TY - JOUR
T1 - Evaluation of Alternative Diagnostic Follow-up Intervals for Lung Reporting and Data System Criteria on the Effectiveness of Lung Cancer Screening
AU - Bastani, Mehrad
AU - Toumazis, Iakovos
AU - Hedou, Julien
AU - Leung, Ann
AU - Plevritis, Sylvia K.
N1 - Funding Information:
Dr Plevritis reports grants from the National Institutes of Health; scientific consultant to GRAIL for clinical trial design of blood-based biomarkers, unrelated to this work; patents in -omic data analysis, unrelated to this work; and member, Scientific Advisory Board, NCI BSA, Knight Cancer Center at OHSU, Ontario Cancer Research Institute. The other authors state that they have no conflict of interest related to the material discussed in this article. All authors are non-partner/non-partnership track/employees.
Publisher Copyright:
© 2021 American College of Radiology
PY - 2021/12
Y1 - 2021/12
N2 - Purpose: The ACR developed the Lung CT Screening Reporting and Data System (Lung-RADS) to standardize the diagnostic follow-up of suspicious screening findings. A retrospective analysis showed that Lung-RADS would have reduced the false-positive rate in the National Lung Screening Trial, but the optimal timing of follow-up examinations has not been established. In this study, we assess the effectiveness of alternative diagnostic follow-up intervals on lung cancer screening. Methods: We used the Lung Cancer Outcome Simulator to estimate population-level outcomes of alternative diagnostic follow-up intervals for Lung-RADS categories 3 and 4A. The Lung Cancer Outcome Simulator is a microsimulation model developed within the Cancer Intervention and Surveillance Modeling Network Consortium to evaluate outcomes of national screening guidelines. Here, among the evaluated outcomes are percentage of mortality reduction, screens performed, lung cancer deaths averted, screen-detected cases, and average number of screens and follow-ups per death averted. Results: The recommended 3-month follow-up interval for Lung-RADS category 4A is optimal. However, for Lung-RADS category 3, a 5-month, instead of the recommended 6-month, follow-up interval yielded a higher mortality reduction (0.08% for men versus 0.05% for women), and a higher number of deaths averted (36 versus 27), a higher number of screen-detected cases (13 versus 7), and a lower number of combined low-dose CTs and diagnostic follow-ups per death avoided (8 versus 5), per one million general population. Sensitivity analysis of nodule progression threshold verifies a higher mortality reduction with a 1-month earlier follow-up for Lung-RADS 3. Conclusions: One-month earlier diagnostic follow-ups for individuals with Lung-RADS category 3 nodules may result in a higher mortality reduction and warrants further investigation.
AB - Purpose: The ACR developed the Lung CT Screening Reporting and Data System (Lung-RADS) to standardize the diagnostic follow-up of suspicious screening findings. A retrospective analysis showed that Lung-RADS would have reduced the false-positive rate in the National Lung Screening Trial, but the optimal timing of follow-up examinations has not been established. In this study, we assess the effectiveness of alternative diagnostic follow-up intervals on lung cancer screening. Methods: We used the Lung Cancer Outcome Simulator to estimate population-level outcomes of alternative diagnostic follow-up intervals for Lung-RADS categories 3 and 4A. The Lung Cancer Outcome Simulator is a microsimulation model developed within the Cancer Intervention and Surveillance Modeling Network Consortium to evaluate outcomes of national screening guidelines. Here, among the evaluated outcomes are percentage of mortality reduction, screens performed, lung cancer deaths averted, screen-detected cases, and average number of screens and follow-ups per death averted. Results: The recommended 3-month follow-up interval for Lung-RADS category 4A is optimal. However, for Lung-RADS category 3, a 5-month, instead of the recommended 6-month, follow-up interval yielded a higher mortality reduction (0.08% for men versus 0.05% for women), and a higher number of deaths averted (36 versus 27), a higher number of screen-detected cases (13 versus 7), and a lower number of combined low-dose CTs and diagnostic follow-ups per death avoided (8 versus 5), per one million general population. Sensitivity analysis of nodule progression threshold verifies a higher mortality reduction with a 1-month earlier follow-up for Lung-RADS 3. Conclusions: One-month earlier diagnostic follow-ups for individuals with Lung-RADS category 3 nodules may result in a higher mortality reduction and warrants further investigation.
KW - Clinical practice guideline
KW - lung cancer
KW - microsimulation modeling
KW - pulmonary nodule
UR - http://www.scopus.com/inward/record.url?scp=85115147472&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85115147472&partnerID=8YFLogxK
U2 - 10.1016/j.jacr.2021.08.001
DO - 10.1016/j.jacr.2021.08.001
M3 - Article
C2 - 34419477
AN - SCOPUS:85115147472
SN - 1546-1440
VL - 18
SP - 1614
EP - 1623
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 12
ER -