Randomized controlled trial with low-dose spiral CT for lung cancer screening: feasibility study and preliminary results.
OBJECTIVE
To assess the feasibility of conducting a randomized controlled trial for lung cancer screening.


METHODS
Subjects are being recruited into a randomized controlled trial to undergo either low-dose spiral computed tomography (CT) or observation. Subjects are from a high-risk group with known chronic obstructive pulmonary disease and sputum atypia and a moderate-risk group randomly selected from the general population of a Veterans Affairs Medical Center. All subjects must be 50-80 years of age with 30 or more pack-years of cigarette smoking and must not have undergone chest CT during the previous 3 years. Baseline screening CT is performed with 50 mA, 120 kVp, 5-mm collimation, and a pitch of 2. CT scan interpretation and management of nodules is based on Society of Thoracic Radiology guidelines. The chi(2) test for categoric data was used for statistical analysis.


RESULTS
To date, 304 eligible subjects have been contacted, and 239 (79%) have agreed to participate in the trial. One hundred nineteen (88%) of the 136 subjects in the high-risk group and 120 (71%) of the 168 subjects in the moderate-risk group agreed to randomization (P <.001). To date, 190 subjects have been randomized. Of the first 92 subjects examined with CT, 22 (40%) of 55 in the high-risk group and eight (22%) of 37 in the moderate-risk group had one to six noncalcified nodules that required follow-up (P =.07). In all but three subjects, nodules were smaller than 5 mm. Two of the three larger nodules were malignancies.


CONCLUSIONS
Findings of this study indicate that a randomized controlled trial of CT to screen for lung cancer is feasible.
Garg
Kavita
K
Department of Radiology, University of Colorado, Denver Veterans Affairs Medical Center, USA. kavita.garg@uchsc.edu
Keith
Robert L
RL
Byers
Tim
T
Kelly
Karen
K
Kerzner
Anne L
AL
Lynch
David A
DA
Miller
York E
YE
D000368:Aged; D000369:Aged, 80 and over; D002283:Carcinoma, Bronchogenic / Q000000981:diagnostic imaging*; D003120:Colorado; D005240:Feasibility Studies; D006787:Hospitals, Veterans; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008403:Mass Screening; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging; D011829:Radiation Dosage; D012306:Risk; D012680:Sensitivity and Specificity; D012907:Smoking / Q000009:adverse effects; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging; D013183:Sputum / Q000166:cytology; D036542:Tomography, Spiral Computed; D014728:Veterans