Cardiac calcium score screening CT can also detect lung cancer

CHICAGO – CT with the coronary artery calcium score (CAC) can incidentally identify early-stage lung cancer, according to a study presented Dec. 4 at the RSNA meeting.

“Our study highlights the importance of monitoring, reporting and tracking incidental lung nodules on calcium score examinations for the early detection and treatment of lung cancer,” moderator Syed Muhammad Awais Bukhari, MD, of Cleveland Medical Center, told session participants.

Calcium score screening (CSS) CT is known to be an effective method for assessing cardiovascular disease risk and guiding therapy, Bukhari said. The fact that cardiovascular disease and lung cancer share several risk factors (such as smoking, obesity and diabetes) means that lung cancer can potentially be detected in patients who undergo coronary artery calcium (CAC) CT scanning, Bukhari remarked.

“Early detection (of lung cancer) is critical because survival rates are significantly higher for (a disease) diagnosed at stage 1 or 2,” he said.

He and his colleagues examined the prevalence of incidental lung cancer detected during routine calcium score screening for cardiac evaluation and evaluated the stage of diagnosis of all lung cancers found. They conducted a study that included data from 914 patients who underwent CAC-CT imaging between January 2013 and February 2019 and were diagnosed with lung cancer. The majority of the patient cohort consisted of whites (84.7%), women (66.8%), and former smokers (48%); 74.1% had hypertension, 24.8% had type 2 diabetes, and 32.1% had coronary artery disease.

Of these 914 patients, 216 were found to have a suspicious pulmonary nodule or mass that was first detected on CT imaging for calcium score screening. Of the 216 patients, 202 had primary lung cancer and 14 had secondary lung cancer. According to Bukhari, 59.4% of primary lung cancer patients were diagnosed at stage 1 or earlier.

“(Our) study results show that coronary artery calcium score CT can detect a significant number of lung cancers at an early stage, offering patients a significant chance of a complete cure,” he concluded.

In a talk at the same session that also highlighted the benefits of opportunistic CT imaging, Tong Yu, MD, of the University of Pittsburgh, shared results of a study that suggest that assessing body composition using CT imaging holds promise for the Differentiation between malignant and malignant diseases is benign pulmonary nodules.

The study included 216 people participating in a low-dose CT lung cancer screening program; All had indeterminate pulmonary nodules (IPNs) detected on baseline CT imaging and at least one follow-up CT scan. Yu and colleagues used AI algorithms to segment and quantify IPNs and track five body composition measurements obtained during these baseline and follow-up visits.

Specifically, they found that skeletal muscle density had predictive power for distinguishing between malignant and benign pulmonary nodules, with an area under the receiver operating curve of 0.87.

“Integrating body composition with nodule characteristics can significantly improve the assessment of malignancy of IPN,” Yu concluded.

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