Thoracic Diseases Lung Cancer, Screening & Early Detection

The Role of CT

The above image shows a lung nodule in a screening CT scan requested by the patient, a 69-year-old former smoker.

Compelling evidence from several sources now suggests that in high-risk individuals, CT (computed tomography or CAT) screening is the best method to detect lung cancer in its earliest stage. The majority of lung cancers originate as a small growth or nodule in the lung. Screening CT scans are extremely sensitive in detecting nodules as small as 2 or 3mm within the lungs—much smaller than can be viewed on a conventional chest Xray. In fact, recently published articles on CT screening found that the majority of lung cancers that revealed on CT scanning could not be detected on a chest X-ray that was performed simultaneously.

The Role of PET (Positron Emission Tomography)

Early lung cancer detection at NewYork-Presbyterian/Columbia benefits greatly from its affiliation with the Columbia Kreitchman PET Center, one of the nation’s foremost clinical and research PET (positron emission tomography) and PET/CT facilities.

PET is powerful, non-invasive, diagnostic tool that detects biochemical changes in body tissues. To feed their rapid growth, tumors consume more glucose than healthy tissues. The PET scanner, which creates a color-coded image of the body’s chemical function reveals the cancer as red "hot spots" of activity.

PET/CT is the combination of PET and CT imaging techniques within a single machine. The individual PET and CT scans are taken concurrently while the patient remains in place, and can be presented separately or as a single, overlapping, "fused" image.

The two techniques present different types of information about the human body: while PET shows chemical activity, CT shows anatomical structures. For example, a PET scan would highlight a tumor’s increased glucose consumption, while a CT scan would reveal its physical mass. The fused PET/CT image provides a more reliable alternative to the traditional side-by-side visual comparison of PET and CT images.

	Images courtesy of Siemens.
The CT image (left) shows a mass in the left lung. The combined PET/CT image (right) reveals the metabolic activity of that mass, as well as its precise location in the lung. The fused image can help physicians with diagnosing and staging the disease, as well as tailoring the treatment plan.

We have used PET and PET/CT scanning in thousands of patients with lung cancer, to determine whether lung nodules are benign or malignant. Incorporating PET scanning in this way often can guide treatment plans—from indicating whether a biopsy is necessary, to guiding the shape of the area to receive radiation therapy, to pinpointing the surgical site.

NY-ELCAP

Thoracic surgeons at NewYork-Presbyterian/Columbia are active participants in CT-scan screening programs to identify and treat lung cancer in its earliest stage. We currently are enrolling patients for study in the New York Early Lung Cancer Action Project (NY-ELCAP). To qualify for this study patients must be over the age of 60, have a 10 year history of smoking one pack per day (or five years, two packs per day), have no prior history of cancer (aside from non-melanoma skin cancer), and be otherwise healthy in order to undergo surgery, should a nodule be detected. They must also have a referring physician who can follow up on any recommendations made.

Patients who qualify for the study will receive a low dose screening CT scan of the chest at no cost. All subjects with an abnormal baseline CT scan (1-6 non-calcified lung nodules) will have conventional thin section CT scanning through the nodule. Conventional management will then include empiric antibiotics, follow-up CT scans, PET scan, and biopsy or surgical removal of the nodule, depending on the characteristics of the nodule. Patients whose baseline CT scan is normal will have a subsequent lowdose CT scan at one year, at no cost.

Patients who do not qualify for this study, but are considered to be at high risk for developing lung cancer (previous or active smokers), can still undergo a low-dose screening CT scan at NewYork-Presbyterian/Columbia. To schedule the scan at your expense, please call 877.928.5864. If an abnormality is found, a conventional highresolution CT scan of the nodule will be required, which is reimbursed by all insurance carriers.