Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2023

Open Access 01-12-2023 | Autopsy | Research

Prevalence of subclinical lung cancer detected at autopsy: a systematic review

Authors: Asha Bonney, Kayo Togawa, Michelle Ng, Michael Christie, Kwun M Fong, Henry Marshall, Katharine See, Cameron Patrick, Daniel Steinfort, Renee Manser

Published in: BMC Cancer | Issue 1/2023

Login to get access

Abstract

Background

Lung cancer screening in high-risk populations with low-dose computed tomography is supported by international associations and recommendations. Overdiagnosis is considered a risk of screening with associated harms. The aim of this paper is to determine the prevalence of subclinical lung cancer diagnosed post-mortem to better understand the reservoir of subclinical lung cancer.

Methods

We searched EMBASE, PubMed, and MEDLINE databases from inception until March 2022 with no language restrictions. We considered all studies with ≥100 autopsies in adults. Two reviewers independently assessed eligibility of studies, extracted data, and assessed risk of bias of included studies. We performed a meta-analysis using a random-effects model for prevalence of subclinical lung cancer diagnosed post-mortem with sensitivity and subgroup analyses.

Results

A total of 13 studies with 16 730 autopsies were included. Pooled prevalence was 0.4% (95% CI 0.20 to 0.82%, I2 = 84%, tau2 = 1.19, low certainty evidence,16 730 autopsies). We performed a sensitivity analysis excluding studies which did not specify exclusion of children in their cohort, with a pooled prevalence of subclinical lung cancer of 0.87% (95% CI 0.48 to 1.57%, I2 = 71%, tau2 = 0.38, 6998 autopsies, 8 studies).

Conclusions

This is the first published systematic review to evaluate the prevalence of post-mortem subclinical lung cancer. Compared to autopsy systematic reviews in breast, prostate and thyroid cancers, the pooled prevalence is lower in lung cancer for subclinical cancer. This result should be interpreted with caution due to the included studies risk of bias and heterogeneity, with further high-quality studies required in target screening populations.
Appendix
Available only for authorised users
Literature
1.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and Mortality Worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–49.CrossRefPubMed
2.
Fidler-Benaoudia MM, Torre LA, Bray F, Ferlay J, Jemal A. Lung cancer incidence in young women vs. young men: a systematic analysis in 40 countries. Int J Cancer. 2020;147(3):811–9.CrossRefPubMed
3.
4.
Bonney A, Malouf R, Marchal C, Manners D, Fong KM, Marshall HM, et al. Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. Cochrane Database Syst Rev. 2022;8(8):Cd013829.PubMed
5.
Park J, Lee J, Kim Y. Public opinion on implementing the National Lung Cancer Screening Program in Korea. Translational Lung Cancer Research. 2021;10(3):1355–67.CrossRefPubMedPubMedCentral
6.
7.
Brodersen J, Voss T, Martiny F, Siersma V, Barratt A, Heleno B. Overdiagnosis of lung cancer with low-dose computed tomography screening: meta-analysis of the randomised clinical trials. Breathe (Sheff). 2020;16(1):200013.CrossRefPubMed
8.
Nicholson AG, Tsao MS, Beasley MB, Borczuk AC, Brambilla E, Cooper WA, et al. The 2021 WHO classification of lung tumors: impact of advances since 2015. J Thorac Oncol. 2022;17(3):362–87.CrossRefPubMed
9.
Park S, Lee SM, Kim S, Lee J-G, Choi S, Do K-H, et al. Volume doubling Times of Lung Adenocarcinomas: correlation with predominant histologic subtypes and prognosis. Radiology. 2020;295(3):703–12.CrossRefPubMed
10.
Thomas ET, Del Mar C, Glasziou P, Wright G, Barratt A, Bell KJL. Prevalence of incidental breast cancer and precursor lesions in autopsy studies: a systematic review and meta-analysis. BMC Cancer. 2017;17(1):808.CrossRefPubMedPubMedCentral
11.
Bell KJ, Del Mar C, Wright G, Dickinson J, Glasziou P. Prevalence of incidental prostate cancer: a systematic review of autopsy studies. Int J Cancer. 2015;137(7):1749–57.CrossRefPubMedPubMedCentral
12.
Furuya-Kanamori L, Bell KJL, Clark J, Glasziou P, Doi SAR. Prevalence of differentiated thyroid Cancer in autopsy studies over six decades: a Meta-analysis. J Clin Oncol. 2016;34(30):3672–9.CrossRefPubMed
13.
Force UPST. Screening for thyroid Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2017;317(18):1882–7.CrossRef
14.
Mottet N, van den Bergh RCN, Briers E, Van den Broeck T, Cumberbatch MG, De Santis M, et al. EAU-EANM-ESTRO-ESUR-SIOG guidelines on prostate Cancer-2020 update. Part 1: screening, diagnosis, and local treatment with curative intent. Eur Urol. 2021;79(2):243–62.CrossRefPubMed
15.
Siu AL. Screening for breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2016;164(4):279–96.CrossRefPubMed
16.
Gezelius C, Eriksson A. Neoplastic disease in a medicolegal autopsy material. A retrospective study in northern Sweden. Z Rechtsmed. 1988;101(2):115–30.CrossRefPubMed
17.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.CrossRefPubMedPubMedCentral
18.
Innovation VH. Covidence systematic review software. 2021 ed. Melbourne, Australia.
19.
Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc. 2015;13(3):147–53.CrossRefPubMed
20.
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36.CrossRefPubMed
21.
Hoy D, Brooks P, Woolf A, Blyth F, March L, Bain C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65(9):934–9.CrossRefPubMed
22.
R Foundation for Statistical Computing. In: Foundation TR, editor. Vienna, Austria2022.
23.
24.
Viechtbauer W. Conducting Meta-analyses in R with the metafor Package. J Stat Softw. 2010;36(3):1–48.CrossRef
25.
Higgins JPTJ, Chandler J, Cumpston M, Li T, Page MJ, et al. editors. (s). Cochrane Handbook for Systematic Reviews of Interventions Version 6.3 (updated February 2022 2022 [Available from: training.cochrane.​org/​handbook.
26.
27.
28.
Rosenblatt MB, Teng PK, Kerpe S. Diagnostic accuracy in cancer as determined by post mortem examination. Prog Clin Cancer. 1973;5:71–80.PubMed
29.
Sens MA, Zhou X, Weiland T, Cooley AM. Unexpected neoplasia in autopsies: potential implications for tissue and organ safety. Arch Pathol Lab Med. 2009;133(12):1923–31.CrossRefPubMed
30.
Suen KC, Lau LL, Yermakov V. Cancer and old age. An autopsy study of 3,535 patients over 65 years old. Cancer. 1974;33(4):1164–8.CrossRefPubMed
31.
Torbenson MS, Wang J, Nichols L, Jain AB, Fung JJ, Nalesnik MA. Occult nonhematopoietic malignancies present at autopsy in solid organ transplant patients who died within 100 days. Transplantation. 2001;71(1):64–9.CrossRefPubMed
32.
Berezowska S, Schmid A, Losmanová T, Trippel M, Blank A, Banz Y et al. Frequency and significance of pathologic pulmonary findings in Postmortem Examinations-A single Center experience before COVID-19. Diagnostics (Basel). 2021;11(5).
33.
Hudák L, Nagy AC, Molnár S, Méhes G, Nagy KE, Oláh L, et al. Discrepancies between clinical and autopsy findings in patients who had an acute stroke. Stroke Vasc Neurol. 2022;7(3):215–21.CrossRefPubMedPubMedCentral
34.
Hudak LNAC, Mehes G, Molnar S, Nagy K, Olah L, Csiba L. Is the autopsy stillvaluable the brain and bodyautopsy results of 534 stroke patients. Int J Stroke. 2020;15(142).
35.
36.
Stanta G, Campagner L, Cavallieri F, Giarelli L. Cancer of the oldest old. What we have learned from autopsy studies. Clin Geriatr Med. 1997;13(1):55–68.CrossRefPubMed
37.
Imaida K, Hasegawa R, Kato T, Futakuchi M, Takahashi S, Ogawa K, et al. Clinicopathological analysis on cancers of autopsy cases in a geriatric hospital. Pathol Int. 1997;47(5):293–300.CrossRefPubMed
38.
Ishii T, Hosoda Y, Maeda K. Cause of death in the extreme aged–a pathologic survey of 5106 elderly persons 80 years old and over. Age Ageing. 1980;9(2):81–9.CrossRefPubMed
39.
Ishii T, Maeda K, Nakamura K, Hosoda Y. Cancer in the aged: an autopsy study of 940 cancer patients. J Am Geriatr Soc. 1979;27(7):307–13.CrossRefPubMed
40.
Strauss GM, Gleason RE, Sugarbaker DJ. Screening for lung cancer re-examined. A reinterpretation of the Mayo Lung Project randomized trial on lung cancer screening. Chest. 1993;103(4 Suppl):337s–41s.PubMed
41.
Karwinski B, Svendsen E, Hartveit F. Clinically undiagnosed malignant tumours found at autopsy. Apmis. 1990;98(6):496–500.CrossRefPubMed
42.
Lung Cancer Incidence. And Mortality with Extended follow-up in the National Lung Screening Trial. J Thorac Oncol. 2019;14(10):1732–42.CrossRef
43.
de Koning HJ, van der Aalst CM, de Jong PA, Scholten ET, Nackaerts K, Heuvelmans MA, et al. Reduced lung-Cancer mortality with volume CT screening in a Randomized Trial. N Engl J Med. 2020;382(6):503–13.CrossRefPubMed
44.
Sterner DJ, Mori M, Roggli VL, Fraire AE. Prevalence of pulmonary atypical alveolar cell hyperplasia in an autopsy population: a study of 100 cases. Mod Pathol. 1997;10(5):469–73.PubMed
45.
Yokose T, Ito Y, Ochiai A. High prevalence of atypical adenomatous hyperplasia of the lung in autopsy specimens from elderly patients with malignant neoplasms. Lung Cancer. 2000;29(2):125–30.CrossRefPubMed
46.
Manser RL, Dodd M, Byrnes G, Irving LB, Campbell DA. Incidental lung cancers identified at coronial autopsy: implications for overdiagnosis of lung cancer by screening. Respir Med. 2005;99(4):501–7.CrossRefPubMed
47.
Dammas S, Patz EF Jr, Goodman PC. Identification of small lung nodules at autopsy: implications for lung cancer screening and overdiagnosis bias. Lung Cancer. 2001;33(1):11–6.CrossRefPubMed
48.
Gao W, Wen CP, Wu A, Welch HG. Association of Computed Tomographic Screening Promotion with Lung Cancer Overdiagnosis among Asian Women. JAMA Intern Med. 2022;182(3):283–90.CrossRefPubMed
Metadata
Title
Prevalence of subclinical lung cancer detected at autopsy: a systematic review
Authors
Asha Bonney
Kayo Togawa
Michelle Ng
Michael Christie
Kwun M Fong
Henry Marshall
Katharine See
Cameron Patrick
Daniel Steinfort
Renee Manser
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2023
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-023-11224-3

Other articles of this Issue 1/2023

BMC Cancer 1/2023 Go to the issue

Research

Clinical characteristics and therapeutic response of differentiated thyroid carcinoma with obesity and diabetes

Research

Safety and feasibility of ultra-long construct navigated minimally invasive spine surgery with adjuvant radiotherapy in extensive spinal metastasis : a comparative analysis

Research

Associations between experience of stressful life events and cancer prevalence in China: results from the China Kadoorie Biobank study

Research

Clinical activity of pembrolizumab with or without chemotherapy in advanced pulmonary large-cell and large-cell neuroendocrine carcinomas: a multicenter retrospective cohort study

Research

Clinical features and imaging examination assessment of cervical lymph nodes for thyroid carcinoma

Research

The impact of PIK3CA mutations and PTEN expression on the effect of neoadjuvant therapy for postmenopausal luminal breast cancer patients
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits