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BackgroundLung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes.MethodsAn early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by χ2 test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008–2010) and the three most recent years for which data are available during the campaign (2013–2015).FindingsCommunity-ordered chest X-ray rates per year increased from 18 909 in 2008–2010 to 34 194 in 2013–2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen (χ2(1)=32.2, pInterpretationThis is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.

Objectives Clinical prediction models assess the likelihood of malignancy in pulmonary nodules detected by computed tomography (CT). This study aimed to validate four such models in a UK population of patients with pulmonary nodules. Three models used clinical and CT characteristics to predict risk (Mayo Clinic, Veterans Association, Brock University) with a fourth model (Herder et al. [4]) additionally incorporating 18 Fluorine-Fluorodeoxyglucose (FDG) avidity on positron emission tomography–computed tomography (PET–CT). Materials and methods The likelihood of malignancy was calculated for patients with pulmonary nodules (4–30mm diameter) and data used to calculate the area under the receiver operating characteristic curve (AUC) for each model. The models were used in a restricted cohort of patients based on each model's exclusion criteria and in the total cohort of all patients. Results Two hundred and forty-four patients were studied, of whom 139 underwent FDG PET–CT. Ninety-nine (40.6%) patients were subsequently confirmed to have malignant nodules (33.2% primary lung cancer, 7.4% metastatic disease). The Mayo and Brock models performed similarly (AUC 0.895 and 0.902 respectively) and both were significantly better than the Veterans Association model (AUC 0.735, p p =0.002 respectively). In patients undergoing FDG PET–CT, the Herder model had significantly higher accuracy than the other three models (AUC 0.924). When the models were tested on all patients in the cohort (i.e. including those outside the original model inclusion criteria) AUC values were reduced, yet remained high especially for the Herder model (AUC 0.916). For sub-centimetre nodules, AUC values for the Mayo and Brock models were 0.788 and 0.852 respectively. Conclusions The Mayo and Brock models showed good accuracy for determining likelihood of malignancy in nodules detected on CT scan. In patients undergoing FDG PET–CT for nodule evaluation, the highest accuracy was seen for the model described by Herder et al. incorporating FDG avidity.

Endobronchial ultrasound guided-transbronchial needle aspiration (EBUS-TBNA) of mediastinal lymph nodes provides a safe alternative to mediastinoscopy for staging patients with lung cancer.1–5 Performing TBNA under real time ultrasound visualisation has been shown to significantly improve the yield of TBNA compared with conventional TBNA performed without visualisation.6 In addition to the clinical benefits of this procedure, EBUS-TBNA is likely to offer ongoing cost savings by avoiding the need for mediastinoscopy procedures and positron emission topography (PET) scans in some patients. At Leeds Teaching Hospitals NHS Trust (LTHT), conventional TBNA is used to assess large subcarinal nodes, but the Trust does not currently offer an EBUS-TBNA service. By reviewing mediastinoscopies performed as staging procedures for lung cancer in LTHT during 2006, we estimated the financial implications of establishing an EBUS-TBNA service. We hypothesised that patients found to have …

Background Lung cancer survival in the UK lags behind other developed nations, and excess early deaths following diagnosis suggest advanced disease at presentation. Patients diagnosed with lung cancer following emergency presentation to hospital have poorer survival than those patients referred to outpatient clinic (1 year survival 9% vs 39% respectively). Leeds has an excess of lung cancer deaths per year compared with the rest of UK, and Leeds Teaching Hospitals NHS Trust (LTHT) sees the highest number of lung cancer cases nationwide. Methods NHS Leeds and LTHT undertook a 12 month campaign to encourage earlier diagnosis of lung cancer comprising four key elements: a marketing communications campaign, a community education programme, a primary care educational programme, and a self request chest X-ray service. Outcome measures for the intervention year (2011) were compared to historical controls (2008–2010). Results The number of community-ordered CXRs increased from 18,909 per annum (2008–2010) to 29,278 in 2011 (55% increase, p Conclusion Improvements in survival and a reduction in emergency admissions are likely to reflect increase referral of symptomatic patients for CXR. Further analysis of Cancer Registry survival data will allow comparison with other UK centres over the same time period. No stage or performance status shift was seen.

A 55-year-old previously fit and well woman was admitted with a 4-week history of dry cough and 1-week history of progressive breathlessness. She had never smoked, was on no regular medications and there was no history of heart disease, malignancy, rheumatological disease or tuberculosis. Physical examination revealed signs of a moderate right-sided pleural effusion but was otherwise unremarkable. Full blood count, clotting, and renal and liver function tests were normal. C reactive protein was

Background Management of solitary pulmonary nodules (SPNs) depends critically on the pre-test probability of malignancy. Several quantitative prediction models have been developed using clinical and radiological criteria. Three models include CT criteria (Mayo, Veterans Association, Brock University) with a fourth model (Herder) incorporating FDG avidity on CT-PET scan in addition. These models have not been validated in a UK population, and the current study aimed to compare their performance in a population of patients recruited from a UK teaching hospital. Methods Patients with SPNs (4–30 mm) were retrospectively identified from the lung cancer MDT and a nodule follow-up clinic (n = 246). All patients had a final diagnosis confirmed by histology or radiological stability on a 2-year follow up. For each patient, the probability of the pulmonary nodule being malignant was calculated using the four models described. The models were used both in a restricted cohort of patients based on their respective exclusion criteria, and in the total cohort of patients. The accuracy of each model was assessed by calculating the area under the receiver operating characteristic (ROC) curve. Results The median age of the patient population was 69 years (range 32–94) and 50% were male. The prevalence of malignancy was 40.6% (33.3% primary lung cancer, 7.3% metastatic disease). Figure 1 shows the distribution of the probabilities of malignancy according to the four different models. The areas under the ROC curves for the cohorts restricted by respective exclusion criteria were (AUC, 95% CI): Mayo 0.892 (0.847–0.937); VA 0.736 (0.672–0.801); Brock 0.901 (0.855–0.947) and Herder 0.924 (0.875–0.974). For the total cohort, the AUC values were Mayo 0.873, VA 0.736, Brock 0.867 and Herder 0.916. There was no statistical difference between the Mayo and Brock models, but both were significantly better than VA (AUC difference of 0.14 and 0.13 respectively, p ≤ 0.0001 for both). The Herder model performed significantly better than both Mayo and Brock models (AUC difference of 0.10 and 0.14 respectively, p ≤ 0.01). Conclusion Both the Mayo and the Brock models perform well in a UK population, but accuracy is improved by incorporating CT-PET findings using the Herder prediction model.

Background PET-CT is an important test in the management of patients with solitary pulmonary nodules (SPNs). There is a paucity of data on clinical characteristics, follow-up and outcomes of patients with PET negative nodules as compared to PET positive ones. Objective To compare the clinical characteristics and outcomes of patients with PET positive vs PET negative SPNs managed by the Lung MDT at a large teaching hospital in North England. Methods 144 patients (age range 32–92 years, 76 females) with SPNs measuring 8–29 mm discussed at the Lung MDT who had PET-CT scans over a 3 year period between 1st January 2007 and 31st December 2009 were identified retrospectively through the Lung Cancer database. Demographic data, nodule characteristics, MDT decisions, median time to diagnosis, and outcomes were evaluated. We tested for differences in characteristics between patients with PET positive and negative nodules using t test and Mann–Whitney U test for continuous variables, and χ2 tests or Fisher exact tests as indicated for categorical variables. Results In comparison to PET positive nodules, PET negative ones were smaller, less likely to be spiculated, more often associated with an MDT decision to follow-up with serial CT scans, less likely to undergo surgical resection or have radical radiotherapy, had a longer median time to diagnosis, and were less likely to be malignant. The overall prevalence of malignancy in patients with PET negative nodules, however (15/41 [36.6%]) was higher than that reported in previous studies. This may be due to the higher prevalence of adenocarcinoma in our series. Conclusions Significant differences in clinical characteristics and outcomes have been demonstrated between patients with PET positive and PET negative solitary pulmonary nodules. The overall prevalence of malignancy in patients with PET negative nodules (15/41 [36.6%]) was higher than that reported in previous studies.