the racial and economic inequalities seen with screening.
Management of Lung Nodules
Guidelines for the management of nodules published by several professional societies based on expert consensus have been evolving over the last decade and are being updated frequently. Some have been developed speci cally for nodules detected in the course lung cancer screening (Lung-RADS→, NCCN), others for nodules detected incidentally (Fleischner Society), and some independent of the detection pathway (American College of Chest Physicians and British Thoracic Society) [18, 40–43]. In general, most recommendations are based on expert reviews and are evolving so quickly that a comprehensive analysis is beyond the scope of this text. The main objectives of guidelines must be to reduce unnecessary invasive procedures and to minimize risks for patients while optimizing the chances of diagnosing the disease in early stages when cure is still feasible with surgery. As mentioned previously, in the IELCAP trial, 11% of surgical procedures were performed on nodules that had benign histology. In NLST, 25% of surgical procedures were performed on benign nodules [44].
Recommendations of all guidelines are based on the pretest probability a nodule has of being cancer, with minor differences in thresholds of risk chosen for immediate diagnostic procedures or observation. In an analysis of two Canadian cohorts of individuals with lung nodules, one from a lung cancer screening study (PanCan), and the other from a chemoprevention study (British Columbia Cancer Agency or BCCA),
researchers tested and validated parameters potentially associated with lung cancer [44]. Over 1800 individuals from the PanCan study, and 1090 from the BCCA study were included with prevalence rates of lung cancer of 5.5% and 3.7%, respectively. In a univariate analysis, size, type (non-solid, part-solid, or solid), location, and the number of nodules were signi cant predictors of lung cancer. In a parsimonious model, the diagnosis of cancer was associated with female sex, increasing size of the nodule, location of the nodule in the upper lobes, and spiculation of the borders. Additional parameters associated with lung cancer in a full model were older age, family history of cancer, emphysema, lower nodule count, and part solid as compared with solid nodules. Non-solid nodules (ground glass opacities) had a reduced risk when compared to solid nodules [44].
Lung Cancer Screening
and Incidental Findings
A high proportion of LDCTs done in the lung cancer screening setting detect incidental ndings [45]. The most common are cardiovascular (coronary calci cations and aortic disorders) and respiratory (emphysema and reticular opacities) [45, 46]. Other less common ndings that may have an impact on patients undergoing lung cancer screening include lymphadenopathy, thyroid nodules, and extrapulmonary malignancies [45, 47]. Some incidental ndings have been found to have a major impact on lung cancer screening itself, especially emphysema, and lymphadenopathy [45, 47, 48]. Although the prevalence of mediastinal lymphadenopathy is low (<2%), in a retrospective analysis of NLST, individuals with enlarged lymph nodes had a signi cantly higher incidence of lung cancer as compared to those without enlarged nodes (17.1% vs. 3.9%). Furthermore, the presence of enlarged lymph nodes was associated with a later stage at diagnosis, increased number of deaths, and reduced survival times [45].
The prevalence of emphysema observed on LDCT in the context of lung cancer screening has been reported to range between 28% and 44%
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[47–49]. For decades it has been known that patients with chronic obstructive pulmonary disease (COPD) have a higher risk of lung cancer [50, 51]. In 2006, an analysis of a lung cancer screening cohort was rst to show that emphysema detected qualitatively on the LDCT was signi cantly associated with a 2.5-fold greater risk of lung cancer [48]. When both emphysemas, detected on LDCT, and COPD, diagnosed by spirometry, were included in a multivariate analysis adjusted for age, sex, and smoking history, only emphysema remained as an independent predictor of risk of lung cancer. Thesendings have been con rmed by other studies [30, 52–55]. Most retrospective analyses of lung cancer screening cohorts have found a signi cant association between emphysema and the risk of diagnosis of lung cancer, with one study also reporting an increased risk of death from lung cancer [52].
How incidental ndings may impact outcomes in lung cancer screening is yet to be determined. There is the risk of harm caused by detecting abnormalities that may lead to unnecessary invasive diagnostic procedures or treatments, but there are potential bene ts beyond early treatment of potentially severe diseases. For example, as mentioned previously, one study has suggested that the presence of emphysema on a baseline lung cancer screening LDCT may have a bene cial impact on the selection of high-risk individuals who should undergo subsequent annual screening [29]. Other possible bene ts include early diagnosis of diseases other than lung cancer, such as coronary artery diseases or other malignancies.
References
1.\https://ourworldindata.org/causes-of-death. Accessed 30 Jan 2022.
2.\https://ourworldindata.org/grapher/lung-cancer- deaths-per-100000-by-sex-1950-2002. Accessed 30 Jan 2022.
3.\https://seer.cancer.gov/explorer/application.html? site=47&data_type=1&graph_type=2&compare By=sex&chk_sex_3=3&chk_sex_2=2&rate_type=2 &race=1&age_range=1&stage=101&advopt_ precision=1&advopt_show_ci=on&advopt_display=2. Accessed 30 Jan 2022.
4.\Barta JA, Powell CA, Wisnivesky JP. Global epidemiology of lung cancer. Ann Glob Health. 2019;85:8.
5.\Triphuridet N, Henschke C. Landscape on CT screening for lung cancer in Asia. Lung Cancer Targets Ther. 2019;10:107–24.
6.\https://seer.cancer.gov/statfacts/html/lungb.html. Accessed 30 Jan 2022.
7.\Flores R, Patel P, Alpert N, Pyenson B, Taioli E. Association of stage shift and population mortality among patients with non-small cell lung cancer. JAMA Netw Open. 2021;4(12):e2137508. https://doi. org/10.1001/jamanetworkopen.2021.37508.
8.\Berlin NI, Buncher CR, Fontana RS, Frost JK, Melamed MR. The National cancer institute cooperative early lung cancer detection program. Results of the initial screen (prevalence). Early lung cancer detection: introduction. Am Rev Respir Dis. 1984;130:545–9.
9.\Flehinger BJ, Kimmel M, Polyak T, Melamed MR. Screening for lung cancer. The Mayo Lung Project revisited. Cancer. 1993;72:1573–80.
10.\Strauss GM, Gleason RE, Sugarbaker DJ, Caro JJ. Screening for lung cancer. Another look; a different view. Chest. 1997;111:754–68.
11.\Marcus PM, Bergstralh EJ, Zweig MH, et al. Extended lung cancer incidence follow-up in the mayo lung project and overdiagnosis. J Natl Cancer Inst. 2006;98:748.
12.\Henschke CI, McCauley DI, Yankelevitz DF, Naidich DP, McGuinness G, Miettinen OS, et al. Early lung cancer action project: overall design and ndings from baseline screening. Lancet. 1999;354(9173):99–105.
13.\Edge SB, Compton CC. The American joint committee on cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4. https://doi.org/10.1245/ s10434-010-0985-4.
14.\International Early Lung Cancer Action Program
Investigators, |
Henschke |
CI, |
Yankelevitz |
DF, |
Libby DM, Pasmantier MW, Smith JP, Miettinen |
||||
OS. Survival |
of patients |
with |
stage I lung |
can- |
cer detected on CT screening. N Engl J Med. 2006;355(17):1763–71.
15.\Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.
16.\de Koning HJ, van der Aalst CM, de Jong PA, Scholten ET, Nackaerts K, Heuvelmans MA, Lammers J-WJ, Weenink C, Yousaf-Khan U, Horeweg N, van‘t Westeinde S, Prokop M, Mali WP, Hoesein FAAM, van Ooijen PMA, Aerts JGJV, den Bakker MA, Thunnissen E, Verschakelen J, Vliegenthart R, Walter JE, ten Haaf K, Groen HJM, Oudkerk M. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 2020;382(6):503–13.
17.\Pastorino U, Silva M, Sestini S, Sabia F, Boeri M, Cantarutti A, Sverzellati N, Sozzi G, Corrao G, Marchiano A. Prolonged lung cancer screening
17 Lung Cancer Screening and Incidental Lung Nodules |
305 |
|
|
reduced 10-year mortality in the MILD trial: new con rmation of lung cancer screening ef cacy. Ann Oncol. 2019;30:1–8.
18.\Kazerooni EA, Baum S, Eapen G, Ettinger D, Hou L, Jackman D. Lung cancer screening, version 32018: clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2018;16(4):412–41. https://doi. org/10.6004/jnccn.2018.0020.
19.\Hammer MM, Hatabu H. Subsolid pulmonary nodules: controversy and perspective. Eur J Radiol Open. 2020;7:100267. https://doi.org/10.1016/j. ejro.2020.100267.
20.\TravisWD, Brambilla E, Noguchi M, et al. International association for the study of lung cancer/American thoracic society/European respiratory society international multidisciplinary classi cation of lung adenocarcinoma. J Thorac Oncol. 2011;6:244–85.
21.\Yoshizawa A, Motoi N, Riely GJ, Sima CS, Gerald WL, Kris MG, Park BJ, RuschVW, Travis WD. Impact of proposed IASLC/ATS/ERS classi cation of lung adenocarcinoma: prognostic subgroups and implications for further revision of staging based on analysis of 514 stage I cases. Mod Pathol. 2011;24:653–64.
22.\Mesa-Guzman M, Gonzalez J, Alcaide AB, Berto J, de -Torres JP, Campo A, Seijoc LM, Ocon MM, Pueyo JC, Bastarrika G, Lozano MD, Pío R, Montuenga LM, García-Granero M, Zulueta J. Surgical outcomes in a lung cancer-screening program using low dose computed tomography. Arch Bronconeumol. 2021;57(2):101–6.
23.\Vonder M, Dorrius MD, Vliegenthart R. Latest CT technologies in lung cancer screening: protocols and radiation dose reduction. Transl Lung Cancer Res. 2021;10(2):1154–64. https://doi.org/10.21037/ tlcr-20-808.
24.\Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer. Radiology. 2004;231:440–5.
25.\Mascalchi M, Belli G, Zappa M, et al. Risk-bene t analysis of X-ray exposure associated with lung cancer screening in the Italung-CT trial. AJR Am J Roentgenol. 2006;187:421–9.
26.\Rampinelli C, De Marco P, Origgi D, et al. Exposure to low dose computed tomography for lung cancer screening and risk of cancer: secondary analysis of trial data and risk-bene t analysis. BMJ. 2017;356:j347.
27.\Moyer VA, U.S. preventive services task force. Screening for lung cancer: U.S. preventive services task force recommendation statement. Ann Intern Med. 2014;160:330–8.
28.\Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Kubik M, Landefeld CS. Screening for lung cancer: US preventive services task force recommendation statement. JAMA. 2021;325(10):962–70. https://doi.org/10.1001/jama.2021.1117.
29.\Sanchez-Salcedo P, Wilson DO, de Torres JP, Weissfeld JL, Berto J, Campo A, Alcaide AB, Pueyo J, Bastarrika G, Seijo LM, Pajares MJ, Pio R, Montuenga
LM, Zulueta JJ. Improving selection criteria for lung cancer screening. The potential role of emphysema. Am J Respir Crit Care Med. 2015;191(8):924–31. https://doi.org/10.1164/rccm.201410-1848OC.
30.\Wilson DO, Weissfeld JL, Balkan A, Schragin JG, Fuhrman CR, Fisher SN, Wilson J, Leader JK, Siegfried JM, Shapiro SD, Sciurba FC. Association of radiographic emphysema and airfow obstruction with lung cancer. Am J Respir Crit Care Med. 2008;178(7):738–44. Epub 2008 Jun 19. PMID: 18565949; PMCID: PMC2556456. https://doi.org/10.1164/rccm.200803-435OC.
31.\https://ec.europa.eu/info/news/improving-citizens- participation-cancer-screening-programmes-and- extending-them-more-types-cancer-will-help-saving- lives-eu-chief-scientific-advisor-recommend-2022- mar-02_en. Accessed 20 Feb 2022.
32.\https://echalliance.com/croatia-first-to-introduce- early-screening-for-lung-cancer/#:~:text=The%20 Croatian%20Health%20Ministry%20has,for%20 early%20lung%20cancer%20detection. Accessed 22 Feb 2022.
33.\van Meerbeeck JP, Franck C. Lung cancer screening in Europe: where are we in 2021? Transl Lung Cancer Res. 2021;10(5):2407–17.
34.\Kaneko M, Eguchi K, Ohmatsu H, et al. Peripheral lung cancer: screening and detection with low- dose spiral CT versus radiography. Radiology. 1996;201(3):798–802.
35.\https://www.canceraustralia.gov.au/about-us/ lung-cancer-screening.
36.\Gould MK, Tang T, Liu I-LA, Lee J, Zheng C, Danforth KN, Kosco AE, Di Fiore JL, Suh DE. Recent trends in the identi cation of incidental pulmonary nodules. Am J Respir Crit Care Med. 2015;192:1208–14.
37.\Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulmonary nodule. N Engl J Med. 2003;348(25):2535–42.
38.\Pyenson BS, Bazell CM, Bellanich MJ, Caplen MA, Zulueta JJ. No apparent workup for most new indeterminate pulmonary nodules in US commercially- insured patients. J Health Econ. 2019;6(3):118–29.
39.\Osarogiagbon RU, Liao W, Faris NR, Meadows- Taylor M, Fehnel C. Lung cancer diagnosed through screening, lung nodule, and neither program: a prospective observational study of the detecting early lung cancer (DELUGE) in the Mississippi Delta Cohort. J Clin Oncol. 2022;40(19):2094–105. https:// doi.org/10.1200/JCO.21.02496.
40.\American College of Radiology Committee on LungRADS®. Lung-RADS Assessment Categories version1.1. https://www.acr.org/-/media/ACR/Files/RADS/ Lung-RADS/LungRADSAssessmentCategoriesv1-1. pdf. Accessed 30 Apr 2022.
41.\Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP, Wiener RS. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Chest. 2013;143(5 Suppl):e93S–e120S.
42.\MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, Mehta AC, Ohno Y, Powell CA, Prokop M, Rubin GD, Schaefer-Prokop CM, Travis
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
306 |
J. J. Zulueta and M. Marín |
|
|
WD, van Schil PE, Bankier AA. Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017. Radiology. 2017;284:228–43.
43.\Baldwin DR, Callister MEJ, Guideline Development Group. The British Thoracic Society guidelines on the investigation and management of pulmonary nodules. Thorax. 2015;70:794–8. https://doi.org/10.1136/ thoraxjnl-2015-207221.
44.\McWilliams A, Tammemagi MC, Mayo JR, Roberts H, Liu G, Soghrati K, Yasufuku K, Martel S, Laberge F, Gingras M, Atkar-Khattra S, Berg CD, Evans K, Finley R, Yee J, English J, Nasute P, Gof n J, Puksa S, Stewart L, Tsai S, Johnston MR, Manos D, Nicholas G, Goss GD, Seely JM, Amjadi K, Tremblay A, Burrowes P, MacEachern P, Bhatia R, Tsao M-S, Lam S. Probability of cancer in pulmonary nodules detected on rst screening CT. N Engl J Med. 2013;369(10):910–9.
45.\McLoud TC. Incidental lymphadenopathy at CT lung cancer screening. Radiology. 2022;302:693–4.
46.\Pinsky PF, Lynch DA, Gierada DS. Incidental ndings on low-dose CT scan lung cancer screenings and deaths from respiratory diseases. Chest. 2022;161(4):1092–110.
47.\Chalian H, McAdams HP, Lee Y, et al. Mediastinal lymphadenopathy in the National Lung Screening Trial (NLST) is associated with interval lung cancer. Radiology. 2022;302(3):684–92.
48.\de Torres JP, Bastarrika G, Wisnivesky JP, Alcaide AB, Campo A, Seijo LM, Pueyo JC, Villanueva A, Lozano MD, Montes U, Montuenga L, Zulueta JJ. Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of
the chest. Chest. 2007;132(6):1932–8. https://doi. org/10.1378/chest.07-1490. PMID: 18079226.
49.\Wilson DO, Weissfeld JL, Balkan A, Schragin JG, Fuhrman CR, Fisher SN, Wilson J, Leader JK, Siegfried JM, Shapiro SD, Sciurba FC. Association of Radiographic Emphysema and Airfow Obstruction with Lung Cancer. Am J Respir Crit Care Med. 2008;178:738–44.
50.\Skillrud DM, Offord KP, Miller RD. Higher risk of lung cancer in chronic obstructive pulmonary disease. A prospective, matched, controlled study. Ann Intern Med. 1986;105:503–7.
51.\Tockman MS, Anthonisen NR, Wright EC, Donithan MG. Airways obstruction and the risk for lung cancer. Ann Intern Med. 1987;106:512–8.
52.\Zulueta JJ, Wisnivesky JP, Henschke CI, et al. Emphysema scores predict death from COPD and lung cancer. Chest. 2012;141(5):1216–23. https://doi. org/10.1378/chest.11-0101.
53.\Maldonado F, Bartholmai BJ, Swensen SJ, et al. Are airfow obstruction and radiographic evidence of emphysema risk factors for lung cancer? A nested case-control study using quantitative emphysema analysis. Chest. 2010;138:1295–302.
54.\Kishi K, Gurney JW, Schroeder DR, et al. The correlation of emphysema or airway obstruction with the risk of lung cancer: a matched case-controlled study. Eur Respir J. 2002;19:1093–8.
55.\Labaki WW, et al. Quantitative emphysema on low-dose CT imaging of the chest and risk of lung cancer and airfow obstruction: an analysis of the national lung screening trial. Chest. 2021;159:1812– 20, ISSN 0012-3692. https://doi.org/10.1016/j. chest.2020.12.004.