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Lung Cancer Detection in the 21st Century

Potential Contributions and Challenges of Emerging Technologies

Phillip M. Boiselle1, Armin Ernst2 and Daniel D. Karp3

1 Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, One Deaconess Rd., Boston, MA 02215.
2 Department of Pulmonary Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215.
3 Department of Medical Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215.



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  		Fig. 1. —Early lung cancer in asymptomatic 67-year-old male smoker. High-resolution (1-mm collimation) CT image (lung window) of upper lobes reveals spiculated 1-cm-diameter nodule (arrow) in periphery of left upper lobe that represented stage IA non-small cell lung cancer (adenocarcinoma) at surgical resection.

 


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  		Fig. 2. —Advanced lung cancer in symptomatic 58-year-old male smoker. Contrast-enhanced CT image (soft-tissue window) reveals collapse of left upper lobe caused by centrally obstructing mass (solid arrows) that represented non-small cell lung cancer (squamous cell) at bronchoscopic biopsy. Small left pleural effusion (open curved arrow) was proven malignant.

 


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  		Arthur C. Christie 22nd President of ARRS 1921-1922

 


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  		William H. Stewart 23rd President of ARRS 1922-1923

 


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  		Fig. 3A. —Three-dimensional (3D) volumetric analysis shows improved detection of malignant growth rate in non-small cell lung cancer. L/H = length/height, L/W = length/width, W/H = width/height. (Adapted and reprinted with permission from [75]) (Courtesy of Yankelevitz DF, New York, NY) Three-dimensional volumetric reconstruction image of left apical lung nodule shows volume measurement of 193 mm3.

 


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  		Fig. 3B. —Three-dimensional (3D) volumetric analysis shows improved detection of malignant growth rate in non-small cell lung cancer. L/H = length/height, L/W = length/width, W/H = width/height. (Adapted and reprinted with permission from [75]) (Courtesy of Yankelevitz DF, New York, NY) Follow-up 3D volumetric reconstruction image of same nodule performed 130 days after A reveals interval increase in volume to 234 mm3. Interval growth of nodule was not apparent on serial axial high-resolution CT images (not shown).

 


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  		Fig. 4. —Virtual bronchoscopy image at level of carina shows normal appearance of the airway lumen. Curvilinear shadows are result of ribbing artifacts and do not represent tracheobronchial cartilage. (Reprinted with permission from [74])

 

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