Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening
- Nanda Horeweg 1, Joost van Rosmalen 2, Marjolein A Heuvelmans 3, Carlijn M van der Aalst 4, Rozemarijn Vliegenthart 3, Ernst Th Scholten 5, Kevin ten Haaf 4, Kristiaan Nackaerts 6, Jan-Willem J Lammers 7, Carla Weenink 8, Harry J Groen 9, Peter van Ooijen 3, Pim A de Jong 10, Geertruida H de Bock 11, Willem Mali 10, Harry J de Koning 4, Matthijs Oudkerk 3
- 1Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
- 2Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands.
- 3Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands; Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- 4Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands.
- 5Department of Radiology, Kennemer Gasthuis, Haarlem, Netherlands.
- 6Department of Pulmonary Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
- 7Department of Pulmonary Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
- 8Department of Pulmonary Medicine, Kennemer Gasthuis, Haarlem, Netherlands.
- 9Department of Pulmonary Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- 10Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands.
- 11Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- 0Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Pulmonary Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
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View abstract on PubMed
Summary
This summary is machine-generated.Lung cancer screening using CT scans is improved by new nodule management protocols. These protocols better predict cancer risk based on nodule size and volume doubling time, outperforming current guidelines.
Area Of Science
- Pulmonology
- Radiology
- Oncology
Background
- Lung cancer screening faces challenges with numerous pulmonary nodules and low cancer incidence.
- Current management protocols rely on nodule size and growth thresholds, which may not accurately reflect individual cancer risk.
- Accurate risk stratification is crucial for optimizing diagnostic procedures in lung cancer screening.
Purpose Of The Study
- To quantify the impact of nodule diameter, volume, and volume doubling time on lung cancer probability within two years of CT screening.
- To propose and evaluate novel thresholds for lung nodule management protocols.
- To compare the performance of new protocols against existing American College of Chest Physicians (ACCP) guidelines.
Main Methods
- Analysis of data from the NELSON CT screening trial, including participants aged 50-75 with significant smoking histories.
- Calculation of lung cancer probabilities stratified by nodule characteristics (diameter, volume, volume doubling time).
- Logistic regression analysis and assessment of management strategies based on nodule threshold characteristics for sensitivity and specificity.
Main Results
- Small nodules (<100 mm³ or <5 mm diameter) showed low lung cancer probability, similar to participants without nodules.
- Intermediate nodules (100-300 mm³ or 5-10 mm diameter) required further follow-up, with volume doubling time refining risk assessment.
- Large nodules (≥300 mm³ or ≥10 mm diameter) indicated high lung cancer probability.
- New diameter-based and volume-based protocols demonstrated improved sensitivity and specificity compared to the simulated ACCP protocol.
Conclusions
- Nodules with <100 mm³ volume or <5 mm diameter are not predictive of lung cancer.
- Large nodules (≥300 mm³ or ≥10 mm) necessitate immediate diagnostic evaluation.
- Volume doubling time is valuable for intermediate-sized nodules (100-300 mm³ or 5-10 mm).
- Nodule management protocols incorporating these thresholds offer superior performance over the ACCP guidelines.
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