TY - JOUR
T1 - Do Current Lung Cancer Screening Guidelines Apply for Populations With High Prevalence of Granulomatous Disease? Results From the First Brazilian Lung Cancer Screening Trial (BRELT1)
AU - dos Santos, Ricardo S.ales
AU - Franceschini, Juliana P.
AU - Chate, Rodrigo C.aruso
AU - Ghefter, Mario C.laudio
AU - Kay, Fernando
AU - Trajano, André Luiz C.
AU - Pereira, José Rodrigues
AU - Succi, José Ernesto
AU - Fernando, Hiran C.
AU - Júnior, Roberto S.aad
N1 - Funding Information:
This research was supported by Public Support Program for the Institutional Development of the National Unified Health System, SUS (PROADI-SUS). We thank Claudio Lottenberg, Alberto Kanamura, Marcelo Funari, Marcia Makdisse, Luiz Vicente Rizzo, and Miguel Cendoroglo for their leadership and support. We also thank Fatima Thomazini, Silvia Morgado, all fellows and multiprofessional team of Hospital Israelita Albert Einstein, without which the present study could not have been successfully completed.
Publisher Copyright:
© 2016 The Society of Thoracic Surgeons
PY - 2016/2/1
Y1 - 2016/2/1
N2 - Background Low-dose computed tomography (LDCT) screening for lung cancer has been demonstrated to be effective in reducing cancer mortality. However, these studies have not been undertaken in countries where the incidence of granulomatous disease is high. The First Brazilian Lung Cancer Screening Trial (BRELT1) has completed initial accrual and is now in the follow-up phase. We present results from the initial prevalence round of screening. Methods The inclusion criteria were the same as those for the National Lung Cancer Screening Trial (NLST). Pulmonary nodules larger than 4 mm were considered positive and required evaluation by a multidisciplinary team. Indeterminate nodules were evaluated with fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) or biopsy when indicated. Statistical analysis was performed with Fisher's exact test to compare our positive findings with those of the NLST. Results From January 2013 to July 2014, 790 participants were enrolled. Positive LDCT scans were reported in 312 (39.4%) participants, with a total of 552 nodules larger than 4 mm. The comparison between positive findings in the NLST (7,191 of 26,722 cases) and those in the BRELT1 (312 of 790 cases) showed a significant difference (p < 0.001). The positive predictive value was lower in BRELT1 than in the NLST (3.2% versus 3.8%, respectively). Follow-up imaging was indicated in 278 of 312 (89.1%) participants; 35 procedures were performed in 25 participants. In 15 cases, benign lesions were diagnosed. Non–small-cell lung cancer (NSCLC) was diagnosed in 10 patients (prevalence of 1.3%). In 8 patients (stage IA/IB disease), treatment was by resection only, in 1 patient neoadjuvant chemotherapy was used (stage IIIA), and in 1 patient advanced disease was diagnosed (stage IV). Conclusions Using NSLT criteria, a larger number of patients had positive scans (nodules), compared with previous lung cancer screening studies. However, the number of participants requiring surgical biopsy procedures and who were ultimately identified as having cancer was similar to other reports. This supports the role of screening in patient populations with a high incidence of granulomatous inflammation.
AB - Background Low-dose computed tomography (LDCT) screening for lung cancer has been demonstrated to be effective in reducing cancer mortality. However, these studies have not been undertaken in countries where the incidence of granulomatous disease is high. The First Brazilian Lung Cancer Screening Trial (BRELT1) has completed initial accrual and is now in the follow-up phase. We present results from the initial prevalence round of screening. Methods The inclusion criteria were the same as those for the National Lung Cancer Screening Trial (NLST). Pulmonary nodules larger than 4 mm were considered positive and required evaluation by a multidisciplinary team. Indeterminate nodules were evaluated with fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) or biopsy when indicated. Statistical analysis was performed with Fisher's exact test to compare our positive findings with those of the NLST. Results From January 2013 to July 2014, 790 participants were enrolled. Positive LDCT scans were reported in 312 (39.4%) participants, with a total of 552 nodules larger than 4 mm. The comparison between positive findings in the NLST (7,191 of 26,722 cases) and those in the BRELT1 (312 of 790 cases) showed a significant difference (p < 0.001). The positive predictive value was lower in BRELT1 than in the NLST (3.2% versus 3.8%, respectively). Follow-up imaging was indicated in 278 of 312 (89.1%) participants; 35 procedures were performed in 25 participants. In 15 cases, benign lesions were diagnosed. Non–small-cell lung cancer (NSCLC) was diagnosed in 10 patients (prevalence of 1.3%). In 8 patients (stage IA/IB disease), treatment was by resection only, in 1 patient neoadjuvant chemotherapy was used (stage IIIA), and in 1 patient advanced disease was diagnosed (stage IV). Conclusions Using NSLT criteria, a larger number of patients had positive scans (nodules), compared with previous lung cancer screening studies. However, the number of participants requiring surgical biopsy procedures and who were ultimately identified as having cancer was similar to other reports. This supports the role of screening in patient populations with a high incidence of granulomatous inflammation.
UR - http://www.scopus.com/inward/record.url?scp=84945550045&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84945550045&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2015.07.013
DO - 10.1016/j.athoracsur.2015.07.013
M3 - Article
C2 - 26409711
AN - SCOPUS:84945550045
SN - 0003-4975
VL - 101
SP - 481
EP - 488
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 2
ER -