CT scans annual repetition can eliminate the need for a biopsy or surgery in NNW -
calculated annual low-dose tomography (CT) screening may eliminate the need a biopsy or surgery in nonsolid pulmonary nodules, according to a new study published online in the journal Radiology .
nonsolid nodules (NSN) are usually symptomless growths in the lung. Their name derives from the fact that the normal lung tissue is visible through the nodule on a CT image. NSN are becoming a more frequent finding in the wake of recent guidelines from the Centers for Medicare & Medicaid Services (CMS), which recommended a CT of annual screening for long-term smokers. Surgical removal is a treatment option, though NNW are rarely life threatening.
"When biopsy a nodule nonsolid, it is usually pre-malignant, non-invasive, or due to other causes, such as infection or fibrosis," co-author said Claudia I. Henschke, MD, Ph.D., of the department of radiology at Mount Sinai School of Medicine in New York.
in a study previously published in Radiology, Dr. Henschke and colleagues analyzed data from more than 57,000 participants in the International Programme early lung cancer (I-ELCAP), a global initiative to reduce lung cancer mortality. They concluded that NNW of any size could be followed with annual repeat CT scans, all the cancers found were at a very early stage and deaths among the study group are not due to these cancers.
For the new study, the researchers sought to validate the I-ELCAP results by examining data from the National Lung Screening Trial (NLST), a large trial that compared low-dose CT with chest X-rays for the detection of lung cancer. They searched the NLST database to identify all the participants who had at least one NSN on a scanner, and then died of lung cancer.
Among the 26.722 participants in 2534, or 9.4 percent, had one or more NNO. Among them, 48 died of lung cancer. Twenty-one of the 48 had no NSN in the cancerous lobe of the lung. A review of the remaining 27 cases found that death was unlikely to be caused by the NSN, as annual monitoring was done.
"The causes of death in this group were likely due to another solid nodule or solid portion in the same lobe of the lung," said study lead author Rowena Yip, MPH, senior biostatistician at Mount Sinai School of Medicine. "in one death linked to a growing nonsolid nodule, TB long before the diagnosis was more than three years."
the new findings and previous research, could help cost replacement patients, complications and stress of the biopsy and unnecessary surgery.
"We think we have enough data now to say that these nodules can safely be followed by annual analysis CT and should not be biopsied or treated immediately, "Dr. Henschke said." Survival remains 100 percent as nodules remain nonsolid, and for those who do ultimately progress, the monitoring interval one year is short enough that they remain fully curable. "
NNW Some go on to develop solid components, a change associated with a higher risk of invasive cancer. The Mount Sinai researchers plan to study these solid nodules part to learn more about optimal screening intervals and help improve opportunities for people with lung cancer, the leading cause of cancer death in men and women . Current screening guidelines cover only about 18 percent of people who eventually die from lung cancer, Dr. Henschke said, and leave out an important group :. people who have had long-term exposure to secondhand smoke
"We are hoping that, by making it more effective screening, we will convince CMS to expand slowly guidelines to include other at risk, including those exposed to secondhand smoke, "said Yip.
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