Low-Dose CT Proves Useful in Surveillance of Second Lung Cancers

October 31, 2003

Martha Kerr

Oct. 31, 2003 (Orlando) — Nodules less than 10 mm in diameter, visible on low-dose computed tomography (CT), are most likely benign in patients with resected stage I or II lung cancer, researchers reported here at CHEST 2003, the annual meeting of the American College of Chest Physicians. In their study, nodules less than 10 mm in diameter visualized on CT remained stable or regressed during follow-up.

The big news of the study, said Diane Stover, MD, from Memorial Sloan-Kettering Medical Center in New York City and President of the Chest Foundation, is that low-dose CT can be used for surveillance in lung cancer. "We don't have a screening tool for lung cancer, which is so important in this high-risk group with a first primary [cancer]," she told Medscape. "This is a big advance."

The study, presented by Manish R. Patel, DO, from Evanston Northwestern Healthcare in Illinois, involved 25 patients with resected stage I or II non-small cell lung cancer who were followed for a year after surgery with low-dose CT. Patients in the study had suspicious noncalcified nodules.

The researchers found 23 nodules less than 10 mm in diameter, 18 of which were less than 5 mm in diameter and five that were between 5 mm and 9 mm. Seven nodules were greater than 10 mm.

Nodules between 5 mm and 9 mm were followed every four to six months with low-dose CT. Nodules less than 5 mm in diameter were followed every six months. Management of nodules greater than 10 mm was left up to the managing clinician.

"All nodules less than 10 mm were either stable or regressed," Dr. Patel told Medscape. One nodule that was 10 mm or greater was observed to grow on two consecutive scans. It was removed and turned out to be positive. That patient is doing well now, Dr. Patel reported. All other nodules 10 mm or greater have remained stable or regressed, he said.

"This is exactly what we do at Memorial Sloan-Kettering," Dr. Stover told Medscape. "There is a whole cadre of patients with nodules," she pointed out. "Many are benign, but we haven't had a screening test.... We haven't known how to manage them."

"The findings here need to be substantiated with a larger test.... It will be interesting to see if these smaller nodules remain benign.... This is a very high-risk population, with a 2% per year risk of developing a second primary cancer..., but this is a very interesting study," Dr. Stover commented.

CHEST 2003: Poster: Surveillance for Recurrent or New Cancer in Patients with Resected Stage I or II Non-Small Cell Lung Cancer. Presented Oct. 29, 2003.

Reviewed by Gary D. Vogin, MD

Martha Kerr is a freelance writer for Medscape.

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