Decision making in patients with pulmonary nodules

American Journal of Respiratory and Critical Care Medicine

Volumn 185, Issue 4, 2012, Pages 363-372

  Ost, David E ^a   Gould, Michael K ^b  

^a UNIVERSITY OF TEXAS   (United States)

^b UNIVERSITY OF SOUTHERN CALIFORNIA   (United States)

Author keywords

Lung cancer; Lung cancer screening; Lung nodule; Positron emission tomography; Solitary pulmonary nodule

Indexed keywords

ASPIRATION BIOPSY; BRONCHOSCOPY; CANCER RISK; CANCER SCREENING; CARDIOPULMONARY HEMODYNAMICS; CLINICAL DECISION MAKING; COMORBIDITY; COMPUTER ASSISTED TOMOGRAPHY; COST EFFECTIVENESS ANALYSIS; DIAGNOSTIC VALUE; EVIDENCE BASED MEDICINE; HUMAN; LUNG CANCER; LUNG NODULE; LUNG SURGERY; PATIENT PREFERENCE; POSITRON EMISSION TOMOGRAPHY; PRIORITY JOURNAL; REVIEW; RISK FACTOR; SURGICAL TECHNIQUE;

ALGORITHMS; DECISION SUPPORT TECHNIQUES; DIAGNOSIS, DIFFERENTIAL; HUMANS; LUNG NEOPLASMS; RISK ASSESSMENT; RISK FACTORS; SOLITARY PULMONARY NODULE;

EID: 84857384053     PISSN: 1073449X     EISSN: 15354970     Source Type: Journal    
DOI: 10.1164/rccm.201104-0679CI     Document Type: Review

References (91)

1. Ost D, Fein AM, Feinsilver SH. Clinical practice: the solitary pulmonary nodule. N Engl J Med 2003;348:2535-2542. (Pubitemid 36712195)
2. Swensen SJ, Morin RL, Schueler BA, Brown LR, Cortese DA, Pairolero PC, Brutinel WM. Solitary pulmonary nodule: CT evaluation of enhancement with iodinated contrast material - a preliminary report. Radiology 1992;182:343-347.
3. Swensen SJ, Jett JR, Payne WS, Viggiano RW, Pairolero PC, Trastek VF. An integrated approach to evaluation of the solitary pulmonary nodule. Mayo Clin Proc 1990;65:173-186. (Pubitemid 20089385)
4. Diederich S, Wormanns D, Semik M, Thomas M, Lenzen H, Roos N, Heindel W. Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers. Radiology 2002;222:773-781. (Pubitemid 34215229)
5. McWilliams A, Mayo J, MacDonald S, leRiche JC, Palcic B, Szabo E, Lam S. Lung cancer screening: a different paradigm. Am J Respir Crit Care Med 2003;168:1167-1173. (Pubitemid 37421833)
6. Swensen SJ, Jett JR, Hartman TE, Midthun DE, Mandrekar SJ, Hillman SL, Sykes AM, Aughenbaugh GL, Bungum AO, Allen KL. CT screening for lung cancer: five-year prospective experience. Radiology 2005;235:259-265. (Pubitemid 40432263)
7. van Klaveren RJ, Oudkerk M, Prokop M, Scholten ET, Nackaerts K, Vernhout R, van Iersel CA, van den Bergh KA, van 't Westeinde S, van der Aalst C, et al. Management of lung nodules detected by volume CT scanning. N Engl J Med 2009;361:2221-2229.
8. National Lung Screening Trial Research Team, Aberle DR, Berg CD, Black WC, Church TR, Fagerstrom RM, Galen B, Gareen IF, Gatsonis C, Goldin J, et al. The national lung screening trial: overview and study design. Radiology 2011;258:243-253.
9. National Cancer Institute. Statement concerning the national lung screening trial [accessed November 14, 2011]. Available from: http://www.cancer.gov/images/dsmb-nlst.pdf
10. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409.
11. Gould MK, Fletcher J, Iannettoni MD, Lynch WR, Midthun DE, Naidich DP, Ost DE. Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132:108S-130S. (Pubitemid 47502803)
12. Xu DM, van der Zaag-Loonen HJ, Oudkerk M, Wang Y, Vliegenthart R, Scholten ET, Verschakelen J, Prokop M, de Koning HJ, van Klaveren RJ. Smooth or attached solid indeterminate nodules detected at baseline CT screening in the nelson study: cancer risk during 1 year of follow-up. Radiology 2009;250:264-272.
13. Ost D, Fein A. Evaluation and management of the solitary pulmonary nodule. Am J Respir Crit Care Med 2000;162:782-787.
14. Almeida FA, Uzbeck M, Ost D. Initial evaluation of the nonsmall cell lung cancer patient: diagnosis and staging. Curr Opin Pulm Med 2010;16:307-314.
15. Ost D, Fein A. Management strategies for the solitary pulmonary nodule. Curr Opin Pulm Med 2004;10:272-278. (Pubitemid 38803119)
16. Swensen SJ, Silverstein MD, Ilstrup DM, Schleck CD, Edell ES. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med 1997;157:849-855. (Pubitemid 28337035)
17. Swensen SJ, Silverstein MD, Edell ES, Trastek VF, Aughenbaugh GL, Ilstrup DM, Schleck CD. Solitary pulmonary nodules: clinical prediction model versus physicians. Mayo Clin Proc 1999;74:319-329. (Pubitemid 29162531)
18. Gould MK, Ananth L, Barnett PG. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest 2007;131:383-388. (Pubitemid 46280396)
19. Schultz EM, Sanders GD, Trotter PR, Patz EF Jr, Silvestri GA, Owens DK, Gould MK. Validation of two models to estimate the probability of malignancy in patients with solitary pulmonary nodules. Thorax 2008;63:335-341. (Pubitemid 351497946)
20. Wahidi MM, Govert JA, Goudar RK, Gould MK, McCrory DC. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132:94S-107S. (Pubitemid 47502802)
21. Siegelman SS, Khouri NF, Scott WW Jr, Leo FP, Hamper UM, Fishman EK, Zerhouni EA. Pulmonary hamartoma: CT findings. Radiology 1986;160:313-317. (Pubitemid 16070632)
22. Noguchi M, Morikawa A, Kawasaki M, Matsuno Y, Yamada T, Hirohashi S, Kondo H, Shimosato Y. Small adenocarcinoma of the lung. Histologic characteristics and prognosis. Cancer 1995;75:2844-2852.
23. Noguchi M, Shimosato Y. The development and progression of adenocarcinoma of the lung. Cancer Treat Res 1995;72:131-142.
24. Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, et al. International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011;6:244-285.
25. Godoy MC, Naidich DP. Subsolid pulmonary nodules and the spectrum of peripheral adenocarcinomas of the lung: recommended interim guidelines for assessment and management. Radiology 2009;253:606-622.
26. Watanabe S, Watanabe T, Arai K, Kasai T, Haratake J, Urayama H. Results of wedge resection for focal bronchioloalveolar carcinoma showing pure ground-glass attenuation on computed tomography. Ann Thorac Surg 2002;73:1071-1075. (Pubitemid 34275880)
27. Suzuki K, Asamura H, Kusumoto M, Kondo H, Tsuchiya R. Early peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan. Ann Thorac Surg 2002;74:1635-1639. (Pubitemid 35222657)
28. Hunink M, Glasziou P, Siegel J, Weeks J, Pliskin J, Elstein A, Weinstein M. Decision making in health and medicine. Cambridge: Cambridge University Press; 2001.
29. Nathan MH, Collins VP, Adams RA. Differentiation of benign and malignant pulmonary nodules by growth rate. Radiology 1962;79:221-232.
30. Yankelevitz DF, Henschke CI. Does 2-year stability imply that pulmonary nodules are benign? AJR Am J Roentgenol 1997;168:325-328. (Pubitemid 27051954)
31. Takashima S, Sone S, Li F, Maruyama Y, Hasegawa M, Matsushita T, Takayama F, Kadoya M. Small solitary pulmonary nodules (< or =1 cm) detected at population-based CT screening for lung cancer: reliable high-resolution CT features of benign lesions. AJR Am J Roentgenol 2003;180:955-964. (Pubitemid 36363031)
32. Hasegawa M, Sone S, Takashima S, Li F, Yang ZG, Maruyama Y, Watanabe T. Growth rate of small lung cancers detected on mass CT screening. Br J Radiol 2000;73:1252-1259. (Pubitemid 32123826)
33. Aoki T, Nakata H, Watanabe H, Nakamura K, Kasai T, Hashimoto H, Yasumoto K, Kido M. Evolution of peripheral lung adenocarcinomas: CT findings correlated with histology and tumor doubling time. AJR Am J Roentgenol 2000;174:763-768. (Pubitemid 30126259)
34. Henschke CI, Yankelevitz D, Westcott J, Davis SD, Fleishon H, Gefter WB, McLoud TC, Pugatch RD, Sostman HD, Tocino I, et al. Work-up of the solitary pulmonary nodule. American College of Radiology appropriateness criteria. Radiology 2000;215:607-609.
35. MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP, Patz EF Jr, Swensen SJ. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005;237:395-400. (Pubitemid 41507873)
36. Bach PB, Silvestri GA, Hanger M, Jett JR. Screening for lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132:69S-77S. (Pubitemid 47502800)
37. Tsubamoto M, Johkoh T, Kozuka T, Honda O, Koyama M, Murai S, Inoue A, Sumikawa H, Tomiyama N, Hamada S, et al. Coronal multiplanar reconstruction view from whole lung thin-section CT by multidetector-row CT: determination of malignant or benign lesions and differential diagnosis in 68 cases of solitary pulmonary nodule. Radiat Med 2003;21:267-271. (Pubitemid 38141233)
38. Kostis WJ, Reeves AP, Yankelevitz DF, Henschke CI. Three-dimensional segmentation and growth-rate estimation of small pulmonary nodules in helical CT images. IEEE Trans Med Imaging 2003;22:1259-1274.
39. Xu DM, Gietema H, de Koning H, Vernhout R, Nackaerts K, Prokop M, Weenink C, Lammers JW, Groen H, Oudkerk M, et al. Nodule management protocol of the nelson randomised lung cancer screening trial. Lung Cancer 2006;54:177-184. (Pubitemid 44802721)
40. Gietema HA, Schaefer-Prokop CM, Mali WP, Groenewegen G, Prokop M. Pulmonary nodules: interscan variability of semiautomated volume measurements with multisection CT-influence of inspiration level, nodule size, and segmentation performance. Radiology 2007;245:888-894.
41. Wang Y, van Klaveren RJ, van der Zaag-Loonen HJ, de Bock GH, Gietema HA, Xu DM, Leusveld AL, de Koning HJ, Scholten ET, Verschakelen J, et al. Effect of nodule characteristics on variability of semiautomated volume measurements in pulmonary nodules detected in a lung cancer screening program. Radiology 2008;248:625-631.
42. Herder GJ, Golding RP, Hoekstra OS, Comans EF, Teule GJ, Postmus PE, Smit EF. The performance of(18)f-fluorodeoxyglucose positron emission tomography in small solitary pulmonary nodules. Eur J Nucl Med Mol Imaging 2004;31:1231-1236. (Pubitemid 39222486)
43. Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 2001;285:914-924. (Pubitemid 32171553)
44. Pastorino U, Bellomi M, Landoni C, De Fiori E, Arnaldi P, Picchio M, Pelosi G, Boyle P, Fazio F. Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results. Lancet 2003;362:593-597. (Pubitemid 37013298)
45. Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K. Evaluation of f-18 fluorodeoxyglucose (FDG) pet scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images. Lung Cancer 2004;45:19-27. (Pubitemid 38757828)
46. Lindell RM, Hartman TE, Swensen SJ, Jett JR, Midthun DE, Nathan MA, Lowe VJ. Lung cancer screening experience: a retrospective review of PET in 22 non-small cell lung carcinomas detected on screening chest CT in a high-risk population. AJR Am J Roentgenol 2005;185:126-131.
47. Weder W, Schmid RA, Bruchhaus H, Hillinger S, von Schulthess GK, Steinert HC. Detection of extrathoracic metastases by positron emission tomography in lung cancer. Ann Thorac Surg 1998;66:886-892; discussion 892-883.
48. Valk PE, Pounds TR, Hopkins DM, Haseman MK, Hofer GA, Greiss HB, Myers RW, Lutrin CL. Staging non-small cell lung cancer by whole-body positron emission tomographic imaging. Ann Thorac Surg 1995;60:1573-1581; discussion 1581-1572.
49. Niho S, Fujii H, Murakami K, Nagase S, Yoh K, Goto K, Ohmatsu H, Kubota K, Sekiguchi R, Nawano S, et al. Detection of unsuspected distant metastases and/or regional nodes by FDG-PET (corrected) scan in apparent limited-disease small-cell lung cancer. Lung Cancer 2007;57:328-333. (Pubitemid 47285426)
50. Cox JE, Chiles C, McManus CM, Aquino SL, Choplin RH. Transthoracic needle aspiration biopsy: variables that affect risk of pneumothorax. Radiology 1999;212:165-168. (Pubitemid 29302530)
51. Laurent F, Michel P, Latrabe V, Tunon de Lara M, Marthan R. Pneumothoraces and chest tube placement after CT-guided transthoracic lung biopsy using a coaxial technique: incidence and risk factors. AJR Am J Roentgenol 1999;172:1049-1053. (Pubitemid 29505637)
52. Ko JP, Shepard JO, Drucker EA, Aquino SL, Sharma A, Sabloff B, Halpern E, McLoud TC. Factors influencing pneumothorax rate at lung biopsy: are dwell time and angle of pleural puncture contributing factors? Radiology 2001;218:491-496. (Pubitemid 32121064)
53. Schreiber G, McCrory DC. Performance characteristics of different modalities for diagnosis of suspected lung cancer: summary of published evidence. Chest 2003;123:115S-128S. (Pubitemid 36135709)
54. Henschke CI, Davis SD, Auh Y, Romano P, Westcott J, Berkmen YM, Kazam E. Detection of bronchial abnormalities: comparison of CT and bronchoscopy. J Comput Assist Tomogr 1987;11:432-435. (Pubitemid 17081510)
55. Naidich DP, Sussman R, Kutcher WL, Aranda CP, Garay SM, Ettenger NA. Solitary pulmonary nodules. CT-bronchoscopic correlation. Chest 1988;93:595-598.
56. Steinfort DP, Khor YH, Manser RL, Irving LB. Radial probe endobronchial ultrasound for the diagnosis of peripheral lung cancer: systematic review and meta-analysis. Eur Respir J 2011;37:902-910.
57. Gildea TR, Mazzone PJ, Karnak D, Meziane M, Mehta AC. Electromagnetic navigation diagnostic bronchoscopy: a prospective study. Am J Respir Crit Care Med 2006;174:982-989. (Pubitemid 44684446)
58. Shulman L, Ost D. Advances in bronchoscopic diagnosis of lung cancer. Curr Opin Pulm Med 2007;13:271-277. (Pubitemid 46847291)
59. Schwarz Y, Greif J, Becker HD, Ernst A, Mehta A. Real-time electromagnetic navigation bronchoscopy to peripheral lung lesions using overlaid CT images: the first human study. Chest 2006;129:988-994.
60. Makris D, Scherpereel A, Leroy S, Bouchindhomme B, Faivre JB, Remy J, Ramon P, Marquette CH. Electromagnetic navigation diagnostic bronchoscopy for small peripheral lung lesions. Eur Respir J 2007;29:1187-1192. (Pubitemid 46895379)
61. Eberhardt R, Anantham D, Herth F, Feller-Kopman D, Ernst A. Electromagnetic navigation diagnostic bronchoscopy in peripheral lung lesions. Chest 2007;131:1800-1805. (Pubitemid 46981637)
62. Eberhardt R, Anantham D, Ernst A, Feller-Kopman D, Herth F. Multimodality bronchoscopic diagnosis of peripheral lung lesions: a randomized controlled trial. Am J Respir Crit Care Med 2007;176:36-41. (Pubitemid 47048052)
63. Seijo LM, de Torres JP, Lozano MD, Bastarrika G, Alcaide AB, Lacunza MM, Zulueta JJ. Diagnostic yield of electromagnetic navigation bronchoscopy is highly dependent on the presence of a bronchus sign on CT imaging: results from a prospective study. Chest 2010;138:1316-1321.
64. Freixinet JL, Varela G, Molins L, Rivas JJ, Rodríguez-Paniagua JM, de Castro PL, Izquierdo JM, Torres J. Benchmarking in thoracic surgery. Eur J Cardiothorac Surg 2011;40:124-129.
65. Okada M, Nishio W, Sakamoto T, Uchino K, Yuki T, Nakagawa A, Tsubota N. Evolution of surgical outcomes for nonsmall cell lung cancer: time trends in 1465 consecutive patients undergoing complete resection. Ann Thorac Surg 2004;77:1926-1930; discussion 1931.
66. Matsubara Y, Takeda S, Mashimo T. Risk stratification for lung cancer surgery: impact of induction therapy and extended resection. Chest 2005;128:3519-3525. (Pubitemid 41698687)
67. Walker WS. Video-assisted thoracic surgery (VATS) lobectomy: the Edinburgh experience. Semin Thorac Cardiovasc Surg 1998;10:291-299.
68. Lewis RJ, Caccavale RJ, Bocage JP, Widmann MD. Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy: a more patient-friendly oncologic resection. Chest 1999;116:1119-1124. (Pubitemid 29491889)
69. Lewis RJ, Caccavale RJ. Video-assisted thoracic surgical non-rib spreading simultaneously stapled lobectomy (VATS(N)SSL). Semin Thorac Cardiovasc Surg 1998;10:332-339.
70. McKenna RJ Jr, Fischel RJ, Wolf R, Wurnig P. Video-assisted thoracic surgery (VATS) lobectomy for bronchogenic carcinoma. Semin Thorac Cardiovasc Surg 1998;10:321-325.
71. Warren WH, Faber LP. Segmentectomy versus lobectomy in patients with stage I pulmonary carcinoma. Five-year survival and patterns of intrathoracic recurrence. J Thorac Cardiovasc Surg 1994;107:1087-1093; discussion 1093-1084.
72. Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 1995;60:615-622; discussion 622-613.
73. Lederle FA. Lobectomy versus limited resection in T1 N0 lung cancer. Ann Thorac Surg 1996;62:1249-1250. (Pubitemid 26340377)
74. Miller DL, Rowland CM, Deschamps C, Allen MS, Trastek VF, Pairolero PC. Surgical treatment of non-small cell lung cancer 1 cm or less in diameter. Ann Thorac Surg 2002;73:1545-1550; discussion 1550-1541.
75. Okada M, Nishio W, Sakamoto T, Uchino K, Yuki T, Nakagawa A, Tsubota N. Effect of tumor size on prognosis in patients with non-small cell lung cancer: the role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg 2005;129:87-93. (Pubitemid 40038100)
76. El-Sherif A, Fernando HC, Santos R, Pettiford B, Luketich JD, Close JM, Landreneau RJ. Margin and local recurrence after sublobar resection of non-small cell lung cancer. Ann Surg Oncol 2007;14:2400-2405. (Pubitemid 47174921)
77. Sienel W, Dango S, Kirschbaum A, Cucuruz B, Horth W, Stremmel C, Passlick B. Sublobar resections in stage Ia non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections. Eur J Cardiothorac Surg 2008;33:728-734.
78. Watanabe A, Ohori S, Nakashima S, Mawatari T, Inoue N, Kurimoto Y, Higami T. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg 2009;35:775-780, discussion 780.
79. Bando T, Miyahara R, Sakai H, Shoji T, Sonobe M, Sato K, Fujinaga T, Chen F, Okubo K, Hirata T, et al. A follow-up report on a new method of segmental resection for small-sized early lung cancer. Lung Cancer 2009;63:58-62.
80. Nomori H, Ohba Y, Shibata H, Shiraishi K, Mori T, Shiraishi S. Required area of lymph node sampling during segmentectomy for clinical stage Ia non-small cell lung cancer. J Thorac Cardiovasc Surg 2010;139:38-42.
81. Kates M, Swanson S, Wisnivesky JP. Survival following lobectomy and limited resection for the treatment of stage I non-small cell lung cancer <= 1cm in size: a review of seer data. Chest 2011;139:491-496.
82. Gould MK, Sanders GD, Barnett PG, Rydzak CE, Maclean CC, McClellan MB, Owens DK. Cost-effectiveness of alternative management strategies for patients with solitary pulmonary nodules. Ann Intern Med 2003;138:724-735. (Pubitemid 38139236)
83. Cummings SR, Lillington GA, Richard RJ. Managing solitary pulmonary nodules. The choice of strategy is a close call. Am Rev Respir Dis 1986;134:453-460. (Pubitemid 16014403)
84. Raab SS, Hornberger J. The effect of a patient's risk-taking attitude on the cost effectiveness of testing strategies in the evaluation of pulmonary lesions. Chest 1997;111:1583-1590. (Pubitemid 27260087)
85. Black C, Bagust A, Boland A, Walker S, McLeod C, De Verteuil R, Ayres J, Bain L, Thomas S, Godden D, et al. The clinical effectiveness and cost-effectiveness of computed tomography screening for lung cancer: systematic reviews. Health Technol Assess 2006;10:iii-iv, ix-x, 1-90.
86. Manser R, Dalton A, Carter R, Byrnes G, Elwood M, Campbell DA. Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting. Lung Cancer 2005;48:171-185.
87. Klittich WS, Caro JJ. Lung cancer screening: will the controversy extend to its cost-effectiveness? Am J Respir Med 2002;1:393-401. (Pubitemid 37062706)
88. Wisnivesky JP, Mushlin AI, Sicherman N, Henschke C. The cost-effectiveness of low-dose CT screening for lung cancer: preliminary results of baseline screening. Chest 2003;124:614-621. (Pubitemid 37000142)
89. Mahadevia PJ, Fleisher LA, Frick KD, Eng J, Goodman SN, Powe NR. Lung cancer screening with helical computed tomography in older adult smokers: a decision and cost-effectiveness analysis. JAMA 2003;289:313-322. (Pubitemid 36083984)
90. Chirikos TN, Hazelton T, Tockman M, Clark R. Screening for lung cancer with CT: a preliminary cost-effectiveness analysis. Chest 2002;121:1507-1514. (Pubitemid 34499663)
91. Marshall D, Simpson KN, Earle CC, Chu C. Potential cost-effectiveness of one-time screening for lung cancer (LC) in a high risk cohort. Lung Cancer 2001;32:227-236. (Pubitemid 32487683)