Retrospective Analysis Comparing Lung-RADS v2022 and British Thoracic Society Guidelines for Differentiating Lung Metastases from Primary Lung Cancer

Loredana Gabriela Stana ¹, Alexandru Ovidiu Mederle ², Claudiu Avram ³

⁰Department I, Discipline of Anatomy and Embriology, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania.

Biomedicines +

|

January 25, 2025

View abstract on PubMed

Summary

The Lung Imaging Reporting and Data System (Lung-RADS) Version 2022 shows higher accuracy in distinguishing lung metastases from primary lung cancer on CT scans compared to British Thoracic Society guidelines. This improves diagnostic precision for patients without a prior cancer diagnosis.

Area Of Science

Radiology
Oncology
Pulmonary Medicine

Background

Differentiating lung metastases from primary lung cancer in patients without a prior cancer diagnosis is clinically significant.
Computed tomography (CT) scans are crucial for detecting pulmonary nodules, but distinguishing their origin can be challenging.
Existing guidelines, such as the Lung Imaging Reporting and Data System (Lung-RADS) and British Thoracic Society (BTS) guidelines, offer frameworks for nodule assessment.

Purpose Of The Study

To compare the diagnostic performance of Lung-RADS Version 2022 and BTS guidelines in distinguishing lung metastases from de novo primary lung cancer.
To evaluate the sensitivity and specificity of each guideline in a cohort of patients with newly detected pulmonary nodules and no prior cancer history.

Main Methods

Retrospective analysis of 196 patients with pulmonary nodules on CT scans (2015-2022) and no prior cancer diagnosis.
Nodules were characterized by size, number, location, margins, attenuation, and growth patterns.
Classification of nodules using Lung-RADS Version 2022 and BTS guidelines, followed by statistical comparison of sensitivity and specificity.

Main Results

Lung-RADS Version 2022 demonstrated significantly higher specificity (87.2%) compared to BTS guidelines (72.3%) (p < 0.001) in differentiating metastases from primary lung cancer.
Sensitivity was comparable between Lung-RADS (91.7%) and BTS (93.8%) (p = 0.68).
Lung metastases were associated with multiple nodules, lower lobe distribution, and smooth margins, while primary lung cancers often presented as solitary nodules in the upper lobe with spiculated margins.

Conclusions

Lung-RADS Version 2022 offers superior specificity over BTS guidelines for differentiating lung metastases from primary lung cancer in CT scans of cancer-naive patients.
Characteristic imaging features of nodules can aid in accurate diagnosis and guide subsequent patient management.
The findings support the utility of Lung-RADS Version 2022 in improving diagnostic accuracy for indeterminate pulmonary nodules.

Keywords:

British Thoracic Society guidelines CT imaging Lung-RADS lung metastases primary lung cancer pulmonary nodules

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