Lung Cancer Screening with Low-Dose CT: What We Have Learned in Two Decades of ITALUNG and What Is Yet to Be Addressed.
Mario MascalchiGiulia PicozziDonella PulitiStefano DiciottiAnnalisa DeliperiChiara RomeiFabio FalaschiFrancesco PistelliMichela GrazziniLetizia VannucchiSimonetta BisanziMarco ZappaGiuseppe GoriniFrancesca Maria CarozziLaura CarrozziEugenio PaciPublished in: Diagnostics (Basel, Switzerland) (2023)
The ITALUNG trial started in 2004 and compared lung cancer (LC) and other-causes mortality in 55-69 years-aged smokers and ex-smokers who were randomized to four annual chest low-dose CT (LDCT) or usual care. ITALUNG showed a lower LC and cardiovascular mortality in the screened subjects after 13 years of follow-up, especially in women, and produced many ancillary studies. They included recruitment results of a population-based mimicking approach, development of software for computer-aided diagnosis (CAD) and lung nodules volumetry, LDCT assessment of pulmonary emphysema and coronary artery calcifications (CAC) and their relevance to long-term mortality, results of a smoking-cessation intervention, assessment of the radiations dose associated with screening LDCT, and the results of biomarkers assays. Moreover, ITALUNG data indicated that screen-detected LCs are mostly already present at baseline LDCT, can present as lung cancer associated with cystic airspaces, and can be multiple. However, several issues of LC screening are still unaddressed. They include the annual vs. biennial pace of LDCT, choice between opportunistic or population-based recruitment. and between uni or multi-centre screening, implementation of CAD-assisted reading, containment of false positive and negative LDCT results, incorporation of emphysema. and CAC quantification in models of personalized LC and mortality risk, validation of ultra-LDCT acquisitions, optimization of the smoking-cessation intervention. and prospective validation of the biomarkers.
Keyphrases
- smoking cessation
- low dose
- replacement therapy
- coronary artery
- cardiovascular events
- simultaneous determination
- healthcare
- randomized controlled trial
- coronary artery disease
- chronic obstructive pulmonary disease
- high dose
- computed tomography
- palliative care
- phase iii
- mass spectrometry
- pulmonary hypertension
- contrast enhanced
- liquid chromatography
- high resolution
- quality improvement
- magnetic resonance imaging
- cardiovascular disease
- idiopathic pulmonary fibrosis
- open label
- double blind
- pulmonary artery
- phase ii
- working memory
- pregnant women
- study protocol
- placebo controlled
- machine learning
- positron emission tomography
- chronic pain
- metabolic syndrome
- data analysis
- decision making
- single cell