• Anish Thomas, Puskar Pattanayak, Eva Szabo, and Paul Pinsky.
• Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD. Electronic address: anish.thomas@nih.gov.
• Chest. 2018 Dec 1; 154 (6): 1284-1290.

BackgroundPrevious studies with a limited number of patients have reported divergent findings on whether screening can detect small cell lung cancer (SCLC) at an earlier stage and whether there might be a survival benefit.MethodsThis study examined the characteristics of SCLC detected by using low-dose CT (LDCT) screening in the National Lung Screening Trial, a randomized study of individuals at high risk for developing lung cancer comparing LDCT imaging vs chest radiography. SCLC was denoted as screen detected if diagnosed ≤ 1 year of a positive screen or after a longer period but with no time gap between diagnostic procedures of > 1 year; interval detected if diagnosed ≤ 1 year of a negative screen; and nonscreen detected if the subject did not receive any screens or otherwise as postscreening.ResultsA total of 143 cases of SCLC were diagnosed, including 49 (34.2%) screen detected, 15 (10.5%) interval detected, and 79 (55.2%) nonscreened/postscreening. Of the screening phase-diagnosed cases (ie, screen or interval detected), a higher proportion of SCLC cases compared with NSCLC cases were interval detected (23% vs 5%; P < .0001). A higher proportion of all SCLC cases compared with NSCLC cases were advanced stage (III/IV: 86% vs 36%; P < .0001). The unfavorable SCLC stage distribution extended across screen-detected (80% stage III/IV), interval-detected (86%), and nonscreened/postscreening (90%) cancers. Among screen-detected SCLC, only 63.3% had ≥ 1 noncalcified nodule in the cancer lobe compared with 85.4% of NSCLC cases (P < .0001). Even with very small LDCT screen-detected nodules, a high proportion of SCLC cases were late stage. There was no significant difference in survival between screen- and interval-detected or postscreening SCLC.Conclusions"Early detection" with the use of LDCT imaging had no impact on SCLC outcomes. A successful screening modality should ideally detect SCLC earlier than when it can be detected on LDCT scans.Published by Elsevier Inc.

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