Author:
Walter Joan E,Heuvelmans Marjolein A,ten Haaf Kevin,Vliegenthart Rozemarijn,van der Aalst Carlijn M,Yousaf-Khan Uraujh,van Ooijen Peter M A,Nackaerts Kristiaan,Groen Harry J M,De Bock Geertruida H,de Koning Harry J,Oudkerk Matthijs
Abstract
BackgroundThe US guidelines recommend low-dose CT (LDCT) lung cancer screening for high-risk individuals. New solid nodules after baseline screening are common and have a high lung cancer probability. Currently, no evidence exists concerning the risk stratification of non-resolving new solid nodules at first LDCT screening after initial detection.MethodsIn the Dutch-Belgian Randomized Lung Cancer Screening (NELSON) trial, 7295 participants underwent the second and 6922 participants the third screening round. We included participants with solid nodules that were registered as new or <15 mm³ (study detection limit) at previous screens and received additional screening after initial detection, thereby excluding high-risk nodules according to the NELSON management protocol (nodules ≥500 mm3).ResultsOverall, 680 participants with 1020 low-risk and intermediate-risk new solid nodules were included. A total of 562 (55%) new solid nodules were resolving, leaving 356 (52%) participants with a non-resolving new solid nodule, of whom 25 (7%) were diagnosed with lung cancer. At first screening after initial detection, volume doubling time (VDT), volume, and VDT combined with a predefined ≥200 mm3 volume cut-off had high discrimination for lung cancer (VDT, area under the curve (AUC): 0.913; volume, AUC: 0.875; VDT and ≥200 mm3 combination, AUC: 0.939). Classifying a new solid nodule with either ≤590 days VDT or ≥200 mm3 volume positive provided 100% sensitivity, 84% specificity and 27% positive predictive value for lung cancer.ConclusionsMore than half of new low-risk and intermediate-risk solid nodules in LDCT lung cancer screening resolve. At follow-up, growth assessment potentially combined with a volume limit can be used for risk stratification.Trial registration numberISRCTN63545820; pre-results.
Funder
KWF Kankerbestrijding
Flemish League Against Cancer
G.Ph.Verhagen Trust
Siemens Foundation
Foundation Against Cancer and Erasmus Trust Fund
ZonMw
Stichting Centraal Fonds Reserves van Voormalig Vrijwillige Ziekenfondsverzekeringen
Rotterdam Oncologic Thoracic Steering committee
Subject
Pulmonary and Respiratory Medicine
Cited by
18 articles.
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