Digital chest tomography may be first stop in lung cancer screening

Digital chest tomosynthesis, a tomographic technique, holds promise as a first-line tool for lung cancer screening, indicate the baseline results of a single-arm, observational study.

As explained in a statement from the International Association for the Study of Lung Cancer (IASLC), digital chest tomosynthesis produces section images through the use of a conventional radiograph tube, a flat-panel detector, a computer-controlled tube mover, and special reconstruction algorithms. This technique lacks the depth resolution of computed tomography (CT), but is less expensive and has a lower radiation dosage than CT.

Of the 1,843 persons participating in the study (mean age 61 years; range 48–73 years), 1,419 (77%) were current smokers, and the rest were former smokers. All had a smoking history of at least 20 pack-years, with no malignancy in the 5 years before the start of the study in December 2010. The most prevalent comorbidities were hypertension, chronic obstructive pulmonary disease, and cardiovascular diseases.

The subjects underwent a tomosynthesis examination at baseline and again 1 year later. Tomosynthesis studies revealed pulmonary abnormalities in 268 persons (14.5%). A total of 132 of those participants (7.2%) then underwent first-line basal CT, 68 (4.9%) of whom were referred for follow-up CT. Positron emission tomography/CT was performed on 27 patients (1.46%), and lung cancer was detected in 18 (0.98%) of them.

“The detection rate of noncalcified lung nodules for tomosynthesis was comparable with rates reported for CT,” wrote Alberto Terzi, MD, of the thoracic surgery unit at S. Croce City Hospital in Cuneo, Italy, and coauthors in the IASLC's Journal of Thoracic Oncology (2013;8[6]:685-692). “A small subgroup underwent low-dosage CT and entered a follow-up program.”
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