Low dose CT lung cancer screening has been performed at UPMC since 1991. The Pittsburgh Lung Cancer Screening Study (PLuSS) was one of the first studies to assess the role of low dose CT for screening of high risk populations for early lung cancer. Those screening studies were funded by research grants and the CT scans were obtained on Saturdays at Hillman Cancer Center. The PLuSS study was one of the first high volume low dose lung cancer screening research studies in the country and it demonstrated the benefit of low dose CT scans for the early diagnosis of lung cancer.
UPMC then participated in the National Lung Cancer Screening Trial (NLST) which was a large multicenter study. The study definitively proved the value of low dose lung cancer screening with a 20% decrease in disease specific mortality.
In February 2015, Medicare announced it would begin paying for low dose screening CT scans in high risk populations. Private insurance companies quickly began to offer low dose CT screening with similar patient criteria as Medicare patients. The U.S. Preventative Service Task Force (USPSTF) now recommends annual screen for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year history of smoking and currently smoke or have quit within the past 15 years.
UPMC started a comprehensive lung cancer screening program in 2015 with 486 screenings. That number has increased to 5,761 in 2018 and continues to increase
. Multidisciplinary (radiology, pulmonary, cardiothoracic surgery) working groups have driven programmatic success and the program has been successfully adopted in community hospitals.
UPMC also has software which allows nodule evaluation and can detect subtle changes in lung size between examinations. Image 1 indicates a small nodule detected on lung cancer screening. Image 2 is the computer-generated nodule analysis. A follow up CT scan in 6 months (Image 3) confirms a subtle increase in size of the mean diameter and volume indicating malignant growth (pathology indicated adenocarcinoma). Caliper measurements of subtle changes in such small nodules is very inaccurate.
In addition, CT images are processed (Imbio software) to give a quantitative emphysema score (percentage of lung involved with emphysema) as well as a display (where emphysema is colored red). An example is provided on Image 4. This is a very useful tool when clinicians discuss emphysema with their patients and the need to stop smoking.