Alla Godelman MD, Abstract Co-Author: Nothing to Disclose

Hannah Milch MD, Presenter: Nothing to Disclose

Mark Kaminetzky, Abstract Co-Author: Nothing to Disclose

Anna Shmukler MD, Abstract Co-Author: Nothing to Disclose

Tova C. Koenigsberg MD, Abstract Co-Author: Nothing to Disclose

Linda Broyde Haramati MD, MS, Abstract Co-Author: Investor, OrthoSpace Ltd Investor, Kryon Systems Ltd Spouse, Board Member, Bio Protect Ltd Spouse, Board Member, OrthoSpace Ltd Spouse, Board Member, Kryon Systems Ltd

To evaluate the applicability of the National Lung Screening Trial (NLST) results to a predominantly poor, overweight, inner-city minority population.

We examined the data for all 198 patients who underwent low dose chest CT as part of our inner-city academic medical center’s lung cancer screening program from its inception in 12/2012 till 2/2014. All met NLST eligibility criteria. A screening coordinator worked closely with patients and tracked follow-up. CTs were interpreted clinically by 1 of 4 cardiothoracic radiologists. Results were reported as 5 standardized categories: 1. No evidence of lung cancer, normal chest; 2. No evidence of lung cancer, benign pulmonary findings; 3. Small nonspecific pulmonary nodules; 4. Small spiculated nodule (4a) or ground glass nodule (4b); 5. Pulmonary mass (5a) or metastatic disease (5b). Routine screening in 1-year was recommended for categories 1 and 2. Shorter follow up (Fleischner criteria) was advised for categories 3 and 4. Tissue correlation was advised for category 5. Calcium score (Shemesh et al. range 0-12) was reported. Additional data included demographics, smoking history, BMI, dose length product (DLP), and lung biopsy/resection pathology.

Of 198 patients, 54% were men, 72% current smokers, 69% non-white (35% black, 31% Hispanic, 3% other). Mean age was 64 yrs, mean BMI 31 (range 20-39). Mean calcium score was 3/12 (range 0-12), mean DLP 107 (range 71-223). 73% results were categories 1 and 2, 22% category 3, 2% category 4 and 3% category 5. 4 of 5 category 5 patients had resections confirming the diagnosis of lung carcinoma, ranging from stage IA to IIIA. One category 5 patient awaits biopsy. One category 4 had ongoing suspicion for cancer on follow up CT but biopsy results were benign.

Low dose CT lung cancer screening using NLST criteria is feasible in a predominantly poor, overweight, inner-city minority population. The screening coordinator plays a crucial role. In the first 15 months, lung cancer was diagnosed in 2%. Interpretation yielded a high specificity with sensitivity to be determined with ongoing follow-up.

Successful initiation of a lung cancer screening program is feasible in a predominantly poor, overweight, inner-city minority population. NLST results require validation in understudied populations.

Godelman, A, Milch, H, Kaminetzky, M, Shmukler, A, Koenigsberg, T, Haramati, L, Lung Cancer Screening in a Predominantly Poor, Overweight, Inner-city Minority Population: Initial Experience.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14010623.html