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Indolent, Potentially Inconsequential Lung Cancers in the Pittsburgh Lung Screening Study.
Prashanth M Thalanayar1, Nejat Altintas2, Joel L Weissfeld3
11 Department of Medicine, University of Pittsburgh Medical Center, McKeesport, Pennsylvania.
Annals of the American Thoracic Society
|June 25, 2015
Summary
Indolent lung cancers, defined by slow growth and low PET uptake, represent 18.5% of screen-detected cancers in lung cancer screening. This highlights the reality of overdiagnosis in screening programs.
Area of Science:
- Oncology
- Radiology
- Pulmonology
Background:
- Overdiagnosis of indolent cancers is a known issue in cancer screening.
- This phenomenon is increasingly recognized in lung cancer screening programs utilizing low-dose computed tomography (LDCT).
Purpose of the Study:
- To identify and characterize indolent, potentially inconsequential lung cancers within the Pittsburgh Lung Screening Study (PLuSS) cohort.
- To assess the prevalence of these slow-growing cancers detected via annual LDCT screening.
Main Methods:
- Analysis of 93 screen-detected prevalence lung cancers in the PLuSS population.
- Definition of indolent cancers: Stage I, volumetric doubling time >400 days, and maximal standardized uptake value (SUVmax) on PET scan ≤1.
- Utilized volumetric doubling time and PET SUVmax for cancer characterization.
Main Results:
- Approximately 18.5% (17 of 93) of screen-detected prevalence lung cancers were classified as indolent.
- The majority of these indolent cancers were adenocarcinomas.
- Indolent cancers exhibited significantly longer median doubling times (752 days) compared to other stage I cancers (284.5 days).
Conclusions:
- Indolent, potentially inconsequential lung cancers are a real finding in LDCT lung cancer screening.
- Clinicians should consider the possibility of indolent cancer in managing slow-growing nodules, particularly those with low PET SUVmax (≤1).
- Longitudinal management strategies should account for the presence of these slow-growing malignancies.
