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Lung Cancer/Solitary Pulmonary Nodule

Risk factors

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


Lababede 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.
PMID: 21208878                  
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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 G, Gould M, Margolis M, et al.  Noninvasive staging of non-small cell lung cancer.  Chest 2007;132:178S-201S. ACCP evidence-based clinical practice guidelines (2nd Edition) reviewing the evidence for staging of non-small cell lung cancer with CT and PET scanning.
PMID:  17873168
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Detterbeck F, Jantz M, Wallace M, et al.  Invasive mediastinal staging of lung cancer.  Chest 2007; 202S-220S.  ACCP evidence-based clinical practice guidelines (2nd Edition) reviewing the sensitivity and specificity of various tissue sampling techniques:  TTNA, TBNA, EBUS, EUS, VATS, Chamberlain procedure, mediastinoscopy and extended cervical mediastinoscopy.
PMID:  17873169
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Annema 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, and in the 65 patients with negative EUS/EBUS-FNA, mediastinoscopy identified cancer in only six, highlighting the high sensitivity of the endosonographic approach alone. The study was performed at tertiary centers using conscious sedation for endosonography.
PMID: 21098770
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Donington 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 therapy.
PMID: 23208335

Screening for lung cancer

National 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 known.
PMID: 21714641
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Oken 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 mortality.
PMID: 22031728
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Solitary pulmonary nodule

Gould MK, Fletcher J, Iannettoni MD, et al.  Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition).  Chest. 2007;132(3 Suppl):108S-130S.  Guideline for how best to work up the incidental nodule(s) that nicely distills the large number of trials on this topic.
PMID:  17873164
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MacMahon H, 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.
PMID:  16244247
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