Practical Strategy to Mitigate Overdiagnosis in Asian Low-dose Computed Tomography Lung Cancer Screening.

Area of Science:

• Pulmonology
• Radiology
• Oncology

Background:

• Low-dose computed tomography (LDCT) screening effectively reduces lung cancer mortality.
• Subsolid nodules (SSNs) in Asian populations undergoing LDCT screening are prone to overdiagnosis and overtreatment.
• Chest X-ray (CXR) triage may improve patient selection for LDCT screening.

Purpose of the Study:

• To evaluate if CXR triage can enhance patient selection in LDCT screening for SSNs.
• To assess the impact of CXR triage on lung cancer prognosis, relapse rates, and the histopathologic spectrum of lung adenocarcinoma.
• To determine if CXR triage reduces unnecessary interventions and overdiagnosis.

Main Methods:

• Retrospective cohort study comparing direct LDCT screening with LDCT and CXR triage for 506 patients with SSNs ≤3cm.
• Propensity score matching (PSM) created 97 matched pairs for balanced comparison.
• Primary outcomes included lung cancer prognosis, relapse, and histopathology to assess overdiagnosis.

Main Results:

• The CXR triage group showed no cases of adenocarcinoma in situ (AIS) or atypical adenomatous hyperplasia (AAH) among resected lesions, unlike the direct LDCT group (37.1%).
• No significant differences in disease-free survival or relapse rates were observed between groups.
• Long-term survival analysis (15 years) revealed similarly high survival rates in both groups, indicating CXR triage does not negatively impact prognosis.

Conclusions:

• CXR triage serves as an effective preliminary step in LDCT screening for lung cancer, particularly for non-smoking Asian high-risk populations.
• This strategy can significantly reduce unnecessary surgical procedures while maintaining diagnostic effectiveness.
• Further prospective studies are warranted to confirm long-term safety, cost-effectiveness, and clinical acceptability.