Screening with Low-Dose Computed Tomography Does Not Improve Survival of Small Cell Lung Cancer Mario Silva, MD, Carlotta Galeone, PhD, Nicola Sverzellati,

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Screening with Low-Dose Computed Tomography Does Not Improve Survival of Small Cell Lung Cancer Mario Silva, MD, Carlotta Galeone, PhD, Nicola Sverzellati, MD, PhD, Alfonso Marchianò, MD, Giuseppina Calareso, MD, Stefano Sestini, MD, Carlo La Vecchia, MD, Gabriella Sozzi, PhD, Giuseppe Pelosi, MD, Ugo Pastorino, MD Journal of Thoracic Oncology Volume 11, Issue 2, Pages 187-193 (February 2016) DOI: 10.1016/j.jtho.2015.10.014 Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 1 Screen-detected extensive-stage single cell lung cancer (SCLC) in a participant undergoing biennial low-dose computed tomography scan. SCLC is an extremely aggressive histotype of lung cancer that can hamper interval between screening rounds, as seen in this case with no parenchymal or mediastinal abnormalities at year 2 (A and B), but evidence at year 3 of untreatable neoplasm in an asymptomatic subject with a left parahilar solid mass (C) and subcarinal lymph node enlargement with central necrosis (D). This case was confirmed as extensive-stage SCLC by mediastinoscopy. Journal of Thoracic Oncology 2016 11, 187-193DOI: (10.1016/j.jtho.2015.10.014) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 2 A false-positive finding requiring further investigation and non-screen-detected extensive-stage single cell lung cancer in a participant undergoing biennial low-dose computed tomography (LDCT) scan. The specificity of LDCT for solid noncalcified nodules detected at baseline is low, which can necessitate further investigation (e.g., additional LDCT control and positron emission tomography (PET)-CT characterization (A–F); this limitation is reflected in overdiagnosis of slow-growing neoplasms or benign findings. On the other hand, screening with LDCT does not provide clinical improvement of aggressive thoracic tumor (G–I). A noncalcified solid pulmonary nodule of the left upper lobe was detected at T0 (A) and remained stable over three biennial LDCT controls (B, C, and D), as well as on a CT scan with contrast agent that was performed almost 2 years after the previous LDCT control (E). Thereafter, the nodule was confirmed as benign by 18F-fluorodeoxyglucose–PET-CT (F). The subject underwent CT with a contrast agent for work-up of a cough with persistent hemoptysis. The CT scan showed a left hilar mass with irregular reticulation of the adjacent lung parenchyma, suggesting lymphangitis carcinomatosa (G) and diffuse mediastinal lymphadenomegaly with compression of the airways (H), which showed high uptake of 18F-fluorodeoxyglucose during PET-CT (I). Journal of Thoracic Oncology 2016 11, 187-193DOI: (10.1016/j.jtho.2015.10.014) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 3 Overall survival curve shows no survivors at 3 years after diagnosis of SCLC. Journal of Thoracic Oncology 2016 11, 187-193DOI: (10.1016/j.jtho.2015.10.014) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions