Lung Cancer Screening and Diagnosis

Trials

NELSON

Guidelines

Mar 2021 USPSTF update -> age now 55->50 to 80; minimum pack years 30->20 and quit within the last 15 years. https://jamanetwork.com/journals/jama/fullarticle/2777244

Shared decision-making

Prediction model - https://www.atsjournals.org/doi/pdf/10.1164/rccm.202104-1009ED

• notably, they state that ~10% of eligible patients currently get screened. Authors state 50% might be reasonable (not clear what this is based on)

PLCOm2012 is another prediction score

The eligibility criteria are another inherent prediction model

Absolute benefits and harms

Editorial of chance of benefits and risk of harm: JAMA. 2020;324(10):937-938. doi:10.1001/jama.2020.0354

Lung cancer specific mortality RRR of 20-33% in high-risk populations

Number needed to screen: ???

Misleading comparison between other screening tests (such as breast cancer, colon cancer) due to differing baseline risk of death from the cancer being screened for. (Ie. NNS is not a surrogate for strength of the test)

Sensitivity to imaging follow-up algorithms?

Discussion on the follow-up used in the trials

Diagnosis and Staging

EBUS-TNA guidelines - Wahidi MM, Herth F, Yasufuku K, et al. Technical aspects of endobronchial ultrasound-guided transbronchial needle aspiration: CHEST guideline and expert panel report. Chest. 2016;149(3):816-835.

Tumor Markers:

CHEST 2021; 160(6):2293-2303

EGFR mutations - allows erlotinib (EGFR TKI). EBUS-FNA is 94.5% sensitivity to identify.

ALK re-arrangement

BRAF 600E

ROSA1

PD-L1 expression over 50% = candidate for first-line immunotherapy.