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class="elsevierStyleSimplePara elsevierViewall">The chest CT scan shows loculated pleural effusion, atelectasia of the lower lobe and lingula, and a 2<span class="elsevierStyleHsp" style=""></span>cm solitary pulmonary nodule in the apical segment of the left lower lobe.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Régulo José Ávila Martínez, Ana Hernández Voth, Victoria Villena Garrido" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Régulo José" "apellidos" => "Ávila Martínez" ] 1 => array:2 [ "nombre" => "Ana" "apellidos" => "Hernández Voth" ] 2 => array:2 [ "nombre" => "Victoria" "apellidos" => "Villena Garrido" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S030028961300080X" "doi" => "10.1016/j.arbres.2013.02.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => 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A Before and After in Lung Cancer Screening With Low-Dose Computed Tomography" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "453" "paginaFinal" => "454" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El <span class="elsevierStyleItalic">National Lung Screening Trial</span>. 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The NLST does not specify the thickness used and, as might be expected, a strong correlation can be observed between thinner slices and the greater detection of positive nodes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It is suggested that the dose of radiation received with CT is questionable. The data we used were obtained from the US Food and Drug Administration website (<a href="http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm095505.htm">http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm095505.htm</a>) and the NLST authors themselves have stated that “the effective dose from conventional chest CT varies considerably in clinical practice but is on the order of 8<span class="elsevierStyleHsp" style=""></span>mSv”.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> These data support the arguments we put forward in the section of the article discussing the risk of cancer due to radiation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">To say that the screening program would cost less than cervical, breast or colon cancer screening programs and that the cost per life-year saved would be more favorable in lung cancer screening is not supported by the scientific evidence. An article is cited in which the cost modeling uses (a) a screening age range of 50–64 years (the NLST includes subjects between 55 and 74 years of age) and (b) a proportion of subjects who are negative in the first screening of 79% (in the NLST this percentage is 72.7%).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These data clearly favor the cost-effectiveness of CT in lung cancer screening. The number of positive nodes increases significantly with age. Another recent cost-effectiveness study states that the cost of CT screening is over $100<span class="elsevierStyleHsp" style=""></span>000 per quality-adjusted life-year (QALY),<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> a cost which cannot be covered by the healthcare system. Also to be taken into account are the intangible costs of anxiety for the 25% of patients with a positive node detected on screening and the lack of resources for managing the thousands of false positives, in whom the imaging studies, and, in a large percentage, invasive procedures for determining the nature of the nodes will have to repeated, which would lead to the saturation of hospital Respiratory Medicine departments. The CT in itself is substantially more expensive than a mammogram, occult blood test or cervical smear test.</p><p id="par0025" class="elsevierStylePara elsevierViewall">It is surprising that no reflection is made regarding something so fundamental in a screening program as the downstaging in successive screening rounds which should be required of any screening program. It is difficult to explain how in the NLST, the percentage of subjects with stage IIIA, IIIB or IV disease is 37.8% in the first round, 31.2% in the second and 30.4% in the third round of screening.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> At least 30% of the cancers detected are at a stage in which surgery is not the first treatment of choice.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Even assuming that the NLST should be a point of departure for the discussion on CT lung cancer screening, too many questions remain unanswered. While they remain so, we cannot talk of an efficient, cost-effective, safe and fair screening modality, despite the NLST results.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interests" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ruano-Ravina A, et al. Réplica. Arch Bronconeumol. 2013;49:454.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El <span class="elsevierStyleItalic">National Lung Screening Trial</span>. Un antes y un después en el cribado de cáncer de pulmón con tomografía computarizada de baja dosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Gorospe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cribado de cáncer de pulmón con tomografía computarizada de baja dosis después del <span class="elsevierStyleItalic">National Lung Screening Trial</span>. El debate continúa abierto" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Ruano-Ravina" 1 => "M. Pérez Ríos" 2 => "A. Fernández-Villar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2012.10.003" "Revista" => array:2 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduced lung-cancer mortality with low-dose computed tomographic screening" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "The National Lung Screening Trial Research Team" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Eng J Med" "fecha" => "2011" "volumen" => "365" "paginaInicial" => "395" "paginaFinal" => "409" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The National Lung Screening Trial: overview and study design" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "National Lung Screening Trial Research Team" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/radiol.10091808" "Revista" => array:6 [ "tituloSerie" => "Radiology" "fecha" => "2011" "volumen" => "258" "paginaInicial" => "243" "paginaFinal" => "253" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21045183" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An actuarial analysis shows that offering lung cancer screening as an insurance benefit would save lives at relatively low cost" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.S. Pyenson" 1 => "M.S. Sander" 2 => "Y. Jiang" 3 => "H. Kahn" 4 => "J.L. Mulshine" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Health Aff (Millwood)" "fecha" => "2012" "volumen" => "31" "paginaInicial" => "770" "paginaFinal" => "779" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-effectiveness of computed tomography screening for lung cancer in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.M. McMahon" 1 => "C.Y. Kong" 2 => "C. Bouzan" 3 => "M.C. Weinstein" 4 => "L.E. Cipriano" 5 => "A.C. Tramontano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/JTO.0b013e31822e59b3" "Revista" => array:6 [ "tituloSerie" => "J Thorac Oncol" "fecha" => "2011" "volumen" => "6" "paginaInicial" => "1841" "paginaFinal" => "1848" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21892105" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000004900000010/v1_201309260158/S1579212913001456/v1_201309260158/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004900000010/v1_201309260158/S1579212913001456/v1_201309260158/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913001456?idApp=UINPBA00003Z" ]
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| 2015 May | 36 | 18 | 54 |
| 2015 April | 25 | 10 | 35 |
| 2015 March | 20 | 11 | 31 |
| 2015 February | 25 | 7 | 32 |
| 2015 January | 21 | 6 | 27 |
| 2014 December | 20 | 5 | 25 |
| 2014 November | 27 | 7 | 34 |
| 2014 October | 33 | 14 | 47 |
| 2014 September | 22 | 12 | 34 |
| 2014 August | 19 | 12 | 31 |
| 2014 July | 19 | 14 | 33 |
| 2014 June | 39 | 13 | 52 |
| 2014 May | 32 | 7 | 39 |
| 2014 April | 30 | 16 | 46 |
| 2014 March | 42 | 10 | 52 |
| 2014 February | 36 | 13 | 49 |
| 2014 January | 30 | 15 | 45 |
| 2013 December | 0 | 1 | 1 |
| 2013 November | 0 | 1 | 1 |
| 2013 October | 1 | 1 | 2 |
Show all
