학술논문
Evaluation of Alternative Diagnostic Follow-up Intervals for Lung Reporting and Data System Criteria on the Effectiveness of Lung Cancer Screening.
Document Type
Academic Journal
Author
Bastani M; Postdoctoral Research Fellow, Departments of Biomedical Data Science and Department of Radiology, Stanford University, Stanford, California.; Toumazis I; Postdoctoral Research Fellow, Departments of Biomedical Data Science and Department of Radiology, Stanford University, Stanford, California.; Hedou' J; Research Assistant, Department of Biomedical Data Science, Stanford University, Stanford, California.; Leung A; Professor, Department of Radiology, Stanford University, Stanford, California.; Plevritis SK; Departments of Biomedical Data Science and Department of Radiology, Stanford University, Stanford, California. Electronic address: sylvia.plevritis@stanford.edu.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 101190326 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1558-349X (Electronic) Linking ISSN: 15461440 NLM ISO Abbreviation: J Am Coll Radiol Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: The ACR developed the Lung CT Screening Reporting and Data System (Lung-RADS) to standardize the diagnostic follow-up of suspicious screening findings. A retrospective analysis showed that Lung-RADS would have reduced the false-positive rate in the National Lung Screening Trial, but the optimal timing of follow-up examinations has not been established. In this study, we assess the effectiveness of alternative diagnostic follow-up intervals on lung cancer screening.
Methods: We used the Lung Cancer Outcome Simulator to estimate population-level outcomes of alternative diagnostic follow-up intervals for Lung-RADS categories 3 and 4A. The Lung Cancer Outcome Simulator is a microsimulation model developed within the Cancer Intervention and Surveillance Modeling Network Consortium to evaluate outcomes of national screening guidelines. Here, among the evaluated outcomes are percentage of mortality reduction, screens performed, lung cancer deaths averted, screen-detected cases, and average number of screens and follow-ups per death averted.
Results: The recommended 3-month follow-up interval for Lung-RADS category 4A is optimal. However, for Lung-RADS category 3, a 5-month, instead of the recommended 6-month, follow-up interval yielded a higher mortality reduction (0.08% for men versus 0.05% for women), and a higher number of deaths averted (36 versus 27), a higher number of screen-detected cases (13 versus 7), and a lower number of combined low-dose CTs and diagnostic follow-ups per death avoided (8 versus 5), per one million general population. Sensitivity analysis of nodule progression threshold verifies a higher mortality reduction with a 1-month earlier follow-up for Lung-RADS 3.
Conclusions: One-month earlier diagnostic follow-ups for individuals with Lung-RADS category 3 nodules may result in a higher mortality reduction and warrants further investigation.
(Copyright © 2021 American College of Radiology. Published by Elsevier Inc. All rights reserved.)
Methods: We used the Lung Cancer Outcome Simulator to estimate population-level outcomes of alternative diagnostic follow-up intervals for Lung-RADS categories 3 and 4A. The Lung Cancer Outcome Simulator is a microsimulation model developed within the Cancer Intervention and Surveillance Modeling Network Consortium to evaluate outcomes of national screening guidelines. Here, among the evaluated outcomes are percentage of mortality reduction, screens performed, lung cancer deaths averted, screen-detected cases, and average number of screens and follow-ups per death averted.
Results: The recommended 3-month follow-up interval for Lung-RADS category 4A is optimal. However, for Lung-RADS category 3, a 5-month, instead of the recommended 6-month, follow-up interval yielded a higher mortality reduction (0.08% for men versus 0.05% for women), and a higher number of deaths averted (36 versus 27), a higher number of screen-detected cases (13 versus 7), and a lower number of combined low-dose CTs and diagnostic follow-ups per death avoided (8 versus 5), per one million general population. Sensitivity analysis of nodule progression threshold verifies a higher mortality reduction with a 1-month earlier follow-up for Lung-RADS 3.
Conclusions: One-month earlier diagnostic follow-ups for individuals with Lung-RADS category 3 nodules may result in a higher mortality reduction and warrants further investigation.
(Copyright © 2021 American College of Radiology. Published by Elsevier Inc. All rights reserved.)