Sequential screening for lung cancer in a high-risk group: randomised controlled trial: LungSEARCH: a randomised controlled trial of Surveillance using sputum and imaging for the EARly detection of lung Cancer in a High-risk group
| Autor: | Penny Shaw, Richard Booton, Matthew E.J. Callister, John F. Allen, Marco Novelli, Paul Dhillon, Michael D Peake, Nicholas Counsell, Yenting Ngai, Robert C. Rintoul, Allan Hackshaw, Victoria Ashford-Turner, Simon P. G. Padley, Pamela Rabbitts, Dahmane Oukrif, Andrew G. Nicholson, Asia Ahmed, Kishore Sridharan, Nicholas D. Magee, Sarah Lewis, Mary Falzon, Sam M. Janes, Gabrijela Kocjan, Jeremy George, Nyasha Chinyanganya, Stephen G. Spiro, Chris Griffiths, Pallav L. Shah, Magali Taylor |
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| Přispěvatelé: | Shah, Pallav L [0000-0002-9052-4638], Janes, Samuel [0000-0002-6634-5939], Booton, Richard [0000-0003-4512-2899], Apollo - University of Cambridge Repository |
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male Sputum Cytology medicine.medical_specialty Lung Neoplasms Cytological Techniques Adenocarcinoma of Lung Risk Assessment Sensitivity and Specificity law.invention 03 medical and health sciences Pulmonary Disease Chronic Obstructive 0302 clinical medicine Randomized controlled trial law Internal medicine Carcinoma Non-Small-Cell Lung Bronchoscopy medicine Carcinoma Humans 030212 general & internal medicine Carcinoma Small Cell Lung cancer Early Detection of Cancer Neoplasm Staging COPD business.industry Lung Cancer Optical Imaging Sputum Original Articles Middle Aged medicine.disease United Kingdom respiratory tract diseases 030228 respiratory system Relative risk Carcinoma Squamous Cell Carcinoma Large Cell Female medicine.symptom business Tomography X-Ray Computed Lung cancer screening |
| Zdroj: | The European Respiratory Journal |
| Popis: | Background Low-dose computed tomography (LDCT) screening detects early-stage lung cancer and reduces mortality. We proposed a sequential approach targeted to a high-risk group as a potentially efficient screening strategy. Methods LungSEARCH was a national multicentre randomised trial. Current/ex-smokers with mild/moderate chronic obstructive pulmonary disease (COPD) were allocated (1:1) to have 5 years surveillance or not. Screened participants provided annual sputum samples for cytology and cytometry, and if abnormal were offered annual LDCT and autofluorescence bronchoscopy (AFB). Those with normal sputum provided annual samples. The primary end-point was the percentage of lung cancers diagnosed at stage I/II (nonsmall cell) or limited disease (small cell). Results 1568 participants were randomised during 2007–2011 from 10 UK centres. 85.2% of those screened provided an adequate baseline sputum sample. There were 42 lung cancers among 785 screened individuals and 36 lung cancers among 783 controls. 54.8% (23 out of 42) of screened individuals versus 45.2% (14 out of 31) of controls with known staging were diagnosed with early-stage disease (one-sided p=0.24). Relative risk was 1.21 (95% CI 0.75–1.95) or 0.82 (95% CI 0.52–1.31) for early-stage or advanced cancers, respectively. Overall sensitivity for sputum (in those randomised to surveillance) was low (40.5%) with a cumulative false-positive rate (FPR) of 32.8%. 55% of cancers had normal sputum results throughout. Among sputum-positive individuals who had AFB, sensitivity was 45.5% and cumulative FPR was 39.5%; the corresponding measures for those who had LDCT were 100% and 16.1%, respectively. Conclusions Our sequential strategy, using sputum cytology/cytometry to select high-risk individuals for AFB and LDCT, did not lead to a clear stage shift and did not improve the efficiency of lung cancer screening. While low-dose CT is now preferred for lung cancer screening, our randomised trial of smokers with COPD showed that a proposed sequential policy using sputum testing to select who receives low-dose CT and autofluorescence bronchoscopy was ineffective http://bit.ly/2JZujnx |
| Databáze: | OpenAIRE |
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