Overview
The American College of Chest Physicians (ACCP) chose the Duke University Center for Clinical Health Policy Research to perform formal systematic reviews of the current evidence in the five new non-small cell lung cancer (NSCLC) topic areas, as well as to provide a search for the existing guidelines, systematic reviews, and meta-analyses in all of the topics areas. In addition, the Agency for Healthcare Quality and Research) AHRQ agreed to fund the BlueCross BlueShield Association Technology Evaluation Center to perform the formal systematic review of literature on small cell lung cancer (SCLC). The Health Outcomes Research Group of the Department of Epidemiology and Biostatistics at Memorial Sloan-Kettering Cancer Center conducted a full-scale review of the literature since the first set of guidelines in the area of screening for lung cancer to assist that particular writing group.
The formal systematic reviews of the five new topic areas were guided by the appropriate chapter editors and their writing committees, in concert with the Executive Committee of the panel.
The two EPC research teams conducted a variety of systematic computerized bibliographic database searches including the following: (1) a search for systematic reviews, guidelines, and meta-analyses published since the last ACCP lung cancer guideline (MEDLINE, The Cochrane Library, National Guidelines Clearinghouse); (2) targeted searches for reviews in each of five selected treatment sections (solitary pulmonary nodules, stage I and II, stage IIIA, stage IIIB, stage IV); these searches, run in OVID version of MEDLINE, were performed in July and August 2005 and were limited to publication years since 1995, English language, and human subjects; and (3) searches related to SCLC are described in the evidence chapter on SCLC. Search terms included the medical subject heading terms lung neoplasms (exploded) and bronchial neoplasms for the lung cancer concept. Each topic search utilized key words specific to the key questions of interest (complete search strategies are available on request from the authors).
Strategy Specific for Bronchial Intraepithelial Neoplasia/Early Central Airways Lung Cancer
To update previous recommendations on bronchial intraepithelial neoplasia/early central airways lung cancer, guidelines on lung cancer diagnosis and management were identified by a systematic review of the literature (see the "Availability of Companion Documents" field in this summary for "Methodology for Lung Cancer Evidence Review and Guidelines Development"). Supplemental material appropriate to this topic was obtained by literature search of a computerized database (MEDLINE) in the English language from January 1966 to January 2006, and review of the Thoracic Oncology NetWork reference lists of relevant articles. The search words that were used were as follows: "carcinoma in situ" (CIS), "angiogenic squamous dysplasia" (ASD), "radiographically
occult lung cancer," "neodymium yttrium-aluminum-garnet," "photodynamic therapy," "electrocautery," "cryotherapy," "non-small cell lung cancer" (NSCLC), "light-induced fluorescence endoscopy," "white light bronchoscopy," (WLB) "autofluorescence bronchoscopy," (AFB) "flexible videobronchoscopy" (FVB), and "narrow band imaging" (NBI).
For the purposes of this guideline, the reviewed literature was limited to diagnostic and treatment approaches to early stage lung cancer. The definition of an early stage cancer is a roentgenographically occult squamous cell carcinoma (SqCC) that is < 2 cm in surface area, appears superficial endoscopically, has clearly visible margins, and demonstrates no invasion beyond the bronchial cartilage assessed either by histopathology or by available imaging including high-resolution CT or endobronchial ultrasound. Although there is an extensive literature on the detection and treatment of early stage lung cancer, the reported studies consist of small to moderate-size case series. Clinical outcomes in these studies were defined as response to treatment and included complete, partial, or no response. Complete response was defined as no evidence of disease visually as well as on histology and cytology examination. Some studies also included time to tumor recurrence. Relative sensitivity is commonly used in these reports to express the additional value of AFB over WLB when, as in most reports, WLB was performed before AFB by the same observer and the actual prevalence of lesions was unknown. Relative sensitivity is defined as the ratio of the sensitivity of WLB alone or WLB combined with AFB divided by the sensitivity of WLB alone.