James Mulshine, MD: Advancements in CT Screening for Lung Cancer


Dr. Mulshine and Dr. Rizzo discuss the diagnostic evolution detailed in several studies in the previous decades, and how CT screening can be used to detect lung cancer early in patients.

To commemorate Lung Cancer Awareness Month, the Lungcast welcomed James Mulshine, MD, Professor of Internal Medicine and Associate Director at the Institute of Translation Medicine at Rush University, to speak on the current state of low-dose computerized tomography (CT) screening for lung cancer, his experience leading quantitative imaging workshops over the past 2 decades, and much more.

Mulshine discussed several initial landmark studies in low-dose CT screening with podcast host and ALA Chief Medical OfficerAl Rizzo, MD, including the National Lung Screening Trial (NLST) which began in 2002.

The NLST, a randomized trial using conventional radiological methods, was an effort in mortality reduction that as well as 1 of the first major approaches in identifying “suspicious nodules” thought to be cancer in patients.

Further trials, such as NELSON, would build upon this idea through the use of a volume criteria, as well as the evaluation of growth over time. Currently, NELSON uses volumetrics, which has resulted in false positivity rates in the single digits in some trials from the United Kingdom.

“Right now, with the evolution of the NLST, the diagnostic workup has transitioned to the American College of Radiology Lung-RAD system, which is a much more systematic approach than was used in the NLST,” Mulshine said. “So, that was progress, but it still has a false positivity rate of 9% to 12%, depending on what the study is and what the context is. Whereas you can do much better with the volumetrics.”

To hear more from Dr. Mulshine on topic such as the recent coverage decision proposal for lung cancer screening recently released by the Center for Medicaid and Medicare Services, as well as the slow adoption of low-dose CT scans, watch the video above.

Listen to the full episode of Lungcast with Dr. Mulshine below

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