19 results on '"Jett, James R."'
Search Results
2. Screening for lung cancer with low-dose CT scans.
- Author
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Jett JR
- Subjects
- Aged, Female, Humans, Lung Neoplasms mortality, Male, Middle Aged, Radiation Dosage, Risk, Survival Rate, Lung Neoplasms diagnostic imaging, Mass Screening methods, Tomography, X-Ray Computed methods
- Published
- 2013
- Full Text
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3. Development of The American Association for Thoracic Surgery guidelines for low-dose computed tomography scans to screen for lung cancer in North America: recommendations of The American Association for Thoracic Surgery Task Force for Lung Cancer Screening and Surveillance.
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Jacobson FL, Austin JH, Field JK, Jett JR, Keshavjee S, MacMahon H, Mulshine JL, Munden RF, Salgia R, Strauss GM, Sugarbaker DJ, Swanson SJ, Travis WD, and Jaklitsch MT
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- Advisory Committees, Age Factors, Aged, Canada epidemiology, Comorbidity, Humans, Lung Neoplasms epidemiology, Mass Screening standards, Middle Aged, Population Surveillance, Radiation Dosage, Risk Assessment, Risk Factors, Smoking adverse effects, Smoking epidemiology, United States epidemiology, Lung Neoplasms diagnostic imaging, Practice Guidelines as Topic, Thoracic Surgical Procedures standards, Tomography, X-Ray Computed standards
- Abstract
Objective: The study objective was to establish The American Association for Thoracic Surgery (AATS) lung cancer screening guidelines for clinical practice., Methods: The AATS established the Lung Cancer Screening and Surveillance Task Force with multidisciplinary representation including 4 thoracic surgeons, 4 thoracic radiologists, 4 medical oncologists, 1 pulmonologist, 1 pathologist, and 1 epidemiologist. Members have engaged in interdisciplinary collaborations regarding lung cancer screening and clinical care of patients with, and at risk for, lung cancer. The task force reviewed the literature, including screening trials in the United States and Europe, and discussed local best clinical practices in the United States and Canada on 4 conference calls. A reference library supported the discussions and increased individual study across disciplines. The task force met to review the literature, state of clinical practice, and recommend consensus-based guidelines., Results: Nine of 14 task force members were present at the meeting, and 3 participated by telephone. Two absent task force members were polled afterward. Six unanimous recommendations and supporting work-up algorithms were presented to the Council of the AATS at the 2012 annual meeting in San Francisco, California., Conclusions: Annual lung cancer screening and surveillance with low-dose computed tomography is recommended for smokers and former smokers with a 30 pack-year history of smoking and long-term lung cancer survivors aged 55 to 79 years. Screening may begin at age 50 years with a 20 pack-year history of smoking and additional comorbidity that produces a cumulative risk of developing lung cancer of 5% or greater over the following 5 years. Screening should be undertaken with a subspecialty qualified interdisciplinary team. Patient risk calculator application and intersociety engagement will provide data needed to refine future lung cancer screening guidelines., (Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)
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- 2012
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4. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups.
- Author
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Jaklitsch MT, Jacobson FL, Austin JH, Field JK, Jett JR, Keshavjee S, MacMahon H, Mulshine JL, Munden RF, Salgia R, Strauss GM, Swanson SJ, Travis WD, and Sugarbaker DJ
- Subjects
- Advisory Committees, Age Factors, Aged, Canada epidemiology, Comorbidity, Humans, Lung Neoplasms epidemiology, Mass Screening standards, Middle Aged, Population Surveillance, Radiation Dosage, Risk Assessment, Risk Factors, Smoking adverse effects, Smoking epidemiology, United States epidemiology, Lung Neoplasms diagnostic imaging, Thoracic Surgical Procedures standards, Tomography, X-Ray Computed standards
- Abstract
Objective: Lung cancer is the leading cause of cancer death in North America. Low-dose computed tomography screening can reduce lung cancer-specific mortality by 20%., Method: The American Association for Thoracic Surgery created a multispecialty task force to create screening guidelines for groups at high risk of developing lung cancer and survivors of previous lung cancer., Results: The American Association for Thoracic Surgery guidelines call for annual lung cancer screening with low-dose computed tomography screening for North Americans from age 55 to 79 years with a 30 pack-year history of smoking. Long-term lung cancer survivors should have annual low-dose computed tomography to detect second primary lung cancer until the age of 79 years. Annual low-dose computed tomography lung cancer screening should be offered starting at age 50 years with a 20 pack-year history if there is an additional cumulative risk of developing lung cancer of 5% or greater over the following 5 years. Lung cancer screening requires participation by a subspecialty-qualified team. The American Association for Thoracic Surgery will continue engagement with other specialty societies to refine future screening guidelines., Conclusions: The American Association for Thoracic Surgery provides specific guidelines for lung cancer screening in North America., (Copyright © 2012. Published by Mosby, Inc.)
- Published
- 2012
- Full Text
- View/download PDF
5. Benefits and harms of CT screening for lung cancer: a systematic review.
- Author
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Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, Byers T, Colditz GA, Gould MK, Jett JR, Sabichi AL, Smith-Bindman R, Wood DE, Qaseem A, and Detterbeck FC
- Subjects
- Cohort Studies, Humans, Radiation Dosage, Randomized Controlled Trials as Topic, Risk, Risk Reduction Behavior, Lung Neoplasms diagnostic imaging, Lung Neoplasms mortality, Tomography, X-Ray Computed adverse effects
- Abstract
Context: Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death from lung cancer., Objective: To conduct a systematic review of the evidence regarding the benefits and harms of lung cancer screening using low-dose computed tomography (LDCT). A multisociety collaborative initiative (involving the American Cancer Society, American College of Chest Physicians, American Society of Clinical Oncology, and National Comprehensive Cancer Network) was undertaken to create the foundation for development of an evidence-based clinical guideline., Data Sources: MEDLINE (Ovid: January 1996 to April 2012), EMBASE (Ovid: January 1996 to April 2012), and the Cochrane Library (April 2012)., Study Selection: Of 591 citations identified and reviewed, 8 randomized trials and 13 cohort studies of LDCT screening met criteria for inclusion. Primary outcomes were lung cancer mortality and all-cause mortality, and secondary outcomes included nodule detection, invasive procedures, follow-up tests, and smoking cessation., Data Extraction: Critical appraisal using predefined criteria was conducted on individual studies and the overall body of evidence. Differences in data extracted by reviewers were adjudicated by consensus., Results: Three randomized studies provided evidence on the effect of LDCT screening on lung cancer mortality, of which the National Lung Screening Trial was the most informative, demonstrating that among 53,454 participants enrolled, screening resulted in significantly fewer lung cancer deaths (356 vs 443 deaths; lung cancer−specific mortality, 274 vs 309 events per 100,000 person-years for LDCT and control groups, respectively; relative risk, 0.80; 95% CI, 0.73-0.93; absolute risk reduction, 0.33%; P = .004). The other 2 smaller studies showed no such benefit. In terms of potential harms of LDCT screening, across all trials and cohorts, approximately 20% of individuals in each round of screening had positive results requiring some degree of follow-up, while approximately 1% had lung cancer. There was marked heterogeneity in this finding and in the frequency of follow-up investigations, biopsies, and percentage of surgical procedures performed in patients with benign lesions. Major complications in those with benign conditions were rare., Conclusion: Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.
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- 2012
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6. Screening for lung cancer: for patients at increased risk for lung cancer, it works.
- Author
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Jett JR and Midthun DE
- Subjects
- Age Factors, Aged, Early Detection of Cancer, False Positive Reactions, Female, Humans, Lung Neoplasms etiology, Lung Neoplasms mortality, Lung Neoplasms prevention & control, Middle Aged, Radiation Dosage, Risk Factors, United States epidemiology, Lung Neoplasms diagnostic imaging, Mass Screening adverse effects, Mass Screening methods, Smoking adverse effects, Tomography, X-Ray Computed adverse effects, Tomography, X-Ray Computed methods, Tomography, X-Ray Computed standards
- Abstract
Screening for lung cancer is not currently recommended, even in persons at high risk for this condition. Most patients with lung cancer present with symptomatic disease that is usually at an incurable, advanced stage. The recently reported NLST (National Lung Screening Trial) showed a 20% decrease in deaths from lung cancer in high-risk persons undergoing screening with low-dose computed tomography of the chest compared with chest radiography. The high-risk group included in the trial comprised asymptomatic persons aged 55 to 74 years, with smoking history of at least 30 pack-years. Screening with low-dose computed tomography detected more cases of early-stage lung cancer and fewer cases of advanced-stage cancer, confirming that screening has shifted the stage of cancer at diagnosis and provides more persons with the opportunity for curative treatment. Although computed tomography screening has risks and limitations, the 20% decrease in deaths is the single most dramatic decrease ever reported for deaths from lung cancer, with the possible exception of smoking cessation. Physicians should offer computed tomography screening for lung cancer to patients who fit the high-risk profile defined in the NLST.
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- 2011
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7. Utility of integrated computed tomography-positron emission tomography for selection of operable malignant pleural mesothelioma.
- Author
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Wilcox BE, Subramaniam RM, Peller PJ, Aughenbaugh GL, Nichols Iii FC, Aubry MC, and Jett JR
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- Adult, Aged, Female, Fluorodeoxyglucose F18, Humans, Male, Mesothelioma surgery, Middle Aged, Neoplasm Staging methods, Pleural Neoplasms surgery, Radiopharmaceuticals, Retrospective Studies, Sensitivity and Specificity, Mesothelioma diagnostic imaging, Pleural Neoplasms diagnostic imaging, Positron-Emission Tomography methods, Tomography, X-Ray Computed methods
- Abstract
Background: Malignant pleural mesothelioma (MPM) is a primary malignancy characterized by local invasion of the pleura and metastasis. Despite advances in computed tomography (CT) and magnetic resonance imaging (MRI), accurately staging patients remains challenging. Recent studies have examined the use of integrated CT-positron emission tomography (PET) for staging patients., Materials and Methods: Mayo Clinic databases were queried to identify cases with a histologic diagnosis of MPM from 2000 to 2006. Inclusion criteria were a diagnosis of MPM, an available CT scan, and an initial staging integrated CT-PET scan. A total of 35 patients were identified who met the inclusion criteria. Computed tomography and integrated CT-PET scans were reviewed by experienced radiologists. Laboratory parameters were reviewed. The Mayo Clinic tumor registry and Social Security database were queried for survival data in patients in which no follow-up was available., Results: Findings on integrated CT-PET excluded 14 of 35 patients from surgical intervention. Extrapleural pneumonectomies (EPPs) were performed in 8 patients, and partial pleurectomies were performed in 2 patients. Upstaging from integrated CT-PET occurred in 70% of the patients when surgical pathology was available, 2 cases to an inoperable stage. Although not statistically significant, median survival was 20 months for patients undergoing an EPP and 12 months for patients excluded from surgical intervention by integrated CT-PET., Conclusion: Malignant pleural mesothelioma is a difficult disease to accurately stage. The most common reason for upstaging in our series was an increase in T (tumor; tumor-node-metastasis staging system) disease. Our data suggest that integrated CT-PET is excellent for detecting nodal and distant metastases. However, the ability of this imaging modality to correctly stage locoregional disease is not superior to the combination of CT and MRI as reported in the literature.
- Published
- 2009
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8. Commentary: CT screening for lung cancer--caveat emptor.
- Author
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Jett JR and Midthun DE
- Subjects
- Biopsy, False Positive Reactions, Humans, Lung Diseases diagnostic imaging, Lung Diseases surgery, Lung Neoplasms prevention & control, Risk Factors, Survival Rate, United States epidemiology, Unnecessary Procedures, Lung Neoplasms diagnostic imaging, Lung Neoplasms mortality, Mass Screening methods, Radiation Injuries etiology, Tomography, X-Ray Computed adverse effects
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- 2008
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9. Computed tomography screening and lung cancer outcomes.
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Bach PB, Jett JR, Pastorino U, Tockman MS, Swensen SJ, and Begg CB
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- Aged, Female, Humans, Lung Neoplasms mortality, Lung Neoplasms surgery, Male, Mass Screening, Middle Aged, Outcome Assessment, Health Care, Pneumonectomy statistics & numerical data, Probability, Smoking, Lung Neoplasms diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Context: Current and former smokers are currently being screened for lung cancer with computed tomography (CT), although there are limited data on the effect screening has on lung cancer outcomes. Randomized controlled trials assessing CT screening are currently under way., Objective: To assess whether screening may increase the frequency of lung cancer diagnosis and lung cancer resection or may reduce the risk of a diagnosis of advanced lung cancer or death from lung cancer., Design, Setting, and Participants: Longitudinal analysis of 3246 asymptomatic current or former smokers screened for lung cancer beginning in 1998 either at 1 of 2 academic medical centers in the United States or an academic medical center in Italy with follow-up for a median of 3.9 years., Intervention: Annual CT scans with comprehensive evaluation and treatment of detected nodules., Main Outcome Measures: Comparison of predicted with observed number of new lung cancer cases, lung cancer resections, advanced lung cancer cases, and deaths from lung cancer., Results: There were 144 individuals diagnosed with lung cancer compared with 44.5 expected cases (relative risk [RR], 3.2; 95% confidence interval [CI], 2.7-3.8; P<.001). There were 109 individuals who had a lung resection compared with 10.9 expected cases (RR, 10.0; 95% CI, 8.2-11.9; P<.001). There was no evidence of a decline in the number of diagnoses of advanced lung cancers (42 individuals compared with 33.4 expected cases) or deaths from lung cancer (38 deaths due to lung cancer observed and 38.8 expected; RR, 1.0; 95% CI, 0.7-1.3; P = .90)., Conclusions: Screening for lung cancer with low-dose CT may increase the rate of lung cancer diagnosis and treatment, but may not meaningfully reduce the risk of advanced lung cancer or death from lung cancer. Until more conclusive data are available, asymptomatic individuals should not be screened outside of clinical research studies that have a reasonable likelihood of further clarifying the potential benefits and risks.
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- 2007
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10. Five-year lung cancer screening experience: CT appearance, growth rate, location, and histologic features of 61 lung cancers.
- Author
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Lindell RM, Hartman TE, Swensen SJ, Jett JR, Midthun DE, Tazelaar HD, and Mandrekar JN
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- Adenocarcinoma diagnostic imaging, Adenocarcinoma pathology, Adenocarcinoma, Bronchiolo-Alveolar diagnostic imaging, Adenocarcinoma, Bronchiolo-Alveolar pathology, Aged, Carcinoma, Large Cell diagnostic imaging, Carcinoma, Large Cell pathology, Carcinoma, Neuroendocrine diagnostic imaging, Carcinoma, Neuroendocrine pathology, Carcinoma, Non-Small-Cell Lung diagnostic imaging, Carcinoma, Non-Small-Cell Lung pathology, Carcinoma, Small Cell diagnostic imaging, Carcinoma, Small Cell pathology, Carcinoma, Squamous Cell diagnostic imaging, Carcinoma, Squamous Cell pathology, Female, Follow-Up Studies, Humans, Lung Neoplasms diagnostic imaging, Lung Neoplasms pathology, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Retrospective Studies, Sex Factors, Lung Neoplasms prevention & control, Mass Screening, Tomography, X-Ray Computed methods
- Abstract
Purpose: To retrospectively evaluate the computed tomography (CT)-determined size, morphology, location, morphologic change, and growth rate of incidence and prevalence lung cancers detected in high-risk individuals who underwent annual chest CT screening for 5 years and to evaluate the histologic features and stages of these cancers., Materials and Methods: The study was institutional review board approved and HIPAA compliant. Informed consent was waived. CT scans of 61 cancers (24 in men, 37 in women; age range, 53-79 years; mean, 65 years) were retrospectively reviewed for cancer size, morphology, and location. Forty-eight cancers were assessed for morphologic change and volume doubling time (VDT), which was calculated by using a modified Schwartz equation. Histologic sections were retrospectively reviewed., Results: Mean tumor size was 16.4 mm (range, 5.5-52.5 mm). Most common CT morphologic features were as follows: for bronchioloalveolar carcinoma (BAC) (n = 9), ground-glass attenuation (n = 6, 67%) and smooth (n = 3, 33%), irregular (n = 3, 33%), or spiculated (n = 3, 33%) margin; for non-BAC adenocarcinomas (n = 25), semisolid (n = 11, 44%) or solid (n = 12, 48%) attenuation and irregular margin (n = 14, 56%); for squamous cell carcinoma (n = 14), solid attenuation (n = 12, 86%) and irregular margin (n = 10, 71%); for small cell or mixed small and large cell neuroendocrine carcinoma (n = 7), solid attenuation (n = 6, 86%) and irregular margin (n = 5, 71%); for non-small cell carcinoma not otherwise specified (n = 5), solid attenuation (n = 4, 80%) and irregular margin (n = 3, 60%); and for large cell carcinoma (n = 1), solid attenuation and spiculated shape (n = 1, 100%). Attenuation most often (in 12 of 21 cases) increased. Margins most often (in 16 of 20 cases) became more irregular or spiculated. Mean VDT was 518 days. Thirteen of 48 cancers had a VDT longer than 400 days; 11 of these 13 cancers were in women., Conclusion: Overdiagnosis, especially in women, may be a substantial concern in lung cancer screening., ((c) RSNA, 2007.)
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- 2007
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11. Lung cancer screening results: easily misunderstood.
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Midthun DE, Swensen SJ, Hartman TE, and Jett JR
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- Humans, Lung Neoplasms diagnostic imaging, Survival Rate, Lung Neoplasms mortality, Survival Analysis, Tomography, X-Ray Computed
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- 2007
- Full Text
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12. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society.
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MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP, Patz EF Jr, and Swensen SJ
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- Diagnosis, Differential, Humans, Radiography, Thoracic, Lung Neoplasms diagnostic imaging, Lung Neoplasms therapy, Practice Guidelines as Topic, Solitary Pulmonary Nodule diagnostic imaging, Solitary Pulmonary Nodule therapy, Tomography, X-Ray Computed methods
- Abstract
Lung nodules are detected very commonly on computed tomographic (CT) scans of the chest, and the ability to detect very small nodules improves with each new generation of CT scanner. In reported studies, up to 51% of smokers aged 50 years or older have pulmonary nodules on CT scans. However, the existing guidelines for follow-up and management of noncalcified nodules detected on nonscreening CT scans were developed before widespread use of multi-detector row CT and still indicate that every indeterminate nodule should be followed with serial CT for a minimum of 2 years. This policy, which requires large numbers of studies to be performed at considerable expense and with substantial radiation exposure for the affected population, has not proved to be beneficial or cost-effective. During the past 5 years, new information regarding prevalence, biologic characteristics, and growth rates of small lung cancers has become available; thus, the authors believe that the time-honored requirement to follow every small indeterminate nodule with serial CT should be revised. In this statement, which has been approved by the Fleischner Society, the pertinent data are reviewed, the authors' conclusions are summarized, and new guidelines are proposed for follow-up and management of small pulmonary nodules detected on CT scans.
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- 2005
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13. Lung cancer screening experience: a retrospective review of PET in 22 non-small cell lung carcinomas detected on screening chest CT in a high-risk population.
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Lindell RM, Hartman TE, Swensen SJ, Jett JR, Midthun DE, Nathan MA, and Lowe VJ
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- Carcinoma, Non-Small-Cell Lung epidemiology, Female, Humans, Incidence, Lung Neoplasms epidemiology, Male, Prevalence, Retrospective Studies, Solitary Pulmonary Nodule diagnostic imaging, Solitary Pulmonary Nodule epidemiology, Carcinoma, Non-Small-Cell Lung diagnostic imaging, Lung Neoplasms diagnostic imaging, Mass Screening methods, Positron-Emission Tomography, Tomography, X-Ray Computed
- Abstract
Objective: The objective of our study was to retrospectively review the PET results of non-small cell lung carcinomas detected on screening chest CT in a high-risk population., Conclusion: PET findings were negative in 32% of the cases of non-small cell carcinomas that were detected on screening CT in a high-risk patient population. These tumors were small, low-grade, or both. The most common histology was bronchioloalveolar cell carcinoma. The role of PET in evaluating screening-detected indeterminate nodules in a high-risk population may be more limited than in a general population.
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- 2005
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14. CT screening for lung cancer: five-year prospective experience.
- Author
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Swensen SJ, Jett JR, Hartman TE, Midthun DE, Mandrekar SJ, Hillman SL, Sykes AM, Aughenbaugh GL, Bungum AO, and Allen KL
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- Aged, Aged, 80 and over, Female, Humans, Incidence, Lung Neoplasms epidemiology, Male, Mass Screening, Middle Aged, Prevalence, Prospective Studies, Time Factors, Lung Neoplasms diagnostic imaging, Tomography, X-Ray Computed
- Abstract
Purpose: To report results of a 5-year prospective low-dose helical chest computed tomographic (CT) study of a cohort at high risk for lung cancer., Materials and Methods: After informed written consent was obtained, 1520 individuals were enrolled. Protocol was approved by institutional review board and National Cancer Institute and was compliant with Health Insurance Portability and Accountability Act, or HIPAA. Participants were aged 50 years and older and had smoked for more than 20 pack-years. Participants underwent five annual (one initial and four subsequent) CT examinations. A significant downward shift was evaluated in non-small cell lung cancers detected initially from advanced stage down to stage I by using a one-sided binomial test of proportions. Poisson regression and Fisher exact tests were used for comparisons with Mayo Lung Project., Results: In 788 (52%) men and 732 (48%) women, 61% (927 of 1520) were current smokers, and 39% were former smokers. After five annual CT examinations, 3356 uncalcified lung nodules were identified in 1118 (74%) participants. Sixty-eight lung cancers were diagnosed (31 initial, 34 subsequent, three interval cancers) in 66 participants. Twenty-eight subsequent cases of non-small cell cancers were detected, of which 17 (61%; 95% confidence interval: 41%, 79%) were stage I tumors. Diameter of cancers detected subsequently was 5-50 mm (mean, 14.4 mm; median, 10.0 mm). Analysis for a more than 50% shift in proportion of stage I non-small cell cancer detection did not show statistical significance. Forty-eight participants died of various causes since enrollment. Lung cancer mortality rate for incidence portion of trial was 1.6 per 1000 person-years. There was no significant difference in lung cancer mortality rates of cancers detected in subsequent examinations between this trial and Mayo Lung Project after separation of participants into subsets (2.8 vs 2.0 per 1000 person-years, P = .43)., Conclusion: CT allows detection of early-stage lung cancers. Benign nodule detection rate is high. Results suggest no stage shift., ((c) RSNA, 2005.)
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- 2005
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15. Thoracic surgical operations in patients enrolled in a computed tomographic screening trial.
- Author
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Crestanello JA, Allen MS, Jett JR, Cassivi SD, Nichols FC 3rd, Swensen SJ, Deschamps C, and Pairolero PC
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- Aged, Aged, 80 and over, Female, Humans, Lung Diseases epidemiology, Lung Neoplasms epidemiology, Male, Mass Screening, Middle Aged, Thoracic Surgical Procedures statistics & numerical data, Lung Diseases diagnostic imaging, Lung Diseases surgery, Lung Neoplasms diagnostic imaging, Lung Neoplasms surgery, Tomography, X-Ray Computed
- Abstract
Objective: Screening for lung cancer with computed tomography may detect cancers at an earlier stage but may also result in overdiagnosis. We reviewed the thoracic surgical operations performed on patients enrolled in our computed tomographic screening program., Methods: From January 1999 through December 2002, screening computed tomography for lung cancer was performed annually on 1520 participants. All participants were at least 50 years old and smoked more than 20 pack/y. We found 3130 indeterminate pulmonary nodules in 1112 participants (73%). Fifty-five participants (3.6%) underwent 60 thoracic operations for a variety of indications. The medical records of these 55 patients were reviewed., Results: Indications for operation included suspicious pulmonary nodules, mediastinal adenopathy, and a spontaneous pneumothorax. Operations performed included a lobectomy in 37 cases, wedge resection in 11, segmentectomy in 6, video-assisted thoracoscopic surgical talc pleurodesis in 1, bilobectomy in 2, mediastinoscopy in 2, and anterior mediastinotomy in 1. Benign disease was found in 10 patients (18.1%), and lung cancer was found in 45 (81.9%), 2 of whom had metachronous lung cancers. Cell types were adenocarcinoma in 15 cancers, bronchioloalveolar cell carcinoma in 13, squamous cell in 13, carcinoid in 2, small cell in 2, and large cell and undifferentiated non-small cell in 1 case each. Twenty-eight cancers were classified as stage IA, 4 as IB, 4 as IIA, 1 as IIB, 4 as IIIA, 3 as IIIB, 1 as IV, and 2 as limited small cell carcinoma. Complications occurred in 27% of patients. Operative mortality was 1.7%., Conclusion: Computed tomographic screening finds a large number of indeterminate pulmonary nodules in smokers 50 years old or older, most of which are observed and not operated on. Although 47 cancers were detected thus far in this highly selected group of patients, this represents only 1.5% of the pulmonary nodules identified.
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- 2004
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16. Glomus tumor of the trachea: value of multidetector computed tomographic virtual bronchoscopy.
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Nadrous HF, Allen MS, Bartholmai BJ, Aughenbaugh GL, Lewis JT, and Jett JR
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- Adult, Glomus Tumor complications, Glomus Tumor metabolism, Hemoptysis etiology, Humans, Image Processing, Computer-Assisted, Imaging, Three-Dimensional, Immunoenzyme Techniques, Male, Tracheal Neoplasms complications, Tracheal Neoplasms metabolism, Bronchoscopy methods, Glomus Tumor diagnosis, Surgery, Computer-Assisted, Tomography, X-Ray Computed methods, Tracheal Neoplasms diagnosis
- Abstract
Glomus tumor of the trachea is extremely rare. We report a case of tracheal glomus tumor in a 39-year-old man who presented with hemoptysis. The diagnosis was made after bronchoscopic biopsy of a tumor involving the posterior wall of the upper trachea. Thin-section multidetector computed tomography of the chest was performed before surgical resection, with multiplanar re-formations and 3-dimensional virtual bronchoscopic reconstruction. Tracheal sleeve resection with reconstruction was successful, and pathological studies confirmed complete resection and the diagnosis of glomus tumor. The patient was disease-free 3 months postoperatively. To our knowledge, this is the first reported case in which additional computed postprocessing was used to help evaluate the extent of such a tumor.
- Published
- 2004
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17. Computed tomographic screening for lung cancer: home run or foul ball?
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Swensen SJ, Jett JR, Midthun DE, and Hartman TE
- Subjects
- Ethics, Medical, Humans, United States, Lung Neoplasms diagnostic imaging, Mass Screening methods, Tomography, X-Ray Computed
- Published
- 2003
- Full Text
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18. Screening for lung cancer with low-dose spiral computed tomography.
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Swensen SJ, Jett JR, Sloan JA, Midthun DE, Hartman TE, Sykes AM, Aughenbaugh GL, Zink FE, Hillman SL, Noetzel GR, Marks RS, Clayton AC, and Pairolero PC
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- Aged, False Positive Reactions, Female, Humans, Incidence, Lung Neoplasms epidemiology, Lung Neoplasms pathology, Male, Middle Aged, Prevalence, Prospective Studies, Smoking, Sputum cytology, United States epidemiology, Lung Neoplasms diagnostic imaging, Lung Neoplasms prevention & control, Mass Screening, Tomography, X-Ray Computed
- Abstract
Studies suggest that screening with spiral computed tomography can detect lung cancers at a smaller size and earlier stage than chest radiography can. To evaluate low-radiation-dose spiral computed tomography and sputum cytology in screening for lung cancer, we enrolled 1,520 individuals aged 50 yr or older who had smoked 20 pack-years or more in a prospective cohort study. One year after baseline scanning, 2,244 uncalcified lung nodules were identified in 1,000 participants (66%). Twenty-five cases of lung cancer were diagnosed (22 prevalence, 3 incidence). Computed tomography alone detected 23 cases; sputum cytology alone detected 2 cases. Cell types were: squamous cell, 6; adenocarcinoma or bronchioalveolar, 15; large cell, 1; small cell, 3. Twenty-two patients underwent curative surgical resection. Seven benign nodules were resected. The mean size of the non-small cell cancers detected by computed tomography was 17 mm (median, 13 mm). The postsurgical stage was IA, 13; IB, 1; IIA, 5; IIB, 1; IIIA, 2; limited, 3. Twelve (57%) of the 21 non-small cell cancers detected by computed tomography were stage IA at diagnosis. Computed tomography can detect early-stage lung cancers. The rate of benign nodule detection is high.
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- 2002
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19. 5-year lung cancer screening experience: growth curves of 18 lung cancers compared to histologic type, CT attenuation, stage, survival, and size
- Author
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Lindell, Rebecca M., Hartman, Thomas E., Swensen, Stephen J., Jett, James R., Midthun, David E., and Mandrekar, Jayawant N.
- Subjects
Male ,Time Factors ,Lung Neoplasms ,Adenocarcinoma ,Adenocarcinoma, Bronchiolo-Alveolar ,Middle Aged ,Models, Biological ,Small Cell Lung Carcinoma ,Tumor Burden ,Survival Rate ,Carcinoma, Non-Small-Cell Lung ,Disease Progression ,Carcinoma, Squamous Cell ,Humans ,Female ,Tomography, X-Ray Computed ,Early Detection of Cancer ,Original Research ,Aged ,Cell Proliferation ,Neoplasm Staging ,Retrospective Studies - Abstract
Although no study has prospectively documented the rate at which lung cancers grow, many have assumed exponential growth. The purpose of this study was to document the growth of lung cancers detected in high-risk participants receiving annual screening chest CT scans.Eighteen lung cancers were evaluated by at least four serial CT scans (4 men, 14 women; age range, 53 to 79 years; mean age, 66 years). CT scans were retrospectively reviewed for appearance, size, and volume (volume [v] = pi/6[ab(2)]). Growth curves (x = time [in days]; y = volume [cubic millimeters]) were plotted and subcategorized by histology, CT scan attenuation, stage, survival, and initial size.Inclusion criteria favored smaller, less aggressive cancers. Growth curves varied, even when subcategorized by histology, CT scan attenuation, stage, survival, or initial size. Cancers associated with higher stages, mortality, or recurrence showed fairly steady growth or accelerated growth compared with earlier growth, although these growth patterns also were seen in lesser-stage lung cancers. Most lung cancers enlarged at fairly steady increments, but several demonstrated fairly flat growth curves, and others demonstrated periods of accelerated growth.This study is the first to plot individual lung cancer growth curves. Although parameters favored smaller, less aggressive cancers in women, it showed that lung cancers are not limited to exponential growth. Tumor size at one point or growth between two points did not appear to predict future growth. Studies and equations assuming exponential growth may potentially misrepresent an indeterminate nodule or the aggressiveness of a lung cancer.
- Published
- 2009
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