TY - JOUR
T1 - CT screening for lung cancer
T2 - comparison of three baseline screening protocols
AU - Writing Committee for the I-ELCAP Investigators
AU - Henschke, Claudia I.
AU - Yip, Rowena
AU - Ma, Teng
AU - Aguayo, Samuel M.
AU - Zulueta, Javier
AU - Yankelevitz, David F.
AU - Xu, Dongming
AU - Salvatore, Mary
AU - Flores, Raja
AU - Wolf, Andrea
AU - McCauley, Dorothy I.
AU - Chen, Mildred
AU - Libby, Daniel M.
AU - Miettinen, Olli S.
AU - Smith, James P.
AU - Pasmantier, Mark
AU - Reeves, A. P.
AU - Markowitz, Steven
AU - Miller, Albert
AU - Deval, Jose Cervera
AU - Roberts, Heidi
AU - Patsios, Demetris
AU - Sone, Shusuke
AU - Hanaoka, Takaomi
AU - Montuenga, Luis
AU - Lozano, Maria D.
AU - Aye, Ralph
AU - Bauer, Thomas
AU - Canitano, Stefano
AU - Giunta, Salvatore
AU - Cole, Enser
AU - Klingler, Karl
AU - Austin, John H.M.
AU - Pearson, Gregory D.N.
AU - Shaham, Dorith
AU - Aylesworth, Cheryl
AU - Meyers, Patrick
AU - Andaz, Shahriyour
AU - Vafai, Davood
AU - Naidich, David
AU - McGuinness, Georgeann
AU - Sheppard, Barry
AU - Rifkin, Matthew
AU - Thorsen, M. Kristin
AU - Hansen, Richard
AU - Kopel, Samuel
AU - Mayfield, William
AU - Luedke, Dan
AU - Klippenstein, Donald
AU - Litwin, Alan
N1 - Publisher Copyright:
© 2018, European Society of Radiology.
PY - 2019/10/1
Y1 - 2019/10/1
N2 - Purpose: Clinical management decisions arising from the baseline round for lung cancer screening are the most challenging, as findings have accumulated over a lifetime and may be of no clinical concern. To minimize unnecessary harms and costs of workup prior to the first, annual repeat screening, workup should be limited to participants with the highest suspicion of lung cancer while still aiming to identify small, early lung cancers. Methods: We compared recommendations for immediate, delayed (by 3 or 6 months) workup to assess growth at a malignant rate, and the resulting overall and potential biopsies of three baseline screening protocols: I-ELCAP, the two scenarios of ACR-LungRADS, and the European Consortium. For each protocol, the efficiency ratio (ER) of each recommendation was calculated by dividing the number of participants recommended for that workup by the number of resulting lung cancer diagnoses. The ER for potential biopsies was calculated, assuming that biopsies were performed on all participants recommended for immediate workup as well as those diagnosed with lung cancer after delayed workup. Results: For I-ELCAP, ACR-LungRADS Scenario 1, ACR-LungRADS Scenario 2, and the European consortium, the overall ER was 13.9, 18.3, 18.3, and 31.9, respectively, and for potential biopsies, it was 2.2, 8.1, 3.2, and 4.4, respectively. ER for immediate workup was 2.9, 8.6, 3.9, and 5.6, respectively, and for delayed workup was 36.1, 160.3, 57.8, and 111.9, respectively. Conclusions: I-ELCAP recommendations had the lowest ER values for overall, immediate, and delayed workup, and for potential biopsies. Key Points: • Small differences in protocol thresholds can lead to many unnecessary diagnostic workups. • I-ELCAP recommendations were the most efficient for immediate and overall workup, and potential biopsies. • Definition of a “positive result” and recommendations for further workup in the baseline round needs to be continually reevaluated and updated.
AB - Purpose: Clinical management decisions arising from the baseline round for lung cancer screening are the most challenging, as findings have accumulated over a lifetime and may be of no clinical concern. To minimize unnecessary harms and costs of workup prior to the first, annual repeat screening, workup should be limited to participants with the highest suspicion of lung cancer while still aiming to identify small, early lung cancers. Methods: We compared recommendations for immediate, delayed (by 3 or 6 months) workup to assess growth at a malignant rate, and the resulting overall and potential biopsies of three baseline screening protocols: I-ELCAP, the two scenarios of ACR-LungRADS, and the European Consortium. For each protocol, the efficiency ratio (ER) of each recommendation was calculated by dividing the number of participants recommended for that workup by the number of resulting lung cancer diagnoses. The ER for potential biopsies was calculated, assuming that biopsies were performed on all participants recommended for immediate workup as well as those diagnosed with lung cancer after delayed workup. Results: For I-ELCAP, ACR-LungRADS Scenario 1, ACR-LungRADS Scenario 2, and the European consortium, the overall ER was 13.9, 18.3, 18.3, and 31.9, respectively, and for potential biopsies, it was 2.2, 8.1, 3.2, and 4.4, respectively. ER for immediate workup was 2.9, 8.6, 3.9, and 5.6, respectively, and for delayed workup was 36.1, 160.3, 57.8, and 111.9, respectively. Conclusions: I-ELCAP recommendations had the lowest ER values for overall, immediate, and delayed workup, and for potential biopsies. Key Points: • Small differences in protocol thresholds can lead to many unnecessary diagnostic workups. • I-ELCAP recommendations were the most efficient for immediate and overall workup, and potential biopsies. • Definition of a “positive result” and recommendations for further workup in the baseline round needs to be continually reevaluated and updated.
KW - Cancer screening
KW - Clinical protocols
KW - Lung neoplasms
KW - Spiral computed
KW - Tomography
UR - http://www.scopus.com/inward/record.url?scp=85058064085&partnerID=8YFLogxK
U2 - 10.1007/s00330-018-5857-5
DO - 10.1007/s00330-018-5857-5
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C2 - 30511179
AN - SCOPUS:85058064085
SN - 0938-7994
VL - 29
SP - 5217
EP - 5226
JO - European Radiology
JF - European Radiology
IS - 10
ER -
