Renée Manser

Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis

Improved diagnostic sensitivity of bronchsocopy for the investigation of peripheral pulmonary lesions (PPLs) with the use of radial probe endobroncial ultrasound (EBUS) has been reported, although diagnostic performance varies considerably. A systematic review of published literature evaluating radial probe EBUS accuracy was performed to determine point sensitivity and specificity, and to construct a summary receiver-operating characteristic curve. Sub-group analysis and linear regression was used to identify possible sources of study heterogeneity. 16 studies with 1,420 patients fulfilled inclusion criteria. Significant inter-study variation in EBUS method was noted. EBUS had point specificity of 1.00 (95% CI 0.99–1.00) and point sensitivity of 0.73 (95% CI 0.70–0.76) for the detection of lung cancer, with a positive likelihood ratio of 26.84 (12.60–57.20) and a negative likelihood ratio of 0.28 (0.23–0.36). Significant inter-study heterogeneity for sensitivity was observed, with prevalence of malignancy, lesion size and reference standard used being possible sources. EBUS is a safe and relatively accurate tool in the investigation of PPLs. Diagnostic sensitivity of EBUS may be influenced by the prevalence of malignancy in the patient cohort being examined and lesion size. Further methodologically rigorous studies on well-defined patient populations are required to evaluate the generalisability of our results.

Surgery for non‐small cell lung cancer: systematic review and meta‐analysis of randomised controlled trials

Background: Surgery is considered the treatment of choice for patients with resectable stage I and II (and some patients with stage IIIA) non-small cell lung cancer (NSCLC), but there have been no previously published systematic reviews. Methods: A systematic review and meta-analysis of randomised controlled trials was conducted to determine whether surgical resection improves disease specific mortality in patients with stages I–IIIA NSCLC compared with non-surgical treatment, and to compare the efficacy of different surgical approaches. Results: Eleven trials were included. No studies had untreated control groups. In a pooled analysis of three trials, 4 year survival was superior in patients undergoing resection with stage I–IIIA NSCLC who had complete mediastinal lymph node dissection compared with lymph node sampling (hazard ratio estimated at 0.78 (95% CI 0.65 to 0.93)). Another trial reported an increased rate of local recurrence in patients with stage I NSCLC treated with limited resection compared with lobectomy. One small study reported a survival advantage among patients with stage IIIA NSCLC treated with chemotherapy followed by surgery compared with chemotherapy followed by radiotherapy. No other trials reported significant improvements in survival after surgery compared with non-surgical treatment. Conclusion: It is difficult to draw conclusions about the efficacy of surgery for locoregional NSCLC because of the small number of participants studied and methodological weaknesses of the trials. However, current evidence suggests that complete mediastinal lymph node dissection is associated with improved survival compared with node sampling in patients with stage I–IIIA NSCLC undergoing resection.

Screening for lung cancer: a systematic review and meta-analysis of controlled trials

Background: Lung cancer is a substantial public health problem in western countries. Previous studies have examined different screening strategies for lung cancer but there have been no published systematic reviews. Methods: A systematic review of controlled trials was conducted to determine whether screening for lung cancer using regular sputum examinations or chest radiography or computed tomography (CT) reduces lung cancer mortality. The primary outcome was lung cancer mortality; secondary outcomes were lung cancer survival and all cause mortality. Results: One non-randomised controlled trial and six randomised controlled trials with a total of 245 610 subjects were included in the review. In all studies the control group received some type of screening. More frequent screening with chest radiography was associated with an 11% relative increase in mortality from lung cancer compared with less frequent screening (RR 1.11, 95% CI 1.00 to 1.23). A non-statistically significant trend to reduced mortality from lung cancer was observed when screening with chest radiography and sputum cytological examination was compared with chest radiography alone (RR 0.88, 95% CI 0.74 to 1.03). Several of the included studies had potential methodological weaknesses. Controlled studies of spiral CT scanning have not been reported. Conclusions: The current evidence does not support screening for lung cancer with chest radiography or sputum cytological examination. Frequent chest radiography might be harmful. Further methodologically rigorous trials are required before any new screening methods are introduced into clinical practice.

Overview of observational studies of low‐dose helical computed tomography screening for lung cancer

Objective:  Lung cancer is a substantial public health problem in Western countries. Evidence from previous controlled trials of chest radiography and sputum cytology does not support lung cancer screening, but computed tomography (CT) screening has recently emerged as a more sensitive screening tool. For the present article, the available observational studies of low‐dose helical CT screening for lung cancer were reviewed.

Measurement variability in sleep disorders medicine: the Victorian experience.

Background: Surveys of laboratories in North America have documented significant diversity in the working definitions used for reporting respiratory events in sleep studies.

Venous thromboembolism management practices and knowledge of guidelines: a survey of Australian haematologists and respiratory physicians.

Current international clinical practice guidelines do not adequately address all clinical scenarios in the management of venous thromboembolism (VTE), and no comprehensive Australian guidelines exist.

The Victorian CPAP Program: is there a need for additional education and support?

Abstract

Estimating the cost-effectiveness of lung cancer screening with low dose computed tomography for high risk smokers in Australia

Introduction: Health economic evaluations of lung cancer screening with low‐dose computed tomography (LDCT) that are underpinned by clinical outcomes are relatively few. Methods: We assessed the cost‐effectiveness of LDCT lung screening in Australia by applying Australian cost and survival data to the outcomes observed in the U.S. National Lung Screening Trial (NLST), in which a 20% lung cancer mortality benefit was demonstrated for three rounds of annual screening among high‐risk smokers age 55 to 74 years. Screening‐related costs were estimated from Medicare Benefits Schedule reimbursement rates (2015), lung cancer diagnosis and treatment costs from a 2012 Australian hospital–based study, lung cancer survival rates from the New South Wales Cancer Registry (2005–2009), and other‐cause mortality from Australian life tables weighted by smoking status. The health utility outcomes, screening participation rates, and lung cancer rates were those observed in the NLST. Incremental cost effectiveness ratios (ICER) were calculated for a 10‐year time horizon. Results: The cost‐effectiveness of LDCT lung screening was estimated at AU

Differential kinetics of response and toxicity using stereotactic radiation and interventional radiological coiling for pulmonary arterio-venous shunting from metastatic leiomyosarcoma.

138,000 (80% confidence interval: AU

Screening for lung cancer

84,700–AU