CT Screening/Early Detection

The Role of CT for Lung Cancer Screening

The above image shows a lung nodule in a screening CT scan requested by the patient, a 69-year-old former smoker.Early detection can dramatically improve survival. When lung cancer is treated in its earliest stage, cure rate approaches 90%. NewYork-Presbyterian Hospital/Columbia operates a robust screening program for patients at risk for lung cancer and a comprehensive, multidisciplinary treatment program for patients with advanced disease. State-of-the-art imaging facilities for lung cancer diagnosis, staging, and monitoring include outpatient high-resolution CT scanning, MRI, PET, PET/CT, and Electromagnetic Navigation Bronchoscopy.

Learn about the CT Lung Screening Program.

Computed Tomography (CT)

Compelling new evidence suggests that in high-risk individuals, CT (computed tomography or CAT) screening is the best method to detect lung cancer in its earliest stage. In a large study involving 50,000 participants, CT screening reduced the mortality from lung cancer by 20% (New England Journal of Medicine, Vol. 365, No. 5). The majority of lung cancers originate as a small growth or nodule in the lung. Screening CT scans are extremely sensitive in detecting nodules as small as 2 or 3mm within the lungs — much smaller than can be viewed on a conventional chest X-ray. In fact, recently published articles on CT screening found that the majority of lung cancers that appeared on CT scans could not be detected on a chest X-ray that was performed simultaneously.

Positron Emission Tomography (PET)

The Columbia Kreitchman PET Center is one of the nation's foremost clinical and research PET and PET/CT facilities. PET is a powerful, non-invasive, diagnostic tool that detects biochemical changes in body tissues. To feed their rapid growth, tumors consume more glucose than healthy tissues. The PET scanner, which creates a color-coded image of the body's chemical function reveals the cancer as red "hot spots" of activity. PET/CT is the combination of PET and CT imaging techniques within a single machine. The individual PET and CT scans are taken concurrently while the patient remains in place, and can be presented separately or as a single, overlapping, "fused" image.

The two techniques present different types of information about the human body: while PET shows chemical activity, CT shows anatomical structures. For example, a PET scan would highlight a tumor's increased glucose consumption, while a CT scan would reveal its physical mass. The fused PET/CT image provides a more reliable alternative to the traditional side-by-side visual comparison of PET and CT images.

The CT image (left) shows a mass in the left lung. The combined PET/CT image (right) reveals the metabolic activity of that mass, as well as its precise location in the lung. Images courtesy of Siemens.

We have used PET and PET/CT scanning in thousands of patients with lung cancer, to determine whether lung nodules are benign or malignant. Incorporating PET scanning often can guide treatment plans — from indicating whether a biopsy is necessary, to guiding the shape of the area to receive radiation therapy, to pinpointing the surgical site.

Electromagnetic Navigation Bronchoscopy (ENB)

We are also among the first to use a new imaging technique called superDimension Electromagnetic Navigation Bronchoscopy (ENB). ENB provides us with a computer-generated image of the lungs in order to view suspicious nodules. This technology allows us to biopsy nodules that would otherwise be inaccessible, with fewer risks of bleeding or other complications.