We use cookies to improve your experience. By continuing to browse this site, you accept our cookie policy.×
Skip main navigation
Aging Health
Bioelectronics in Medicine
Biomarkers in Medicine
Breast Cancer Management
CNS Oncology
Colorectal Cancer
Concussion
Epigenomics
Future Cardiology
Future Microbiology
Future Neurology
Future Oncology
Future Rare Diseases
Future Virology
Hepatic Oncology
HIV Therapy
Immunotherapy
International Journal of Endocrine Oncology
International Journal of Hematologic Oncology
Journal of 3D Printing in Medicine
Journal of Comparative Effectiveness Research
Lung Cancer Management
Melanoma Management
Nanomedicine
Neurodegenerative Disease Management
Pain Management
Pediatric Health
Personalized Medicine
Pharmacogenomics
Regenerative Medicine
Review

Lung cancer screening: detected nodules, what next?

    Yu Chen

    Bronchoscopy & Interventional Pulmonology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China

    Search for more papers by this author

    ,
    Danai Khemasuwan

    Interventional Pulmonary Medicine, Intermountain Medical Center, Murray, Salt Lake City, UT, USA

    Search for more papers by this author

    &
    Michael J Simoff

    *Author for correspondence:

    E-mail Address: MSimoff1@hfhs.org

    Bronchoscopy & Interventional Pulmonology, Interventional Pulmonary & International Interventional Pulmonary Fellowships, Pulmonary & Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA

    Search for more papers by this author

    Published Online:6 Feb 2017https://doi.org/10.2217/lmt-2016-0008

    Abstract

    Since the success of the NLST study, the incorporation of lung cancer screening programs into current academic programs has been growing. Center for Medicare and Medicaid Services have acknowledged the importance and potential impact of lung cancer screening by making it a reimbursable study. Based on Fleischner Society Guidelines, many nodules will require follow-up imaging. The remainder of those nodules will need tissue to appropriately make the diagnosis. The use of bronchoscopy with transbronchial biopsy has been a standard technique for many years, but as smaller nodules need to be assessed, more advanced tools, such as endobronchial ultrasound and electromagnetic navigation are now improving the yield on the diagnosis of these smaller peripheral nodules. As electromagnetic navigation and peripheral ultrasound are significant changes from practice only 10 years ago, further advancements in the technology, such as bronchoscopic robots and advanced optical imaging tools, that are becoming available, need to be assessed as to their possible incorporation into the evaluation of peripheral nodules. The ceiling to the diagnosis of these small lesions remains at 70–75%; techniques and tools need to be used to improve upon this to maximize the impact of lung cancer screening and minimize the risk to patients.

    Papers of special note have been highlighted as: • of interest

    References

    • 1 Torre LA, Bray F, Siegel RL et al. Global cancer statistics, 2012. CA. Cancer J. Clin. 65(2), 87–108 (2015).Crossref, Medline, Google Scholar
    • 2 American Cancer Society. Cancer Facts & Figures 2013. www.cancer.org/research/cancerfactsfigures/cancerfactsfigures/cancer-facts-figures-2013.Google Scholar
    • 3 Jemal A, Siegel R, Xu J, Ward E. Cancer statistics. CA Cancer J. Clin. 60(5), 277–300 (2010).Crossref, Medline, Google Scholar
    • 4 U.S. National Institutes of Health, National Cancer Institute. Cancer Trends Progress Report – 2011/2012 Update. https://progressreport.cancer.gov/sites/default/files/archive/report2011.pdf. • Landmark studies reporting the role of lung cancer screening.Google Scholar
    • 5 National Lung Screening Trial Research Team, Aberle DR, Adams AM et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N. Engl. J. Med. 365(5), 395–409 (2010).Crossref, Google Scholar
    • 6 Infante M, Cavuto S, Lutman FR et al. A randomized study of lung cancer screening with spiral computed tomography: three-year results from the DANTE trial. Am. J. Respir. Crit. Care Med. 180(5), 445–453 (2009).Crossref, Medline, Google Scholar
    • 7 Saghir Z, Dirksen A, Ashraf H et al. CT screening for lung cancer brings forward early disease. The randomized Danish Lung Cancer Screening Trial: status after five annual screening rounds with low-dose CT. Thorax 67(4), 296–301 (2012).Crossref, Medline, Google Scholar
    • 8 Aberle DR, Adams AM, Berg CD et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N. Engl. J. Med. 365(5), 395–409 (2011).Crossref, Medline, Google Scholar
    • 9 McKee BJ, Regis SM, McKee AB et al. Performance of ACR Lung-RADS in a clinical CT lung screening program. J. Am. Coll. Radiol. 12(3), 273–276 (2015).Crossref, Medline, Google Scholar
    • 10 American College of Radiology. Lung CT Screening Reporting and Data System (Lung-RADS). www.acr.org/Quality-Safety/Resources/LungRADS.Google Scholar
    • 11 National Comprehensive Cancer Network. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): lung cancer screening. www.nccn.org/professionals/physician_gls/f_guidelines.asp.Google Scholar
    • 12 American Colleage of Radiology. LungRADS Assessment Categories. www.acr.org/˜/media/ACR/Documents/PDF/QualitySafety/Resources/LungRADS/AssessmentCategories.pdf.Google Scholar
    • 13 MacMahon H, Austin JHM, Gamsu G et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 237, 395–400 (2005).Crossref, Medline, Google Scholar
    • 14 U.S. Preventive Services Task Force. Final Update Summary: lung cancer screening. www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. • Transbronchial biopsy and advanced diagnostic tools including radial probe ultrasound and electromagnetic navigation.Google Scholar
    • 15 Rittirak W, Sompradeekul S. Diagnostic yield of fluoroscopy-guided transbronchial lung biopsy in non-endobronchial lung lesion. J. Med. Assoc. Thai. 90(Suppl. 2), 68–73 (2007).Medline, Google Scholar
    • 16 British Thoracic Society Bronchoscopy Guidelines Committee. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax 56(Suppl. 1), i1–i21 (2001).Medline, Google Scholar
    • 17 Goyal R, Gogia P, Chachra V. Endobronchial ultrasound-radial probe-assisted cryobiopsy for peripheral lung mass: a new way for better yield? J. Bronchology Interv. Pulmonol. 23(1), 67–70 (2016).Crossref, Medline, Google Scholar
    • 18 Yoshikawa M, Sukoh N, Yamazaki K et al. Diagnostic value of endobronchial ultrasonography with a guide sheath for peripheral pulmonary lesions without x-ray fluoroscopy. Chest 131(6), 1788–1793 (2007).Crossref, Medline, Google Scholar
    • 19 Chen A, Pastis N, Furukawa B et al. The effect of respiratory motion on pulmonary nodule location during electromagnetic navigation bronchoscopy. Chest 147(5), 1275–1281 (2015).Crossref, Medline, Google Scholar
    • 20 Rivera MP, Mehta AC, Wahidi MM. Establishing the diagnosis of lung cancer: diagnosis and management of lung cancer, 3rd ed.: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(Suppl. 5), e142–e165 (2013).Crossref, Google Scholar
    • 21 Gildea TR1, Mazzone PJ, Karnak D et al. Electromagnetic navigation diagnostic bronchoscopy: a prospective study. Am. J. Respir. Crit. Care Med. 174(9), 982–989 (2006).Crossref, Medline, Google Scholar
    • 22 Eberhardt R, Anantham D, Ernst A et al. Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am. J. Respir. Crit. Care Med. 176(1), 36–41 (2007).Crossref, Medline, Google Scholar
    • 23 Asahina H, Yamazaki K, Onodera Y et al. Transbronchial biopsy using endobronchial ultrasonography with a guide sheath and virtual bronchoscopic navigation. Chest 128(3), 1761–1765 (2005).Crossref, Medline, Google Scholar
    • 24 Ishida T, Asano F, Yamazaki K et al. Virtual bronchoscopic navigation combined with endobronchial ultrasound to diagnose small peripheral pulmonary lesions: a randomized trial. Thorax 66(12), 1072–1077 (2011).Crossref, Medline, Google Scholar
    • 25 Matsumoto Y, Izumo T, Sasada S, Tsuchida T, Ohe Y. Diagnostic utility of endobronchial ultrasound with a guide sheath under the computed tomography workstation (ziostation) for small peripheral pulmonary lesions. Clin. Respir. J. doi:10.1111/crj.12321 (2015) (Epub ahead of print).Google Scholar
    • 26 Wahidi MM, Govert JA, Goudar RK et al. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132(Suppl. 3), 94–107 (2007). • Studies on imaging-guided transthoracic needle biopsy.Crossref, Google Scholar
    • 27 Yamauchi Y, Izumi Y, Nakatsuka S et al. Diagnostic performance of percutaneous core needle lung biopsy under multi-CT fluoroscopic guidance for ground-glass opacity pulmonary lesions. Eur. J. Radiol. 79(2), e85–e89 (2011).Crossref, Medline, Google Scholar
    • 28 Hur J, Lee HJ, Byun MK et al. Computed tomographic fluoroscopy-guided needle aspiration biopsy as a second biopsy technique after indeterminate transbronchial biopsy results for pulmonary lesions: comparison with second transbronchial biopsy. J. Comput. Assist. Tomogr. 34(2), 290–295 (2010).Crossref, Medline, Google Scholar
    • 29 Gould MK, Donington J, Lynch WR et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd Ed.: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 143(Suppl. 5), e93S–e120S (2013).Crossref, Medline, Google Scholar
    • 30 Chang CY, Tzao C, Lee SC et al. Incremental value of integrated FDG-PET/CT in evaluating indeterminate solitary pulmonary nodule for malignancy. Mol. Imaging Biol. 12(2), 204–209 (2010).Crossref, Medline, Google Scholar
    • 31 Kothary N, Lock L, Sze DY et al. Computed tomography-guided percutaneous needle biopsy of pulmonary nodules: impact of nodule size on diagnostic accuracy. Clin. Lung Cancer 10(5), 360–363 (2009).Crossref, Medline, Google Scholar
    • 32 Ng YL, Patsios D, Roberts H et al. CT-guided percutaneous fine-needle aspiration biopsy of pulmonary nodules measuring 10 mm or less. Clin. Radiol. 63(3), 272–277 (2008).Crossref, Medline, CAS, Google Scholar
    • 33 Ohno Y, Hatabu H, Takenaka D et al. CT-guided transthoracic needle aspiration biopsy of small (≤20 mm) solitary pulmonary nodules. Am. J. Roentgenol. 180(6), 1665–1669 (2003). • Future trends on diagnostic approach for management of pulmonary nodules.Crossref, Medline, Google Scholar
    • 34 Wiener RS, Schwartz LM, Woloshin S et al. Population-based risk for complications after transthoracic needle lung biopsy of a pulmonary nodule: an analysis of discharge records. Ann. Intern. Med. 155(3), 137–144 (2011).Crossref, Medline, Google Scholar
    • 35 Allen MS, Deschamps C, Lee RE et al. Video-assisted thoracoscopic stapled wedge excision for indeterminate pulmonary nodules. J. Thorac. Cardiovasc. Surg. 106(6), 1048 (1993).Crossref, Medline, CAS, Google Scholar
    • 36 Bernard A. Resection of pulmonary nodules using video-assisted thoracic surgery. The Thorax Group. Ann. Thorac. Surg. 61(1), 202 (1996).Crossref, Medline, CAS, Google Scholar
    • 37 Shennib H. Intraoperative localization techniques for pulmonary nodules. Ann. Thorac. Surg. 56(3), 745 (1993).Crossref, Medline, CAS, Google Scholar
    • 38 Hutchinson JP, Fogarty AW, McKeever TM et al. In-hospital mortality after surgical lung biopsy for interstitial lung disease in the United States. 2000 to 2011. Am. J. Respir. Crit. Care Med. 193(10), 1161–1167 (2016).Crossref, Medline, CAS, Google Scholar
    • 39 Rakotomamonjy A, Petitjean C, Salaün M et al. Scattering features for lung cancer detection in fibered confocal fluorescence microscopy images. Artif. Intell. Med. 61(2), 105–118 (2014).Crossref, Medline, Google Scholar
    • 40 Thiberville L, Salaun M, Lachkar S et al. Confocal fluorescence endomicroscopy of the human airways. Proc. Am. Thorac. Soc. 6, 444–449 (2009).Crossref, Medline, Google Scholar
    • 41 Sorokina A, Danilevskaya O, Averyanov A et al. Comparative study of ex vivo probe-based confocal laser endomicroscopy and light microscopy in lung cancer diagnostics. Respirology 19, 907–913 (2014).Crossref, Medline, Google Scholar
    • 42 Ikeda S, Yanai N, Ishikawa S. Flexible bronchofiberscope. Keio. J. Med. 17(1), 1–16 (1968).Crossref, Medline, CAS, Google Scholar