Navigational Bronchoscopy or Transthoracic Needle Biopsy for Lung Nodules
Non-inferior in diagnosing malignant or benign lesions, and safer (less pneumothorax). The question remains about the amount of tissue for further testing.
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
Author(s): Raymond U. Osarogiagbon , MBBS1;Wei Liao, PhD1;Nicholas R. Faris, MDiv1;Meghan Meadows-Taylor, PhD1;Carrie Fehnel, BBA1;Jordan Lane, MA1;Sara C. Williams, MFA1;Anita A. Patel, MBBS1;Olawale A. Akinbobola, MPH1;Alicia Pacheco, MHA1;Amanda Epperson, RN1;Joy Luttrell, RN1;Denise McCoy, BS1;Laura McHugh, RN1;Raymond Signore, RN1;Anna M. Bishop, MSN1;Keith Tonkin, MD1,2;Robert Optican, MD, MSHA1,2;Jeffrey Wright , MD, PhD1,3;Todd Robbins, MD1;Meredith A. Ray , PhD4;and Matthew P. Smeltzer , PhD4
Source: DOI: 10.1200/JCO.21.02496 Journal of Clinical Oncology 40, no. 19 (July 01, 2022) 2094-2105.
Interesting study which the demonstrates the importance of prescriptive approach to detect NSCLC. Hopefully, in the future ctDNA may enhance or replace LDCT ability to detect patients with stage I/II disease.
PURPOSE
Lung cancer screening saves lives, but implementation is challenging. We evaluated two approaches to early lung cancer detection—low-dose computed tomography screening (LDCT) and program-based management of incidentally detected lung nodules.
METHODS
A prospective observational study enrolled patients in the early detection programs. For context, we compared them with patients managed in a Multidisciplinary Care Program. We compared clinical stage distribution, surgical resection rates, 3- and 5-year survival rates, and eligibility for LDCT screening of patients diagnosed with lung cancer.
RESULTS
From 2015 to May 2021, 22,886 patients were enrolled: 5,659 in LDCT, 15,461 in Lung Nodule, and 1,766 in Multidisciplinary Care. Of 150, 698, and 1,010 patients diagnosed with lung cancer in the respective programs, 61%, 60%, and 44% were diagnosed at clinical stage I or II, whereas 19%, 20%, and 29% were stage IV (P = .0005); 47%, 42%, and 32% had curative-intent surgery (P < .0001); aggregate 3-year overall survival rates were 80% (95% CI, 73 to 88) versus 64% (60 to 68) versus 49% (46 to 53); 5-year overall survival rates were 76% (67 to 87) versus 60% (56 to 65) versus 44% (40 to 48), respectively. Only 46% of 1,858 patients with lung cancer would have been deemed eligible for LDCT by US Preventive Services Task Force (USPSTF) 2013 criteria, and 54% by 2021 criteria. Even if all eligible patients by USPSTF 2021 criteria had been enrolled into LDCT, the Nodule Program would have detected 20% of the stage I-II lung cancer in the entire cohort.
CONCLUSION
LDCT and Lung Nodule Programs are complementary, expanding access to early lung cancer detection and curative treatment to different-risk populations. Implementing Lung Nodule Programs may alleviate emerging disparities in access to early lung cancer detection.
Author Affiliations
1Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, TN 2Mid-South Imaging and Therapeutics, Memphis, TN 3Memphis Lung Physicians, Memphis, TN 4Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TNRelated Articles
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Suddenly met-NSCLC is a crowded space. This study did not conclude that T+D+CT was better than D+CT, the findings showed that D+CT was better than CT alone. The addition of T to D+CT improved the PFS and OS trend but I don’t think this was a homerun result. There was not a significant OS benefit and further follow-up will declare these results. Also an improved outcomes were not seen in the non-squamous population. The pembrolizumab studies have 5+ years of follow-up and an improvement in PFS and OS across NSCLC subtypes.