ACR Lung CT Screening Reporting and Data System, a Systematic Review and Meta-Analysis Before Change in US...

Area of Science:

• Radiology and Imaging
• Oncology
• Public Health

Background:

• The Lung-RADS (Lung CT Screening Reporting and Data System) is crucial for standardizing lung cancer screening interpretation.
• Understanding real-world performance of Lung-RADS is essential, especially before potential changes in screening eligibility criteria.
• Previous estimates by the American College of Radiology (ACR) provide a benchmark for expected Lung-RADS score distributions and positive predictive values (PPV).

Approach:

• A systematic review and meta-analysis was conducted using data from 2014 to 2021.
• Searched databases included MEDLINE, Embase, CINAHL, and Web of Science.
• Extracted data encompassed patient demographics, smoking history, screening timeline, Lung-RADS scores, and PPV from 24 studies involving 32,817 patient encounters.

Key Points:

• The meta-analysis found lower rates of Lung-RADS 1-2 scores (84.4%) and higher rates of Lung-RADS 3 (8.7%) and 4 (6.5%) compared to ACR expectations.
• The overall observed PPV for Lung-RADS 3-4 was 13.1%, lower than the ACR's minimum estimate of 21%.
• The PPV for Lung-RADS 4 specifically was 28.6%, aligning with the ACR's minimum estimate.

Conclusions:

• Current literature data on Lung-RADS scores and PPV are not consistent with ACR estimates.
• Re-examination of Lung-RADS categorization may be necessary to improve concordance with real-world lung cancer screening populations.
• This study provides a valuable benchmark before broader screening guideline implementation and informs future reporting practices.