The outcome differences of CT screening for lung cancer pre and post following an algorithm in Zhuhai, China

Purpose

To evaluate the change in outcomes from CT screening for lung cancer before and after collaboration with the International Early Lung Cancer Action Program (I-ELCAP) as well as changing from a single-row detector to a multi-row detector CT scanner (MDCT).

Methods and materials

All participants in the screening program were 40 years of age and older. From 1994 to 2002, a single slice spiral CT was used, the screening protocol was established empirically at our institution. From 2003 to 2009 a 16 slice MDCT was used and our institute became the first I-ELCAP site in China. Collaboration included use of the I-ELCAP protocol, image reading training, teaching files training and attendance at international conferences. The clinical and CT characteristics of participants and diagnosed lung cancers pre and post-collaboration were summarized. The outcomes before and after collaboration were compared, including nodule positive rate, lung cancer frequency, stage distribution, pathology, intervals between last routine screening and surgery, the rate of surgery for benign disease and survival rate.

Results

3348 participants were enrolled during 1994-2002 and 3582 participants during 2003-2009. Their age, gender, smoking and family cancer histories were comparable. The screening detection rate of lung cancer was 1.1% (36/3348) vs. 1.0% (34/3582) (P = 0.6), mean size was 18.6 mm vs. 15.6 mm (P = 0.04), stage I lung cancer was 67% vs. 91% (P = 0.38), median intervals between last routine screening and surgery was 213 days vs. 96 days (P < 0.001), 5-year survival rate due to lung cancer was 75% vs. 95% (P = 0.032) in pre- and post collaboration group respectively. The nodule positive rate was 6.2% (208/3348) vs. 9.8% (351/3582) (P < 0.001), the rate of surgery for benign disease was 18% (8/44) vs. 8% (3/37) (P = 0.4) in pre- and post collaboration group respectively.

Conclusion

Smaller lung cancer were detected, interval between last routine screening and surgery was shorter, surgery for benign disease decreased, and survival rate increased in CT screening for lung cancer in Zhuhai after the collaboration with I-ELCAP and with MDCT. Technology improvements along with a well defined protocol improved outcomes of CT screening for lung cancer in Zhuhai, China.