We recently spoke with Network member Vitali Grozman, Senior Consultant in Thoracic Radiology at the Department of Molecular Medicine and Surgery at the Karolinska Institute, Stockholm. He shared his insights into the potential benefit of immediate access to cytologists in lung cancer diagnosis.
What is the current status of low-dose computed tomography screening for lung cancer in Sweden?
Currently, there is no national, targeted low-dose computed tomography (LDCT) screening programme in Sweden. However, there is an ongoing pilot at the Karolinska Institute (a medical university with an associated teaching hospital on the outskirts of Stockholm) in collaboration with the Regional Cancer Center Stockholm Gotland, to assess the possibility of implementation.1 Additionally, there are plans to set up three more pilot sites across Sweden. The overall aim of these pilot programmes is to find out if targeted LDCT screening can be a cost-effective way to detect lung cancer at an early stage and if the method is feasible in practice.1 The final results of the active pilot at the Karolinska Institute will be published in 2025.
What is unique about the role of cytologists at the Karolinska Institute?
If an LDCT scan detects a tumour suspicious of lung cancer, it is important to quickly determine whether this is malignant or benign. To do this a tissue biopsy may be needed. At the Karolinska Institute, there is rapid access to computed tomography (CT)-guided fine needle aspirations to sample tissue from the lungs. This is performed in close cooperation between the radiologist and cytologist, with the cytologist performing a rapid staining of the tissue sample in the CT lab to confirm whether the material is representative and sufficient for all analyses. If necessary, a repeat biopsy can be performed immediately. One cytologist works across two CT labs simultaneously and the biopsies are staggered to allow the cytologist to efficiently utilise time by only joining the procedures when needed.
What are the main benefits of this process?
By having immediate and direct feedback from the cytologist there is a very low frequency of biopsy failure, as another biopsy can be taken immediately. In a standard process, if the sample is not adequate the fine needle aspiration must be carried out again at a later appointment. This causes delays to lung cancer diagnosis, which may allow the disease to advance.
The role of the cytologist across two CT labs with staggered procedures makes this process more streamlined than usual care. By only involving the cytologist as needed, more fine needle aspirations can be carried out while also limiting any additional workload for cytologists.
In your opinion, what are the key next steps to move towards large-scale lung cancer screening in Sweden?
To advance towards a national LDCT screening programme in Sweden it will be important to increase cooperation between regions to share learning, expertise and information. This will help establish cost-effective procedures that identify and screen relevant individuals, and process the images.
In radiology, we need to develop artificial intelligence to aid with the lung screening process and work on safe and effective ways to implement this throughout Sweden. This will be important to maximise the amount of people with lung cancer detected while limiting the need for additional radiographers.
Overall, we need clear recommendations and regulation, and support for research to facilitate the implementation of LDCT screening in Sweden and ultimately improve survival for people with lung cancer.
The Lung Cancer Policy Network is publishing brief case studies of countries that have implemented LDCT screening; you can read other examples here.
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Regionalt Cancercentrum I Samverkan. 2021. Regionala cancercentrum. Kunskapsstöd för dig som arbetar i cancervården [Regional cancer centers. Knowledge support for those who work in cancer care]. Available from: https://cancercentrum.se/samverkan/ [Accessed 16/03/2021]