European and North American lung cancer screening experience and implications for pulmonary nodule management

• Published in: European radiology Vol. 21; no. 12; pp. 2445 - 2454
• Main Authors: Nair, Arjun, Hansell, David M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.12.2011; Springer Nature B.V
• Subjects: Chest; Diagnostic Radiology; Early Detection of Cancer - methods; Europe - epidemiology; Humans; Imaging; Internal Medicine; Interventional Radiology; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - epidemiology; Lung Neoplasms - pathology; Medicine; Medicine & Public Health; Multicenter Studies as Topic; Neuroradiology; North America - epidemiology; Practice Guidelines as Topic; Precancerous Conditions - diagnostic imaging; Precancerous Conditions - epidemiology; Precancerous Conditions - pathology; Radiation Dosage; Radiology; Randomized Controlled Trials as Topic; Solitary Pulmonary Nodule - diagnostic imaging; Solitary Pulmonary Nodule - epidemiology; Solitary Pulmonary Nodule - pathology; Tomography, X-Ray Computed - methods; Ultrasound; Clinical trials; Screening; Helical computed tomography; Randomized; Solitary pulmonary nodules; Lung cancer
• ISSN: 0938-7994; 1432-1084; 1432-1084
• DOI: 10.1007/s00330-011-2219-y

The potential for low dose computed tomography (LDCT) to act as an effective tool in screening for lung cancer is currently the subject of several randomised control trials. It has recently been given prominence by interim results released by the North American National Lung Screening Trial (NLST). Several other trials assessing LDCT as a screening tool are currently underway in Europe, and are due to report their final results in the next few years. These include the NELSON, DLSCT, DANTE, ITALUNG, MILD and LUSI trials. Although slow to instigate a trial of its own, the UK Lung Screen (UKLS) trial will shortly commence. The knowledge gained from the newer trials has mostly reinforced and refined previous concepts that have formed the basis of existing nodule management guidelines. This article takes the opportunity to summarise the main aspects and initial results of the trials presently underway, assess the status of current collaborative efforts and the scope for future collaboration, and analyse observations from these studies that may usefully inform the management of the indeterminate pulmonary nodule. Key Points • Low dose CT screening for lung cancer is promising. • The effect of LDCT screening on mortality is still uncertain. • Several European randomised controlled trials for LDCT are underway. • The trials vary in methodology but most compare LDCT to no screening. • Preliminary results have reinforced existing nodule management concepts.