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The First International Conference on Screening for Lung Cancer

Location: Weill Medical College of Cornell University

1300 York Avenue, New York NY 10021

Workshop 2 - Possible regimens for lung cancer screening

Mission:To produce a statement of what kinds of screening are, at present, promising enough to warrant an effectiveness trial in their own right, and what tests might then be studied as add-ons. Big picture, not details. Also, a brief justification. Note: What makes a particular type of screening (spiral CT, say) promising is an appreciable shift in the size-distribution of detected malignancies without too many false positives - this in repeat screenings.
Co-Chair:Robert Clark, James Mulshine
Members:Kenji Eguchi, Thomas Hartman, Dorith Shaham, Shusuke Sone, David Yankelevitz

Summary 1. Our workshop defined screening as the identification of preclinical risk or presence of a specific condition (e.g., lung cancer) in an asymptomatic population.

2. We agreed that the screening test(s) should be simple, cost-effective, noninvasive, and potentially widely available, with demonstrated adequate sensitivity, specificity, and predictive value.

3. The tests that we considered as potential screening regimens are:

  • Chest radiography (plain; digital, with or without computer-assisted diagnosis [CAD]; energy-subtraction imaging, with or without CAD.
  • Helical CT (with or without CAD)
  • Positron Emission Tomography [PET]
  • Electrical impedance tomography imaging
  • Helium Magnetic Resonance Imaging [MRI]
  • Sputum evaluation (cytology, and/or immune-markers)
  • Pulmonary function tests (PFTs)
  • LIFE bronchoscopy
  • CT virtual bronchography
4. We agreed that the most promising modalities (based on the criteria noted in #2) are:
  • Helical CT; state of the art, with standardized interpretive, diagnostic and interventional algorithms.
  • Sputum analysis with immune markers (e.g. hnRNP) with automated computerized reading and with standardized diagnostic or interventional algorithms.
5. We agreed that helical CT and sputum analysis with immune markers are potentially complementary screening tests.
  • Anatomical (central vs. peripheral)
  • Histological (squamous vs. adenocarcinoma)
  • Time course and function (early molecular changes vs. early morphological)
6. We agreed that screening should be performed in a programmatic setting including outcome evaluation, quality assurance, standardized interpretation, diagnostic evaluation, and organized reporting and results communication to physicians and screenees. 7. The remaining modalities were not recommended as screening modalities in their own right because they:
  • did not meet the criteria noted in item #2,
  • were too early in their investigative course, or
  • were considered more appropriate for diagnostic evaluations.
However, many of these are appropriate for consideration as add-on research studies, but not as primary screening modalities. 8. Further research is necessary to determine optimum details for:
  • Target population characteristics (age, PFTs, smoking history, etc.)
  • Periodicity of screening
  • Noninvasive diagnostic algorithms after abnormal screening results
  • Invasive tissue sampling and treatment algorithms
9. Consideration should be made to bank (store) certain samples from screened subjects for further study (e.g., sputum, blood, buccal smears)

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