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OBJECTIVE: Low dose computed tomography (LDCT) is becoming part of standard of care for lung cancer (LC) detection in high risk individuals. Little is known about incidence of screening detected lung nodules or LC in Brazil. Our objective is to evaluate the value of LDCT on detection of benign or malignant thoracic diseases in asymptomatic smokers in Brazil.
METHODS: The 1st Brazilian Early Lung Cancer Detection Program (BRELT1) was designed to provide free care and monitoring of 1000 smokers. The current accrual was initiated on March-2013. All included individuals underwent baseline LDCT and were invited to participate in smoking cessation program. LDCT results were evaluated by a multidisciplinary team consisted of radiologists, pulmonologists, oncologists and thoracic surgeons. Studies with 4 mm or above nodules were classified as "positive". The inclusion and exclusion criteria were similar to National Lung Screening Trial: 55-74 years, current or former smoking history of at least 30 pack years, smoking cessation of less than 15 years, excluding candidates with suggestive symptoms of LC or serious illness.
RESULTS: From March to November, 292 participants were recruited. Initial results are depicted in Table 1. Following the NCCN guidelines, individuals with positive studies underwent: PET-CT (7), Bronchoscopy (5), Transthoracic Needle Aspiration (3), Robotic or VATS (4). Three patients were diagnosed with LC, all stage I disease. One Schwannoma and 2 active tuberculosis infections were found. Recommendations for 3-6 months LDCT were given to 116 individuals (39.7%). In despite of a “positive study”, 11 individuals will repeat LDCT in one year due to suggestive findings of previous granulomatous disease.
CONCLUSIONS: Preliminary data indicate a similar incidence of lung cancer in high risk smokers living in Brazil. A large number of lung nodules suggestive of tuberculosis exposure were seen; nevertheless, invasive diagnostic assessment should not be recommended on asymptomatic individuals with benign findings. Further assessment of all nodules with serial LDCT will add significative information for the development of a local lung cancer CT screening protocol.

Table 1: Demographics and lung nodule findings in 292 individuals

Recruited participants	292
- Women	156 (53.4%)
- Age (mean ± SD)	61.9 ± 7.4 years
Total number of all size nodules	1372
- Range per patient	1- 47
- Mean	4,8
Positive studies	138 (47.3%)
- Number of nodules above 4 mm	269
Volunteers with nodules registered to be followed with LDCT	265
Volunteers not diagnosed with any lung nodule	27 (9,2%)