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Screening for lung cancer: in pursuit of pre-metastatic disease

Nature Reviews Cancer volume 3, pages 65–73 (2003)Cite this article

Abstract

One reason for the high death rate of lung cancer is that tumours are not usually detected until the disease is at a late stage, at which point the cancer is non-curable. Spiral computerized tomography is a highly sensitive imaging method that could be used to screen high-risk populations, such as current or former smokers, for early-stage tumours. Trials to validate this tool are just underway, but beyond the imaging tools, population-based care of pre-metastatic lung cancer requires considerable evolution in clinical management approaches. More sensitive imaging tools might also provide a window into earlier biology, enabling the molecular dynamics of lung cancer progression to be elucidated.

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Figure 1: Effect of computed tomography (CT) slice thickness on volume reconstruction.
Figure 2: Lung imaging with chest X-ray and spiral computed tomography (CT).
Figure 3: Small-volume primary lung cancer.
Figure 4: 'Ground-glass opacity' or non-solid lung nodule.

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Acknowledgements

The author thanks the following for their useful comments and insights, including members of the Intervention Section, D. Sullivan, R. Smith, M. Schiffman, D. Yankelvitz and J. Gomez. In addition, the author apologizes to the authors of relevant publications in this area that were omitted due to space constraints.

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  1. the Intervention Section, Cell and Cancer Biology Branch, Center for Cancer Research, National Cancer Institute, National Institutes for Health, Bethesda, 20892-1906, Maryland, USA

    James L. Mulshine

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Glossary

FIELD CARCINOGENESIS

A term for a chronic cancer diathesis coined to describe the multifocal and pleotrophic pre-cancerous and overt cancer involvement that is evident throughout the surgically removed tissues of smokers with cancer. This phenomenon occurs as a consequence of chronic exposure to aerosolized carcinogens in smokers and leads to metachronous (sequential, independent) primary cancers.

GROUND GLASS OPACITIES

A descriptive term that is used by radiologists to describe areas of interstitial congestion that is variably due to infectious processes, non-specific factors or, in a fraction of cases, related to metaplastic alveolar-cell infiltrations or early lung cancer.

REGISTRATION

The orientation of an organ structure relative to the location of the detection system when an imaging study is performed.

SOJOURN TIME

Time spent in the preclinical phase (detectable, but no symptoms present) of the natural history of a chronic disease. More-sensitive cancer-detection tests can increase the sojourn time. This could result in a longer therapeutic window before the occurrence of metastatic disease.

THORACOTOMY

An operation in which one lobe of the lung is removed along with the regional lymph nodes.

3D VOLUME RENDERING

The process of reconstructing imaging data from serial consecutive slices in three dimensions for display purposes.

VOXEL

A unit of volume corresponding to the smallest element depicted in a three-dimensional computed tomography (CT) image. For spiral CT, the size of this volume is determined by the design of the instrument and the instrument settings. For the latest scanners, the voxel size can be 0.3 mm × 0.3 mm × 0.6 mm, yielding a volume of 0.054 mm3.

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Mulshine, J. Screening for lung cancer: in pursuit of pre-metastatic disease. Nat Rev Cancer 3, 65–73 (2003). https://doi.org/10.1038/nrc972

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