BACKGROUND:Lung cancer yield from lung cancer screening (LCS) via low-dose computed tomography (LDCT) may differ in community-based settings compared to clinical trials. RESEARCH QUESTION:What proportion of those receiving a baseline LCS LDCT in five healthcare systems in the United States were diagnosed with lung cancer within 12-months, overall, and by LCS findings and patient characteristics? STUDY DESIGN AND METHODS:Study participants were LCS-eligible and received care and a baseline LCS LDCT within healthcare systems in the Population-based Research to Optimize the Screening Process Lung Consortium (PROSPR-Lung) from 2014-2020. We collected data on LCS utilization, results, patient characteristics, and smoking history via electronic health records. Baseline LCS LDCT findings were categorized using Lung-RADS, and lung cancer diagnoses were ascertained via cancer registries. The primary outcome was 12-month lung cancer yield. RESULTS:Of 13,448 patients, 47% were female, 48% ages <65 years, 74% White, 14% Black, 4% Hispanic, 3% Asian, and 1% Native Hawaiian/Pacific Islander. There were 304 (2.3%) patients diagnosed with lung cancer within 12 months of baseline LDCT. Among those with Lung-RADS 1 (n=3,047) or 2 (n=7,978), there were 1 and 16 lung cancers, respectively. Among those with positive LCS findings (n=2,408), 12-month lung cancer yield was as follows: Lung-RADS 3=1.7%, 4-NOS (not otherwise specified)=38.5%, 4A=10.8%, 4B=38.8%, or 4X=69.2%. Among those with missing Lung-RADS (n=15), 1 lung cancer was diagnosed. Those at older ages, who currently smoked, with higher pack-years, greater comorbidity, or lower body mass index had higher lung cancer yields (p-value < 0.05). INTERPRETATION:Lung cancer yield within 12 months after a baseline LDCT within PROSPR-Lung healthcare systems was higher than in LCS clinical trials. Differences may be attributable to higher smoking intensity, increased comorbidities, and an average older age at baseline scan in community settings compared to clinical trial settings.

BACKGROUND Lung cancer yield from lung cancer screening (LCS) via low-dose computed tomography (LDCT) may differ in community-based settings compared to clinical trials. RESEARCH QUESTION What proportion of those receiving a baseline LCS LDCT in five healthcare systems in the United States were diagnosed with lung cancer within 12-months, overall, and by LCS findings and patient characteristics? STUDY DESIGN AND METHODS Study participants were LCS-eligible and received care and a baseline LCS LDCT within healthcare systems in the Population-based Research to Optimize the Screening Process Lung Consortium (PROSPR-Lung) from 2014-2020. We collected data on LCS utilization, results, patient characteristics, and smoking history via electronic health records. Baseline LCS LDCT findings were categorized using Lung-RADS, and lung cancer diagnoses were ascertained via cancer registries. The primary outcome was 12-month lung cancer yield. RESULTS Of 13,448 patients, 47% were female, 48% ages <65 years, 74% White, 14% Black, 4% Hispanic, 3% Asian, and 1% Native Hawaiian/Pacific Islander. There were 304 (2.3%) patients diagnosed with lung cancer within 12 months of baseline LDCT. Among those with Lung-RADS 1 (n=3,047) or 2 (n=7,978), there were 1 and 16 lung cancers, respectively. Among those with positive LCS findings (n=2,408), 12-month lung cancer yield was as follows: Lung-RADS 3=1.7%, 4-NOS (not otherwise specified)=38.5%, 4A=10.8%, 4B=38.8%, or 4X=69.2%. Among those with missing Lung-RADS (n=15), 1 lung cancer was diagnosed. Those at older ages, who currently smoked, with higher pack-years, greater comorbidity, or lower body mass index had higher lung cancer yields (p-value < 0.05). INTERPRETATION Lung cancer yield within 12 months after a baseline LDCT within PROSPR-Lung healthcare systems was higher than in LCS clinical trials. Differences may be attributable to higher smoking intensity, increased comorbidities, and an average older age at baseline scan in community settings compared to clinical trial settings.

A new generation of cancer screening tests, Multi-Cancer Detection (MCD) tests, aims to advance cancer early detection. MCD tests combine blood-based assays of biological components and bioinformatics algorithms to simultaneously detect multiple types of cancer. If shown to improve health outcomes, these new technologies would be simple to implement, improving accessibility and uptake. Importantly, MCD tests offer early detection opportunities for cancers with no established screening modalities. Despite their promise, evidence supporting public health benefits of MCD tests for early detection benefits is lacking. No consensus yet exists for determining the level of screening performance or the effects on cancer outcomes needed to recommend adoption. Further, the potential harms of screening (e.g., unnecessary procedures, increased anxiety and cancer worry) are often overlooked. To address the need for objective evaluation of novel screening methods, the National Cancer Institute created the Cancer Screening Research Network (CSRN). The CSRN mission is to implement rigorous clinical trials to evaluate a broad range of technologies and approaches for cancer screening. The CSRN Vanguard Study is the first US randomized trial of MCDs. The study will develop and determine the feasibility of critical protocol components of a subsequent full-scale trial to evaluate MCD tests. The study will enroll 18,000-24,000 participants aged 45-75 years without known cancer and randomize them into one of 3 arms: two separate intervention arms each evaluating one MCD test, or a control arm. Information gained will inform full-scale trial design and implementation features. ClinicalTrials.gov Identifier: NCT06995898; https://clinicaltrials.gov/study/NCT06995898; registered May 29, 2025.

Background: Bronchopleural fistula (BPF) is a rare and often difficult postoperative complication to manage. This case series describes a bronchoscopic technique using a bone plug for closure of BPFs. Methods: Six patients at Henry Ford Hospital from 2014 to 2021, who had a postoperative BPF after lung resection with curative intent for non-small cell lung cancer, underwent bronchoscopic placement of a customized bone plug. Results: All 6 patients experienced initial resolution of the BPF after bone plug placement. Four of the 6 (66.7%) patients were inpatients, with severe pleural space infections requiring chest tube drainage; all patients clinically improved with resolution of persistent air leaks resulting in chest tube removal. Two of the 6 (33.3%) patients had BPF recurrence within 2 months, and 2 of the /6 (33.3%) patients also eventually required additional surgical repair. Conclusions: Endobronchial placement of a customized bone plug is an option for the management of postoperative BPF.

Background: The ION system is a shape-sensing robotic-assisted bronchoscopy (SS-RAB) platform developed to biopsy peripheral pulmonary nodules (PPNs). There is a lack of data describing the use of this system in the Chinese population. The study aimed to assess the feasibility and safety of using SS-RAB to diagnose PPNs across multiple centers within China. Methods: This prospective, multicenter study used SS-RAB in consecutive patients with solid or sub-solid PPNs 8 to 30 mm in largest diameter. Primary endpoints were diagnostic yield and the rates of procedure- or device-related complications. Radial endobronchial ultrasound (rEBUS) was to confirm lesion localization, followed by sampling, using the Flexision biopsy needle, biopsy forceps, and cytology brush. Subjects with nonmalignant index biopsy results were followed up to 6 months. Results: A total of 90 PPNs were biopsied from 90 subjects across 3 centers using SS-RAB. The median nodule size was 19.4 mm (IQR: 19.3, 24.6) in the largest dimension. In all (100%) cases, the catheter successfully reached the target nodule with tissue samples obtained. The diagnostic yield was 87.8% with a sensitivity for malignancy of 87.7% (71/81). In a univariate analysis, nodule lobar location, presence of bronchus sign, and rEBUS view were associated with a diagnostic sample, but only rEBUS view showed an association in a multivariate analysis. The overall pneumothorax rate was 1.1% without pneumothorax requiring intervention, and there was no periprocedural bleeding. Conclusion: As an emerging technology in the Chinese population, SS-RAB can safely biopsy PPNs with strong diagnostic performance.

Background: Tobacco quit rates in the adult U.S. population range from 4% to 8% annually. Lung cancer screening (LCS) provides an opportunity for discussion of smoking cessation. Outside of LCS, Blacks have been shown to make more quit attempts and have higher readiness to quit, but have lower quit rates among current smokers and higher relapse rates among former smokers. In this study, we determined quit and relapse rates after a provider referral for LCS in Black and White patients. Methods: We conducted an observational study within an integrated health system that has both a LCS program and an independent smoking cessation program. Patients, aged 55-77 years who received at least one provider referral (order) for LCS between September 2016 and April 2022 and a second order within 9-36 months, were included in this study.Smoking status was captured in LCS orders. Demographic variables, completion of a low-dose screening CT (LDSCT), smoking cessation counseling referral and medication prescription were captured from the electronic medical record. Pearson Chi-squared test and multivariable logistic regression were used to determine group differences and important predictors of tobacco quit and relapse. Results: During the study period, 6,096 patients (21% Black) received a referral to LCS and 75% of these patients completed an LDSCT between orders. Among current smokers (N=3715) the quit rate was 14% and relapse occurred in 10% of former smokers (N=2381), overall. Rates of quit (12.0% LDSCT no vs. 14.6% LDSCT yes, p=0.048) and relapse (13.7% LDSCT no vs. 9.4% LDSCT yes, p=0.006) were worse for those who did not complete the LDSCT between orders. Black patients had lower quit (11% vs. 14%, p=0.003) and higher relapse (13.6% vs. 9.7%, p=0.03) rates than Whites. Among Black former smokers who did not complete the LDSCT, the relapse rate was nearly 20% and these patients received referrals to counseling and prescriptions for cessation medications at higher rates than White former smokers. In multivariable models, older age, receiving a prescription for a cessation medication, and completing the LDSCT were associated with smoking cessation, while Black race and receiving a referral for counseling were associated with lower odds of quitting. Black race and longer duration between orders were associated with greater likelihood of relapse, while older age and completing the LDSCT were associated with lower likelihood of relapse. Discussion: Rates of smoking cessation appear higher in patients referred for LCS than in the general population. In the context of LCS, Black patients still have lower quit and higher relapse rates than White patients. Relapse is particularly high in Black former smokers who do not complete LDSCT after a referral for screening. Lung screening and smoking cessation programs will need to work together to find culturally appropriate resources and ways to reach out to patients referred for screening, especially those who do not complete the LDSCT, to encourage quitting and provide equitable cessation support. Citation Format: Christine Neslund-Dudas, Amy Tang, Katie Zarins, Elizabeth Alleman, Amanda Holm, Vritti Gupta, Michael Simoff. Smoking cessation and relapse among Black and White patients referred for lung cancer screening [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A111.

Purpose:As screening chest computed tomography for patients at high risk for cancer has become more widely accepted, increasing numbers of patients with early-stage small cell lung cancer (SCLC) are being diagnosed. Although surgery is an accepted option for patients with early-stage SCLC, for patients who decline or cannot undergo surgery, stereotactic body radiation treatment (SBRT) is an alternative. Although prophylactic cranial irradiation (PCI) improves survival in patients with limited-stage SCLC, PCI for early-stage SCLC (stage T1-T2) has not been explored. This study defines survival and recurrence patterns in patients with early-stage SCLC who were treated with surgery or SBRT in the absence of PCI. Methods and Materials:In this single-institution retrospective study, 14 patients diagnosed with early-stage SCLC (stage T1-T2) between July 2015 and May 2021 at a single tertiary care hospital were treated with SBRT or surgery with no PCI. Primary outcomes were locoregional cancer recurrence, distant recurrence, recurrence-free survival, and overall survival. The secondary outcome was development of brain metastasis. Analyses included Cox regression, Kaplan-Meier survival, and log-rank tests. Results:A total of 14 patients (5 women and 9 men) were included in the study: 9 with stage T1 and 5 with stage T2 SCLC. Six patients (43%) received SBRT and 8 (57%) had surgical treatment. All patients except 1 received adjuvant chemotherapy. Median follow-up was 14.3 months (range, 2.4-64.4 months), and the median age at diagnosis was 71.5 years (range, 54-81 years). Cox regression and log-rank tests showed no significant differences in any outcomes between the surgery and SBRT groups, and no patients developed brain metastases during the study period. Conclusions:Data are lacking regarding the benefit of PCI in early-stage SCLC. Although the sample size in this study was too small to draw any conclusions, the findings add to the ongoing dialogue regarding the importance of PCI in this patient population. No difference was identified in survival and cancer recurrence in patients who received either surgery or SBRT in the absence of PCI.

"Socioeconomic Status as a Mediator of Racial Disparity in Annual Lung Cancer Screening Adherence." American Journal of Respiratory and Critical Care Medicine, 207(6), pp. 777–780

8581 Background: At diagnosis, the majority of SCLC patients have extensive-stage disease, and their median survival is only 13 months, even with the addition of checkpoint inhibitors. Previous CT screening trials did not reveal reduction in mortality for SCLC patients. The aim of our study was to analyze the baseline characteristics and clinical outcomes of SCLC patients diagnosed with low-dose CT scan as a part of lung cancer screening program. Methods: A retrospective chart review-based study of SCLC patients diagnosed clinically or by lung cancer screening between January 2018 and June 2022 at the Henry Ford Health System was conducted. Baseline characteristics, details of SCLC diagnosis and treatment, and outcome were recorded. Statistical analysis was performed using Chi-squared test, T-test and log-rank test. Results: Of the 258 patients who met eligibility criteria, 34 were diagnosed by lung cancer screening. Patients diagnosed with screening tended to be older (mean age- 70.5 years vs. 67.3 years, p=0.010). There were no differences in gender distribution, race and smoking status. Mean smoking history was 43 pack-years in both groups. Among screen-detected patients, 73.5% had limited-stage disease compared to 36.6% among clinically detected patients (p<0.001). No significant difference in the presence of brain metastases at diagnosis was observed. Among screen-detected patients, 97.1% received any therapy compared to 85.3% among the clinically detected patients (p=0.105). Overall survival (OS) was significantly better in screen-detected patients, with a 3-year survival rate of 45.5% vs. 17% (p=0.00027). By multivariable analysis, OS was better in screen-detected patients (HR=0.37, 95% CI 0.20-0.68; p=0.001) (Table). There was no significant difference in progression-free survival between the groups. Conclusions: Our results demonstrate that SCLC patients diagnosed through the lung cancer screening program have better overall survival rates than those diagnosed clinically. These results suggest that developing appropriate screening measures may impact SCLC-related mortality. [Table: see text]

Abstract Background: The USPSTF currently recommends lung cancer screening (LCS) by low-dose CT (LDCT) in those 50 to 80 years of age with 20+ pack-years of smoking who are currently smoking or quit smoking within the last 15 years. LCS LDCT often detects non-cancer related incidental findings, most commonly coronary artery calcifications (CAC). CAC is a measure of subclinical coronary atherosclerosis, is higher in those with tobacco use, and may require additional clinical assessment after LCS. In the National Lung Screening Trial, reductions in all-cause mortality were stronger among Black than White participants undergoing LDCT. It was hypothesized that this may have been due to follow-up and treatment of incidental findings such as CAC during the trial. Methods: In this on-going observational study, we are evaluating clinical follow-up of moderate or severe CAC within 12 months of LCS among individuals undergoing baseline LCS at two Michigan health systems, one urban and one rural. We report here our initial findings for individuals with a baseline LCS LDCT at Henry Ford Health in 2018. Pearson Chi Square and McNemar’s tests were used to determine differences between race and sex groups and in change in statin use and cardiology visits (yes/no) pre- to post-screening. Results: Of 1,630 individuals (18% Black) with a baseline LDCT in 2018, moderate or severe CAC was documented in 154 (9.4%). Moderate or severe CAC prevalence was significantly higher among Black versus Non-Black ( 17.7 % vs 7.1%; p= <0.001) individuals and men versus women ( 11.7% vs 7.1%; p=0.002 ). Pre- to post-LCS increases in statin use (68.2% vs. 76.0%; p=0.02) and cardiology visits (25.9% vs. 50.7%; p<0.01) were observed, overall. Statin use did not differ by race, sex, or race-sex group in the pre- or post- periods. Cardiology visits were less common among Blacks (18.2% vs. 28.9%; p=0.14) and women ( 18.2% vs. 28.9%; p= 0.14) in the pre-LCS period with Black women (8.3%) being the least likely to have a cardiology visit before LCS. Post-LCS, the cardiology gap between Black and Non-Black individuals (43.6% vs. 55.6%: p=0.16) narrowed and was eliminated between women and men (53.6 % vs. 50%; p=0.67). This was due in part to a substantial uptick of cardiology visits post-LCS in Black females. However, Black men, were significantly less likely than Non-Black men (32.3 % vs 56.7% ; p=0.024 ) and Black women (32.2% vs. 62.5%; p=0.024) to have a cardiology visit post-LCS . Conclusions: Our study is on-going; however, preliminary results suggest that in addition to reducing lung cancer mortality, LCS provides an opportunity for CAC detection and its related management. LCS, if implemented equitably with comprehensive follow-up of incidental findings, may help to close gaps in cardiac care for Black individuals and women. Further investigation is needed to assess whether appropriate follow-up of CAC decreases cardiovascular risks for those undergoing screening. Citation Format: Christine Neslund-Dudas, Katie R. Zarins, Punith Shetty, Andrea E. Cassidy-Bushrow, Nada Al-Antary, Katie A. Latack, Vritti Gupta, Michael Simoff, Riley Draper, Samuel Wilcox, Kendra Worden, Kathy LaRaia, Kelly Hirko. Follow-up of moderate and severe coronary artery calcifications identified on lung cancer screening CT scans: An opportunity to improve cardiac health outcomes in Black men and women [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C121.

Lung cancer screening (LCS) currently has a low reported uptake rate in eligible patients. Identifying the population eligible for screening is crucial to assessing uptake yet is more difficult than for other cancer screening tests as LCS requires documentation of smoking history. Because new screening recommendations may experience disparities in early implementation, it is crucial to evaluate the uptake of LCS in diverse populations. The goal of this study is to evaluate any potential disparities in the uptake of LCS at a large healthcare system in southeast Michigan using previously published eligibility assessment methods. We assessed patient LCS eligibility using Medicare criteria (ages 50-77, currently/formerly smoking within 15 years and at least 20 pack-years) and two methods: a cross-sectional method currently in place clinically and a published algorithm using longitudinal data, accounting for all smoking history entries in the patient’s record. We compared differences in eligibility across patient-reported race and sex groups (Black female, Black male, White female, and White male). Using electronic health record data, we determined how many patients had received an LCS low-dose chest CT (LDCT) or an LDCT for another reason in the previous twelve months. These patients are considered up to date with screening. For both eligibility and uptake, we used Chi-Square for pairwise comparisons with a multiple comparisons adjustment to evaluate differences across race-sex categories. In total, 143,740 patients between the ages of 50-77 with no history of lung cancer had a healthcare encounter between July and December 2022. Of those patients, 38,026 (26.5%) were determined to be eligible for LCS. There were observed differences across the race-sex groups; Black female patients had the lowest proportion of those eligible (20.3%) while White male patients had the highest proportion eligible (29.5%). Of eligible patients, 9,718 (25.6%) received a verified LCS LDCT in the preceding twelve months; 7,144 (18.8%) received a LDCT for another reason; resulting in 44.3% being up to date with screening. Black female patients were the race-sex category with the highest proportion screened in the previous 12 months, and White male patients had the lowest proportion of patients screened (34.0% Black female, 28.8% Black male, 24.5% White female, 24.3% White male; p<0.0001). Black male patients had the highest proportion receiving an LDCT for any reason, and White females had the lowest (51.9% Black female, 52.4% Black male, 41.4% White female, 44.4% White male; p<0.0001). Our estimates indicate that 44.3% of patients would be considered up to date with screening, and 18.8% received an LCS LDCT. These estimates are higher than other reported LCS rates but significantly less than other cancer screening rates. These data do not suggest disparities exist related to the uptake of LCS at our health system; however, uptake remains low and measures to increase uptake should include methods effective and acceptable in diverse patients. Citation Format: Elizabeth R. Alleman, Katie Latack, Jessica Dagenais, Michael Sheehan, Katherine R. Zarins, Vritti Gupta, Michael Simoff, Christine Neslund-Dudas. Evaluating potential disparities in lung cancer screening eligibility and uptake in a large urban healthcare system [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C120.

PURPOSE:Lung cancer is the leading cause of cancer death in men and women in the United States and world.Currently, smoking cessation and lung cancer screening are the only interventions that have demonstrated to decrease mortality from lung cancer.Lung cancer screening has been shown to reduce lung cancer mortality by 20-24% for high-risk patients (based on age and smoking status) in both the National Lung Screening Trial (NLST) and the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON).Despite this evidence, we continue to face challenges with very low proportions of eligible patients having the opportunity to be screened.Several studies report non-adherence rates varying from 23 -45% across hospital systems.Our aim was to determine the effectiveness of a centralized program in improving patient adherence to lung cancer screening.METHODS: Henry Ford Health System in Metropolitan-Detroit launched a centralized LCS program through its Interventional Pulmonary team in 2018.We evaluated adherence, return within 12 to 18 months for the first and second annual scans, following a baseline screen between January 2015 and April 2021.Adherence was assessed following exams with a LungRADS score of 1 or 2. We accounted for patients who died within 18 months of exam date, did not have a full 18 months follow-up time in our dataset, or completed a computer tomography (CT) for another reason within 18 months.Adherence was assessed pre-and postcentralization of the LCS program.RESULTS: During the study period, 11,466 exams were considered eligible for annual screening of which 6,356 were considered baseline to first annual and 2,993 were first annual to second annual.Overall, the adherence rate for annual visits, ranging from one to seven, for patients with LungRADS 1 or 2 during the de-centralized period was 35%, with the rate increasing to 64% postcentralization of the LCS program.Adherence increased from pre-to post-centralization for both the first annual exam (pre¼35%, post¼56%) and second annual exam (pre¼48%, post¼70%).The overall adherence rate was higher for the second annual exam at 68% when compared to adherence for their first annual screening CT at 49%.The gap in adherence between Black and white patients decreased from 10% to 3% across centralization of the LCS program. CONCLUSIONS:In conclusion, centralization of the LCS program led to an improvement in adherence rates for annual visits among patients with LungRADS 1 or 2. These findings emphasize the positive impact of centralizing LCS programs on patient compliance and underscore the importance of continuous efforts to enhance program accessibility and patient engagement.CLINICAL IMPLICATIONS: Centralizing LCS programs can effectively improve adherence to annual screening visits for patients which may lead to more timely detection of lung cancer and better patient outcomes.These findings emphasize the need for healthcare systems to consider implementing centralized LCS programs to enhance patient compliance and streamline the screening process.Furthermore, they highlight the importance of continuous quality improvement initiatives, patient education, and targeted interventions to address potential barriers to adherence, ultimately leading to improved lung cancer detection, treatment, and survival rates.

Uptake of lung cancer screening (LCS) has been slow with less than 20

BACKGROUND:Nonsurgical patients with complex postintubation tracheal stenosis (PITS) and tracheostomy-associated tracheal stenosis (PTTS) often require airway stenting. However, the optimal approach is unknown. Identifying patients at higher risk for restenosis after stent removal may allow the treating physician to individualize the vigilance and duration of airway stenting, and help optimize outcomes.METHODS:This was a single-center retrospective analysis of prospectively collected data on all patients with complex PITS and/or PTTS treated with protocolized bronchoscopic airway stenting over a consecutive 16-year period. The primary outcome analyzed was restenosis rate at 1 year after stent removal. Predictors for restenosis and factors influencing risk for death during stent therapy were also assessed.RESULTS:Of the 181 subjects treated with silicone airway stenting, 128 were available for analysis of the primary outcome. Restenosis by 1 year after stent removal occurred in 58%. Independent predictors for restenosis were coexisting diabetes [odd ratio (OR)=3.10, 95% confidence interval (CI)=1.04-9.24; P =0.04], morbid obesity (OR=3.13, 95% CI=1.20-8.17; P =0.02), and occurrence of stent-associated complications requiring bronchoscopic management (OR=2.13, 95% CI=1.12-4.03; P =0.02). The overall mortality during the initial stenting period was 14%, and a silicone Y-stent was associated with a higher risk of death (OR=3.58, 95% CI=1.40-9.14; P =0.008).CONCLUSION:Tracheal restenosis after silicone stent therapy for complex PITS and PTTS is common and more likely to occur in patients with diabetes, morbid obesity, and frequent stent-associated complications. Mortality risk during stent therapy is not negligible, and a Y-stent should be utilized only after careful consideration. These findings may be incorporated into the approach to bronchoscopic airway stenting in these patients.

PURPOSE:Lung cancer is the leading cause of mortality in men and women in the U.S. Lung cancer screening with low-dose chest Computed Tomography (CT) has been shown to reduce lung cancer mortality by 20-24% for high-risk patients (based on age and smoking status) in the National Lung Screening Trial (NLST) and the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON).Despite this evidence supporting lung cancer screening, we continue to face challenges with low proportion of eligible patients being screened.According to data published in 2018, nationally, only 5% of eligible current and former smokers nationally and 8% of eligible patients in Michigan are being screened.Our aim in this study was to determine current uptake of lung cancer screening in a health system based centralized lung cancer screening (LCS) program.METHODS: Henry Ford Health System in Metropolitan-Detroit launched a centralized LCS program through its Interventional Pulmonary team in 2018.In this analysis, we included all patients aged 50-77 years who had a visit between July 1, 2020 and June 30, 2022.Using a previously published algorithm (Kukhareva et al 2022), lung screening eligibility was assessed, using both the most recent EHR smoking history as well as longitudinal EHR smoking history over time.Patients with prior lung cancer diagnosis were excluded.Percent of eligible patients who received a screening CT or CT for other purposes within the 12 months prior to eligibility assessment was determined overall and compared across race-sex groups by chi-square test.Simple logistic regression was used to compare race-sex groups with white males as the referent group. RESULTS:Of the total 495,258 patients captured to assess screening uptake, 44,089 patients (23%) were eligible for screening based on age and smoking history.Of these 52% were female and 22% were Black.17% of eligible patients (7,396) received a screening CT within the previous 12 months.The highest proportion screened among eligible patients was observed for Black females at 21%, while the lowest proportion was for White males (16%).When compared to White males, Black females (21%, p<0.001) and Black males (18%, p<0.001) had a significantly higher proportion of eligible patients completing screening.We observed no difference in screening uptake between White females and males (p¼0.5).When considering screening and nonscreening CTs, the proportion of eligible patients up-to-date with screening increased to 30% (N¼13,004).CONCLUSIONS: Implementation of a centralized LCS program has streamlined the LCS process leading to higher proportions of eligible patients undergoing screening than previously reported.Further, our program appears to be effective for our Black patients.CLINICAL IMPLICATIONS: Although our centralized program has higher screening proportions than some previous reports, a significant gap still exists in LCS uptake among eligible patients, leading to missed opportunities for early detection and timely intervention.This highlights the importance of improving healthcare providers' awareness and adherence to screening guidelines and enhancing access to screening programs for high-risk populations.Additionally, targeted outreach and education efforts may help address disparities in screening rates among different demographic groups, contributing to better patient outcomes and reducing lung cancer mortality.

Background: Bronchoscopy has gradually become valuable armamentarium in evaluating and applying endoscopic therapy to peripheral pulmonary lesions (PPLs) around the world. We aimed to make a comprehensive understanding of the application of bronchoscopy in the diagnosis and treatment of PPLs in China. Methods: A cross-sectional survey was carried out in China between January 2022 and March 2022. The survey was in the form of an online questionnaire which was filled in with real-time data by the respondents. Results: A total of 347 doctors from 284 tertiary hospitals (81.8%) and 63 secondary general hospitals (18.2%) were included in the data analysis. More than half of the surveyed doctors (55.0%) had independently performed respiratory endoscopy for 5-15 years. Higher proportions of hospitals with a fixed nursing team, anesthesiologists and rapid on-site evaluation (ROSE) during bronchoscopic procedures were performed in tertiary hospitals than those in secondary general hospitals (P<0.001 each). There were 316 hospitals (91.7%) eligible for performing biopsies of PPLs less than 30mm, while more than 300 PPLs biopsies were performed in only 78 hospitals (24.7%) per year. Radial probe endobronchial ultrasound (r-EBUS) (50.3%) was the commonest type of technique used in the guidance of a bronchoscope to PPLs, followed by navigational bronchoscopy (30.3%) and cone beam CT (CBCT) (17.0%). Although two thirds of the surveyed hospitals had at least one bronchoscopic guidance devices, the actual utilization of these devices was not high due to high capital costs and absence of training. To note, more diagnostic procedures and allocated devices were concentrated in the southeast region and coastal cities. Furthermore, therapeutic bronchoscopic interventions for peripheral lung cancer and/or high-risk PPLs could be performed in 124 (35.7%) of the 347 involved hospitals. Conclusions: Bronchoscopy for the diagnosis of PPLs has been carried out in most hospitals in China and yields in different hospitals and regions varied greatly. To date, only a few hospitals in China can develop therapeutic bronchoscopy for PPLs.