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. 2018 Dec;154(6):1284-1290.
doi: 10.1016/j.chest.2018.07.029. Epub 2018 Aug 3.

Characteristics and Outcomes of Small Cell Lung Cancer Detected by CT Screening

Anish Thomas  1 , Puskar Pattanayak  2 , Eva Szabo  3 , Paul Pinsky  3
Affiliations

Characteristics and Outcomes of Small Cell Lung Cancer Detected by CT Screening

Anish Thomas et al. Chest. 2018 Dec.

Abstract

Background: Previous studies with a limited number of patients have reported divergent findings on whether screening can detect small cell lung cancer (SCLC) at an earlier stage and whether there might be a survival benefit.

Methods: This study examined the characteristics of SCLC detected by using low-dose CT (LDCT) screening in the National Lung Screening Trial, a randomized study of individuals at high risk for developing lung cancer comparing LDCT imaging vs chest radiography. SCLC was denoted as screen detected if diagnosed ≤ 1 year of a positive screen or after a longer period but with no time gap between diagnostic procedures of > 1 year; interval detected if diagnosed ≤ 1 year of a negative screen; and nonscreen detected if the subject did not receive any screens or otherwise as postscreening.

Results: A total of 143 cases of SCLC were diagnosed, including 49 (34.2%) screen detected, 15 (10.5%) interval detected, and 79 (55.2%) nonscreened/postscreening. Of the screening phase-diagnosed cases (ie, screen or interval detected), a higher proportion of SCLC cases compared with NSCLC cases were interval detected (23% vs 5%; P < .0001). A higher proportion of all SCLC cases compared with NSCLC cases were advanced stage (III/IV: 86% vs 36%; P < .0001). The unfavorable SCLC stage distribution extended across screen-detected (80% stage III/IV), interval-detected (86%), and nonscreened/postscreening (90%) cancers. Among screen-detected SCLC, only 63.3% had ≥ 1 noncalcified nodule in the cancer lobe compared with 85.4% of NSCLC cases (P < .0001). Even with very small LDCT screen-detected nodules, a high proportion of SCLC cases were late stage. There was no significant difference in survival between screen- and interval-detected or postscreening SCLC.

Conclusions: "Early detection" with the use of LDCT imaging had no impact on SCLC outcomes. A successful screening modality should ideally detect SCLC earlier than when it can be detected on LDCT scans.

Keywords: low-dose CT scan; lung cancer screening; non-small cell lung cancer; small cell lung cancer.

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Figures

Figure 1
Figure 1
A, The National Lung Screening Trial design. Subjects were enrolled and randomly assigned to undergo three annual screenings with either LDCT imaging or CXR. B, Mode of detection of screen-detected or interval-detected lung cancers. Compared with NSCLC cases, a significantly higher proportion of SCLC cases were interval detected than screen detected. C, Stage distribution of all cancers. Compared with NSCLC cases, a significantly higher proportion of SCLC cases were detected in stages III and IV than stages I and II. CXR = chest radiograph; LDCT = low-dose CT; NSCLC = non-small cell lung cancer; SCLC = small cell lung cancer.
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