#NET SENSITIVITY FOR SEQUENTIAL TESTING TRIAL#

The sensitivity for detecting abnormal lesions using AFB with white light could be two times that using white light alone. AFB has a sensitivity for early-stage lung cancer of 44–82% compared with 9–58% using conventional white light bronchoscopy. We hypothesised that the high-performance sensitivities expected using modern cytology/cytometry would miss few cancers as a first screening test.Īutofluorescence bronchoscopy (AFB) is an optical imaging technique that compares fluorescence properties between normal and malignant/pre-malignant bronchial mucosa. In a large study of smokers, 80% of lung cancers with sputum samples had abnormal cytometry compared with only 4% who had abnormal cytology. Another sputum test involves computer-assisted image analysis (automated image cytometry), which quantitatively analyses the nuclear structure and DNA content of individual cells, distinguishing normal from suspicious cells. However, modern cytology methods have better sensitivity. There is an established association between having abnormal sputum cytology and lung cancer, although the earlier randomised trials of cytology failed to reduce lung cancer mortality. Many smokers (particularly those with COPD) produce more sputum, containing exfoliated cells from the bronchial tree. Sample procurement can be done at home without specialist equipment.

Sputum cytology is a noninvasive and nonradiological test for lung disease, especially central airway tumours. Therefore, targeted lung cancer screening among individuals with COPD is appealing. Decreasing lung function (using Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria) is associated with increasingly worse survival. current/ex-smokers with chronic obstructive pulmonary disease (COPD), based on promising evidence for the component tests.ĬOPD is correlated with lung cancer risk, and is an independent risk factor to smoking and other characteristics. Instead of offering a single screening test, we created a novel approach of sequential screening (using sputum and imaging) and in a particularly high-risk group, i.e. We proposed a different strategy to make screening more efficient. Our LungSEARCH study was developed in 2006, long before NLST and NELSON were published. However, uptake in the USA is low (<5% of those eligible). LDCT screening is recommended in the USA and suggested for Europe.

#NET SENSITIVITY FOR SEQUENTIAL TESTING TRIAL#

Two major LDCT trials (the US National Lung Screening Trial (NLST) and the NELSON study) now show a clear reduction in lung cancer mortality among current/ex-smokers who had annual LDCT compared with either chest radiography or no screening. Furthermore, LDCT might miss early squamous cell tumours located in the central airways. Expected major issues with LDCT screening included affordability and high false-positive rates (FPRs) (which can be reduced through improved management of pulmonary nodules). ĭuring the 2000s, several randomised trials were developed to evaluate low-dose computed tomography (LDCT). However, early detection with intended curative treatments can have an 80% 1-year survival rate for stage I disease. Lung cancer is associated with poor survival because most cases are diagnosed at a late stage.

Net sensitivity for sequential testing