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Lung-Reporting and Data System Category (Lung-RADS) and Adherence to Low-Dose Computed Tomography Screening and
Pratibha Shrestha1, Michael K Gould2, Gerard A Silvestri3
1Division of Population Health Sciences, Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida.
Background:
Adherence to guideline-recommended low-dose computed tomography (CT) screening and follow-up remains suboptimal, and determinants may vary by Lung Imaging Reporting and Data System (Lung-RADS) category.
Methods:
This retrospective, multi-site cohort study used electronic medical records from adults aged 50 to 80 years. Eligible individuals had at least one primary care visit in the previous 12 months, no lung cancer diagnosis in the preceding 5 years, and underwent an index low-dose CT between 2016 and 2021. Participants were followed through 2022. Adherence to follow-up chest CT within 11 to 15 months (Lung-RADS 1-2) and category-specific recommended follow-up (Lung-RADS 3-4X) was assessed using mixed-effects logistic regression to estimate adjusted ORs (aORs) and 95% confidence intervals (CIs).
Results:
Among 22,034 individuals with Lung-RADS 1 to 2, 21.67% completed follow-up CT within 11 to 15 months. The odds of adherence were higher among individuals aged 65 or more years (versus <65) (aOR = 1.22; 95% CI: 1.14-1.31) and those with chronic obstructive pulmonary disease (COPD) (aOR = 1.18; 95% CI: 1.09-1.27) and lower among black (versus white) individuals (aOR = 0.87; 95% CI: 0.79-0.96) and frail (versus non-frail) individuals (aOR = 0.88; 95% CI: 0.80-0.98). Among 4518 individuals with Lung-RADS 3 to 4X, 28.51% adhered to category-specific follow-up; COPD was the only factor independently associated with adherence (aOR = 1.22; 95% CI: 1.06-1.40).
Conclusion:
Adherence to follow-up CT and recommended care remains low in real-world settings; older age and COPD predicted higher adherence, while lower adherence among black individuals identifies a key target for improving lung cancer screening retention.
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