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  • br period to tests patient year in the


    period to 0.77 tests/patient-year in the post-guideline period (p = 0.028). There was no statistically significant difference between number of CT scans ordered with Adrucil and number of CT scans ordered without contrast (Table 2). Interestingly, the rates of PET scans dropped between pre- and post-guideline periods from 0.45 tests/pa-tient-year to 0.26 tests/patient-year (p < 0.0001).
    3.3. Annual chest imaging in laryngeal cancer patients
    The USPSTF recommendations are based upon the evidence that annual chest imaging improves the survival of smokers through the early detection of lung cancer. Therefore annual chest imaging, ideally a low-dose non-contrast CT scan as per USPSTF guidelines, is essential in this high-risk group of smokers with laryngeal cancer. Out of 332 analyzed patient-years in the pre-guidelines period, only 184 (55%) included at least one chest CT (CT or PET-CT), and out of 414 patient-years in the post-guidelines period, only 246 (59%) included any CT imaging test (Table 3). There was no statistically significant difference between these groups (p = 0.2726). There was also no statistically significant difference between these groups when we compared num-bers of patient-years with any radiological chest imaging (Xray, CT or PET-CT), as 248/332 (75%) patient-years in the pre-guidelines period and 314/414 (76%) in the post-guidelines period included at least one chest imaging (X-ray, CT or PET-CT; p = 0.72). There is therefore no evidence that the frequency of chest imaging changed for patients with laryngeal cancer as a results of published screening guidelines for smokers.
    K. Piersiala, et al.
    Patients with laryngeal cancer assessed for eligibility
    1st stage
    2nd stage
    3rd stage
    Met inclusion criteria and were
    * Synchronous/metastatic lung cancer (n=26)
    Fig. 1. Three stage exclusion protocol to identify index patients that meet USPSTF criteria for annual chest screening. Patients were excluded in three stages: 1) age,
    2) inadequate follow-up, and finally 3) smoking history or synchronous lung cancer. Of 998 initial patients, 151 fully met study criteria and were included for further analysis. * indicates the reason for exclusion.
    Table 1
    Patient demographics and laryngeal cancer staging (N = 151).
    Patients (n) Percentagea
    Tumor location Glottic 58 38.4%
    a Totals may not equal 151, as data was not available for all patients.
    Table 2
    Total chest imaging between 2010 and 2017 in patients with laryngeal cancer.
    Type of chest Pre-guidelines period Post-guidelines period p value
    Number of Mean [N]/ Number of Mean [N]/
    tests [N] patient- tests [N] patient-
    a Unpaired t-test with Welch's correction.
    b CT with contrast.
    c CT without contrast.
    3.4. Annual CT chest imaging by TNM staging
    There were some differences in the incidence of chest imaging when examining patients by TNM staging, but these patterns were stable across the study periods and did not change as a result of the in-troduction of screening guidelines (Table 4). Patients with early lar-yngeal cancer (T1-T2) and negative nodal status (N0) had significantly less chest imaging ordered (52% and 58%, respectively) compared to
    Table 3
    Annual chest imaging in patients with laryngeal cancer.
    Pre-guidelines Post-guidelines p-Value 2010–2017
    a Unpaired t-test.
    Table 4
    Annual chest imaging in patients with laryngeal cancer by TNM staging.
    TNM-staging Pre-guidelines (patient- Post-guidelines (patient- p-Value
    years with CT chest years with CT chest
    imaging) imaging)
    a Unpaired t-test.
    3.5. Per patient analysis of indicated screening
    For the purposes of cancer screening, perhaps the most relevant data point is that each individual patient in cycads study, based on their smoking history rather than their history of laryngeal cancer, should have had at least one CT scan performed every year. An analysis of the annual chest screening with CT or CT-PET for each individual patient showed that in both pre- and post-guideline periods 70% of patients missed at least one year of indicated screening (Table 5). In this ana-lysis, the number of years with CT chest exam was divided by the number of follow-up years available, for example a CT chest exam in three of four years of follow-up available for analysis would be a screening rate of 75%. Almost 20% of LC patients received no screening at all, and in both pre- and post-guideline periods approximately 50% of patients had annual CT chest imaging performed in 50% or less of analyzed follow-up years. Only 30% of patients received indicated screening in all follow-up years available for analysis.