Lung Cancer/Solitary Pulmonary Nodule
United States. Surgeon General's Advisory Committee on Smoking and Health, and United States. Public Health Service. Office of the Surgeon General. "Smoking and Health." United States. Public Health Service. Office of the Surgeon General, 1964. Official Report This landmark U.S. Surgeon General’s report added to the growing international recognition of the multiple hazards of cigarette smoking. http://profiles.nlm.nih.gov/NN/B/B/M/Q/segments.html
Staging and Surgical Risk Assessment
O, Meziane M, Rice T. Seventh edition of the cancer staging manual and stage
grouping of lung cancer: quick reference chart and diagrams. Chest 2011;139:183-9.
This quick and comprehensive reference is invaluable for determining stage
based on the updated TNM classification.
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staginglungcancer.org Created by the American College of Chest Physicians with other partners, this interactive website includes a staging calculator, an interactive staging table with links to representative diagnostic images, and survival figures, all designed to help navigate the complexity of lung cancer staging.
Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd Ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e211S-50S. ACCP evidence-based clinical practice guidelines (3rd Edition) reviewing the evidence for both invasive and non-invasive staging of non-small cell lung cancer with CT and PET scanning as well as TTNA, TBNA, EBUS, EUS, VATS, Chamberlain procedure, mediastinoscopy and extended cervical mediastinoscopy.
JT, van Meerbeeck JP, Rintoul RC, et al. Mediastinoscopy vs
endosonography for mediastinal nodal staging of lung cancer: a randomized
trial. JAMA 2010;304:2245-52. An RCT of EUS/EBUS/surgical
staging vs. surgical staging alone in 241 patients with potentially resectable
NSCLC found a sensitivity and NPV of 94% and 93% with the combined approach, a
substantial improvement over surgical staging alone (79% and 86%). In the
123 patients assigned to the combined modality arm, endosonography identified
mediastinal metastases in half, precluding the need for mediastinoscopy. In the
65 patients with negative EUS/EBUS-FNA, mediastinoscopy identified cancer in
six patients. The study was performed at tertiary centers using conscious
sedation for endosonography.
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J, Ferguson M, Mazzone P, et al. American College Of Chest Physicians And
Society Of Thoracic Surgeons consensus statement for evaluation and management
for high-risk patients with stage I non-small cell lung cancer. Chest 2012;
142:1620-35. This summary is a useful resource for identifying and weighing
treatment options for stage I patients unlikely to tolerate lobectomy,
including the relative merits of wedge resection vs. segmentectomy, as well as
use of adjuvant therapies, radiation therapy, and percutaneous ablative
DJ. Physiologic evaluation of the patient with lung
cancer being considered for resectional surgery: Diagnosis and management of
lung cancer, 3rd ed: American College of Chest Physicians evidence-based
clinical practice guidelines. Chest.
2013 May;143(5 Suppl):e166S-90S. These guidelines provide methods of
identifying low-risk and high-risk patients for lung resection surgery, as well
as appropriate further testing once identified.
Colt HG, Murgu SD, Korst RJ, et al. Follow-up and surveillance of the patient
with lung cancer after curative-intent therapy: Diagnosis and management of
lung cancer, 3rd ed: American College of Chest Physicians
evidence-based clinical practice guidelines. Chest 2013; 142(5 Suppl):e437S-54S. Guideline recommends serial surveillance
chest CT scans and measures of quality of life following resection while
acknowledging the paucity of studies guiding care in this population.
Screening for lung cancer
Lung Screening Trial Research Team. Reduced lung-cancer mortality with
low-dose computed tomographic screening. N Engl J Med 2011;365:395-409.
This large trial compared annual CT versus CXR over two years (baseline,
one-year, and two-year screening). Analyzing only those who underwent at
least one screening test, the absolute risk reduction for lung
cancer-associated mortality was 0.3% (relative reduction of 20%), yielding a number
needed to screen to prevent one death of approximately 320, with a CT false
positive rate of 96.4%. Cost-effectiveness analyses and evaluation of the
impact of invasive procedures related to false-positive results are not yet
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MM, Hocking WG, Kvale PA, et al. Screening by chest radiograph and lung
cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized
trial. JAMA 2011;306:1865-73. A large prospective trial of annual CXR
versus usual care found no difference in the incidence of lung cancer or in
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Solitary pulmonary nodule
Lynch WR, et al. Evaluation of
individuals with pulmonary nodules: when is it lung cancer? Diagnosis and
management of lung cancer, 3rd ed: American College of Chest Physicians
evidence-based clinical practice guidelines.
Chest. 2013;143(5 Suppl):e93S-120S.
Guideline for how best to work up the
nodule(s) that nicely distills the large number of trials on this
Austin JH, Gamsu G, et al. Guidelines for management of small pulmonary
nodules detected on CT scans: A statement from the Fleischner Society.
Radiology 2005; 237:395-400. This statement recommends less aggressive
follow-up of small (6 mm or less) pulmonary nodules based on findings from
recent lung cancer screening studies.
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