Ikuma Kasuga^1-4* and Osamu Ohtsubo^2,5

¹Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Tokyo, Japan
²Department of Nursing, Faculty of Human Care, Tohto University, Saitama, Japan
³Department of Internal Medicine, Faculty of Medicine, Tokyo Medical University, Tokyo, Japan
⁴Life Redesign College, Waseda University, Tokyo, Japan
⁵Kenkoigaku Association, Tokyo, Japan

*Corresponding Author: Ikuma Kasuga, Director and Professor, Healthcare Center, Shinjuku Oiwake Clinic and Ladies Branch, Seikokai, Shinjuku-ku, Shinjuku, Tokyo, Japan.

Received: June 07, 2024; Published: July 16, 2024

Abstract

Background: The usefulness of low-dose computed tomography (LDCT) for early detection of lung cancer has been widely reported. In addition to the early detection of lung cancer, many improved cases and false-positive scans by LDCT screening have also been reported. Therefore, the actual situation of LDCT screening for lung cancer and other thoracic diseases remains unclear. The aim of this study was to investigate the detailed clinical course of cases detected by LDCT and evaluate the usefulness of LDCT for lung cancer and other thoracic diseases during health checkups.

Materials and Methods: Among 6,402 (4,444 men and 1,958 women) individuals who had received LDCT at health checkups over a recent 12-year period, we investigated the number of cases who have abnormal opacity on LDCT and warrant detailed examination. We also investigated the final outcomes of these patients after a detailed examination.

Results: Totally, 206 cases were detected for detailed examination by LDCT and 50 out of 206 cases (24%) were finally taken medical treatment. Among them, the most commonly encountered lesion was pulmonary infection, and 22 patients were treated with antibiotics. Eleven patients with lung cancer and 4 patients with mediastinal tumors were also detected, which could lead to early surgical treatment. Early signs of chronic obstructive pulmonary disease (COPD) was also found and among them, smoking cessation could be performed in 10 patients. Other pulmonary diseases were occasionally detected using LDCT, including 1 case of lymphangioleiomyomatosis (LAM), 1 case of idiopathic pulmonary fibrosis (IPF), and 1 case of pulmonary sequestration. In contrast, 156 other cases (76%) were determined to continue follow-up or improve spontaneously at the time of the outpatient clinic.

Conclusions: LDCT found various thoracic diseases including lung cancer, mediastinal tumors and COPD which could lead to early treatment. However, we also found that more than three-quarters of untreated cases were present after a detailed examination.

 Keywords: Lung Cancer; Mediastinal Tumor; Chronic Obstructive Pulmonary Disease; Pulmonary Infection; Low-Dose; Computed Tomography

References

1. Raoof S., et al. “Interpretation of plain chest roentgenogram”. Chest 141 (2012): 545-558.
2. Wielputz MO., et al. “Incidential findings in chest X-rays”. Radiologe 57 (2017): 263-269.
3. van’t Westeinde SC., et al. “How to deal with incidentally detected pulmonary nodules less than 10 mm in size on CT in a healthy person”. Lung Cancer 60 (2008): 151-159.
4. Spiro SG and Silvestri GA. “One hundred years of lung cancer”. American Journal of Respiratory and Critical Care Medicine 172 (2005): 523-529.
5. Pastorino U., et al. “Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results”. Lancet 362 (2003): 593-597.
6. Henschke CL., et al. “Early lung cancer action project: overall design and findings from baseline screening”. Lancet 354 (1999): 99-105.
7. Swensen SG., et al. “CT screening for lung cancer: five-year prospective experience”. Radiology 235 (2005): 259-265.
8. Kasuga I., et al. “Evaluation of chest radiography and low-dose computed tomography as valuable screening tools for thoracic diseases”. Medicine 101 (2022): e29261.
9. Mihara S., et al. “Cancer registration on Ningen Dock—2017 Data”. Ningen Dock 35 (2020): 74-89.
10. Du Y., et al. “Computed tomography screening for early lung cancer, COPD and cardiovascular disease in Shanghai: rationale and design of a population-based comparative study”. Academic Radiology 28 (2021): 36-45.
11. Goddard PR., et al. “Computed tomography in pulmonary emphysema”. Clinical Radiology 33 (1982): 379-387.
12. Ding L., et al. “Somatic mutations affect key pathways in lung adenocarcinoma”. Nature 455 (2008): 1069-1075.
13. Kasuga I., et al. “Tumor-related leukocytosis is linked with poor prognosis in patients with lung carcinoma”. Cancer 92 (2001): 2399-2405.
14. Kasuga I., et al. “Alpha-fetoprotein producing pulmonary blastoma in a patient with systemic sclerosis: pathogenetic analysis”. European Respiratory Journal 11 (1998): 1185-1187.
15. National Cancer Center Ganjoho service. National Cancer Center Japan; (2019).
16. National Cancer Center Ganjoho service. National Cancer Center Japan (2019).
17. Candemir S and Antani S. “A review on lung boundary detection in chest X-rays”. International Journal of Computer Assisted Radiology and Surgery 14 (2019): 563-576.
18. Doi K. “Computer-aided diagnosis in medical imaging: historical review, current status and future potential”. Computerized Medical Imaging and Graphics 31 (2007): 198-211.
19. Yan JH., et al. “Lung ultrasound vs chest radiography in the diagnosis of children pneumonia: Systematic evidence”. Medicine 99 (2020): e23671.
20. Oken MM., et al. “Screening by chest radiograph and lung cancer mortality: The Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial”. The Journal of the American Medical Association 306 (2011): 1865-1873.
21. Aberle DR., et al. “Reduced lung-cancer mortality with low-dose computed tomographic screening”. The New England Journal of Medicine 365 (2011): 395-409.
22. Jemal A and Fedewa SA. “Lung cancer screening with low-dose computed tomography in the United States-2010 to 2015”. The Journal of the American Medical Association Oncology 3 (2017): 1278-1281.
23. Soneji S., et al. “Underuse of chest radiography versus computed tomography for lung cancer screening”. American Journal of Public Health 107 (2017): 1248-1250.
24. Giordano L., et al. “Mammographic screening programmes in Europe: organization, coverage and participation”. Journal of Medical Screening 19 (2012): 72-82.
25. National Cancer Center Ganjoho service. National Cancer Center Japan; (2019).
26. Kasuga I., et al. “Hamartoma, teratoma, dermoid cyst, embryoma, heteroplasia”. Nippon Rinsho Ryoikibetsu Shokogun Series 4 (1994): 224-225.
27. Kasuga I., et al. “An autopsy case of lymphoepithelioma-like carcinoma of the mediastinum”. Nihon Kyobu Shikkan Gakkai Zasshi 32 (1994): 507-510.
28. Kasuga I., et al. “A case of mediastinal teratoma diagnosed by transbronchial lung biopsy”. Kikanshigaku 13 (1991): 616-619.
29. Yano M., et al. “Thymic carcinoma: 30 cases at a single institution”. Journal of Thoracic Oncology 3 (2008): 265-269.
30. Kondo K and Monden Y. “Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan”. The Annals of Thoracic Surgery 76 (2003): 878-884.
31. Yamane M and Toyooka S. “Redo operation for mediastinal tumor”. Kyobu Geka 74 (2021): 839-844. (in Japanese)
32. Suster DI and Suster S. “Liposarcomas of the mediastinum”. Mediastinum 4 (2020): 27.
33. Bokhari SA., et al. “Myxomatous liposarcoma of the mediastinum: A review of the literature”. Cureus 14 (2022): e28438.
34. Miura K., et al. “Primary mediastinal dedifferentiated liposarcoma: Five case reports and a review”. Thoracic Cancer 9 (2018): 1733-1740.
35. Springfield D. “Liposarcoma”. Clinical Orthopaedics and Related Research 289 (1993): 50-57.
36. Yoshino R., et al. “Primary dedifferentiated liposarcoma of the posterior mediastinum with a positive surgical margin”. Cureus 15 (2023): e36611.
37. Ruparel M., et al. “Pulmonary nodules and CT screening: the past, present and future”. Thorax 71 (2016): 367-375.
38. Wiener RS., et al. “An official American Thoracic Society/American Clooege of Chest Physicians policy statement: implementation of low-dose computed tomography lung cancer screening programs in clinical practice”. American Journal of Respiratory and Critical Care Medicine 192 (2015): 881-891.
39. Siegfried JM. “Sex and gender differences in lung cancer and chronic obstructive lung disease”. Endocrinology 163 (2022): bqab254.
40. File Jr TM. “Streptococcus pneumoniae and community-acquired pneumonia: a cause for concern”. The American Journal of Medicine Supplements 117 (2004): 39-50.
41. Upchurch CP., et al. “Community-acquired pneumonia visualized on CT scans but not chest radiographs: pathogens, severity, and clinical outcomes”. Chest 153 (2018): 601-610.
42. Ahn DG., et al. “Current status of epidemiology, diagnosis, therapeutics, and vaccines for novel coronavirus disease 2019 (COVID-19)”. Journal of Microbiology and Biotechnology 30 (2020): 313-324.
43. Henry BM and Vikse J. “Clinical characteristics of Covid-19 in China”. The New England Journal of Medicine 382 (2020): 1860-1861.
44. Guan W-J., et al. “Characteristics of coronavirus disease 2019 in China”. The New England Journal of Medicine 382 (2020): 1708-1720.
45. Ledford H. “How severe are Omicron infections?’’ Nature 600 (2021): 577-578.
46. Maslo C., et al. “Characteristics and outcomes of hospitalized patients in South Africa during the COVID-19 omicron wave compared with previous waves”. The Journal of the American Medical Association 327 (2022): 583-584.
47. Antonelli M., et al. “Risk of long COVID associated with delta versus omicron variants of SARS-CoV-2”. Lancet 399 (2022): 2263-2264.
48. Gao SJ., et al. “Omicron variant (B.1.1.529) of SARS-CoV-2, a global urgent public health alert!”. Journal of Medical Virology 94 (2022): 1255-1256.
49. He JQ., et al. “Genetics of COPD. Chap. VII Pharmacotherapy in Chronic Obstructive Pulmonary Disease”. Editor: Bartolome RC. Boca Raton: CRC Press, New York (2003), 119-144.
50. Hogg JC., et al. “The nature of small-airway obstruction in chronic obstructive pulmonary disease”. The New England Journal of Medicine 350 (2004): 2645-2653.
51. Kasuga I., et al. “Lack of association of group specific component haplotypes with lung function in smokers”. Thorax 58 (2003): 790-793.
52. Kasuga I., et al. “Lack of association of human leukocyte antigen-B7 with COPD and rate of decline in lung function”. Respiratory Medicine 99 (2005): 1528-1533.
53. Kasuga I., et al. “Role of genetic susceptibility to latent adenoviral infection and decreased lung function”. Respiratory Medicine 103 (2009): 1672-1680.
54. Wheaton AG., et al. “Chronic obstructive pulmonary disease and smoking status - United States, 2017”. Morbidity and Mortality Weekly Report 68 (2019): 533-538.
55. Talamo RC., et al. “Hereditary alpha-1-antitrypsin deficiency”. The New England Journal of Medicine 278 (1968): 345-351.
56. Bai JW., et al. “Smoking cessation affects the natural history of COPD”. International Journal of Chronic Obstructive Pulmonary Disease 12 (2017): 3323-3328.
57. Tashkin DP. “Smoking cessation in chronic obstructive pulmonary disease”. Seminars in Respiratory and Critical Care Medicine 36 (2015): 491-507.
58. Madani A., et al. “Quantitative computed tomography assessment of lung structure and function in pulmonary emphysema”. European Respiratory Journal 18 (2001): 720-730.
59. Gelb AF., et al. “Contribution of emphysema and small airways in COPD”. Chest 109 (1996): 353-359.
60. Komatsu N. “Radiological diagnosis –diagnosis and evaluation by chest X ray, chest CT and chest MRI”. Nihon Rinsho 65 (2007): 670-674.
61. Wagner PD., et al. “Major causes of death in China”. The New England Journal of Medicine 354 (2006): 874-876.
62. Duffy SP and Criner GJ. “Chronic obstructive pulmonary disease: Evaluation and management”. Medical Clinics of North America 103 (2019): 453-461.
63. Fukuchi Y., et al. “COPD in Japan: the Nippon COPD epidemiology study”. Respirology 9 (2004): 458-465.
64. Boxt LM., et al. “Normal plain film examination of the heart and great arteries in the adult”. Journal of Thoracic Imaging 9 (1994): 208-218.
65. Messerli M., et al. “Diagnostic accuracy of chest X-ray dose-equivalent CT for assessing calcified atherosclerotic burden of the thoracic aorta”. British Journal of Radiology 90 (2017): 20170469.
66. Sayed A., et al. “Aortic Dissection: A review of the pathophysiology, management and prospective advances”. Current Cardiology Reviews 17 (2021): e230421186875.
67. Brenner DJ and Hall EJ. “Computed tomography--an increasing source of radiation exposure”. The New England Journal of Medicine 357 (2007): 2277-2284.
68. McCollough CH., et al. “Strategies for reducing radiation dose in CT”. Radiologic Clinics of North America 47 (2009): 27-40.
69. Vehmas T, et al. “Factors influencing patient radiation doses from barium enema examinations”. Acta Radiologica 41 (2000): 167-171.

Citation

Citation: Ikuma Kasuga and Osamu Ohtsubo. “Actual Situation on Low-dose Computed Tomography Screening for Thoracic Diseases at Health Checkup”.Acta Scientific Medical Sciences 8.8 (2024): 120-130.

Copyright

Copyright: © 2024 Ikuma Kasuga and Osamu Ohtsubo. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.