CT screening for lung cancer

comparison of three baseline screening protocols

Writing Committee for the I-ELCAP Investigators

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Clinical management decisions arising from the baseline round for lung cancer screening are the most challenging, as findings have accumulated over a lifetime and may be of no clinical concern. To minimize unnecessary harms and costs of workup prior to the first, annual repeat screening, workup should be limited to participants with the highest suspicion of lung cancer while still aiming to identify small, early lung cancers. Methods: We compared recommendations for immediate, delayed (by 3 or 6 months) workup to assess growth at a malignant rate, and the resulting overall and potential biopsies of three baseline screening protocols: I-ELCAP, the two scenarios of ACR-LungRADS, and the European Consortium. For each protocol, the efficiency ratio (ER) of each recommendation was calculated by dividing the number of participants recommended for that workup by the number of resulting lung cancer diagnoses. The ER for potential biopsies was calculated, assuming that biopsies were performed on all participants recommended for immediate workup as well as those diagnosed with lung cancer after delayed workup. Results: For I-ELCAP, ACR-LungRADS Scenario 1, ACR-LungRADS Scenario 2, and the European consortium, the overall ER was 13.9, 18.3, 18.3, and 31.9, respectively, and for potential biopsies, it was 2.2, 8.1, 3.2, and 4.4, respectively. ER for immediate workup was 2.9, 8.6, 3.9, and 5.6, respectively, and for delayed workup was 36.1, 160.3, 57.8, and 111.9, respectively. Conclusions: I-ELCAP recommendations had the lowest ER values for overall, immediate, and delayed workup, and for potential biopsies. Key Points: • Small differences in protocol thresholds can lead to many unnecessary diagnostic workups. • I-ELCAP recommendations were the most efficient for immediate and overall workup, and potential biopsies. • Definition of a “positive result” and recommendations for further workup in the baseline round needs to be continually reevaluated and updated.

Original languageEnglish (US)
JournalEuropean Radiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Lung Neoplasms
Biopsy
Early Detection of Cancer
Costs and Cost Analysis
Growth

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging

Cite this

@article{e4c8133cb8cc4d37befab73fc95fbacc,
title = "CT screening for lung cancer: comparison of three baseline screening protocols",
abstract = "Purpose: Clinical management decisions arising from the baseline round for lung cancer screening are the most challenging, as findings have accumulated over a lifetime and may be of no clinical concern. To minimize unnecessary harms and costs of workup prior to the first, annual repeat screening, workup should be limited to participants with the highest suspicion of lung cancer while still aiming to identify small, early lung cancers. Methods: We compared recommendations for immediate, delayed (by 3 or 6 months) workup to assess growth at a malignant rate, and the resulting overall and potential biopsies of three baseline screening protocols: I-ELCAP, the two scenarios of ACR-LungRADS, and the European Consortium. For each protocol, the efficiency ratio (ER) of each recommendation was calculated by dividing the number of participants recommended for that workup by the number of resulting lung cancer diagnoses. The ER for potential biopsies was calculated, assuming that biopsies were performed on all participants recommended for immediate workup as well as those diagnosed with lung cancer after delayed workup. Results: For I-ELCAP, ACR-LungRADS Scenario 1, ACR-LungRADS Scenario 2, and the European consortium, the overall ER was 13.9, 18.3, 18.3, and 31.9, respectively, and for potential biopsies, it was 2.2, 8.1, 3.2, and 4.4, respectively. ER for immediate workup was 2.9, 8.6, 3.9, and 5.6, respectively, and for delayed workup was 36.1, 160.3, 57.8, and 111.9, respectively. Conclusions: I-ELCAP recommendations had the lowest ER values for overall, immediate, and delayed workup, and for potential biopsies. Key Points: • Small differences in protocol thresholds can lead to many unnecessary diagnostic workups. • I-ELCAP recommendations were the most efficient for immediate and overall workup, and potential biopsies. • Definition of a “positive result” and recommendations for further workup in the baseline round needs to be continually reevaluated and updated.",
author = "{Writing Committee for the I-ELCAP Investigators} and Henschke, {Claudia I.} and Rowena Yip and Teng Ma and Aguayo, {Samuel M.} and Javier Zulueta and Yankelevitz, {David F.} and Dongming Xu and Mary Salvatore and Raja Flores and Andrea Wolf and McCauley, {Dorothy I.} and Mildred Chen and Libby, {Daniel M.} and Miettinen, {Olli S.} and Smith, {James P.} and Mark Pasmantier and Reeves, {A. P.} and Steven Markowitz and Albert Miller and Deval, {Jose Cervera} and Heidi Roberts and Demetris Patsios and Shusuke Sone and Takaomi Hanaoka and Luis Montuenga and Lozano, {Maria D.} and Ralph Aye and Thomas Bauer and Stefano Canitano and Salvatore Giunta and Enser Cole and Karl Klingler and Austin, {John H.M.} and Pearson, {Gregory D.N.} and Dorith Shaham and Cheryl Aylesworth and Patrick Meyers and Shahriyour Andaz and Davood Vafai and David Naidich and Georgeann McGuinness and Barry Sheppard and Matthew Rifkin and Thorsen, {M. Kristin} and Richard Hansen and Samuel Kopel and William Mayfield and Dan Luedke and Donald Klippenstein and Mark Widmann",
year = "2018",
month = "1",
day = "1",
doi = "10.1007/s00330-018-5857-5",
language = "English (US)",
journal = "European Radiology",
issn = "0938-7994",
publisher = "Springer Verlag",

}

CT screening for lung cancer : comparison of three baseline screening protocols. / Writing Committee for the I-ELCAP Investigators.

In: European Radiology, 01.01.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - CT screening for lung cancer

T2 - comparison of three baseline screening protocols

AU - Writing Committee for the I-ELCAP Investigators

AU - Henschke, Claudia I.

AU - Yip, Rowena

AU - Ma, Teng

AU - Aguayo, Samuel M.

AU - Zulueta, Javier

AU - Yankelevitz, David F.

AU - Xu, Dongming

AU - Salvatore, Mary

AU - Flores, Raja

AU - Wolf, Andrea

AU - McCauley, Dorothy I.

AU - Chen, Mildred

AU - Libby, Daniel M.

AU - Miettinen, Olli S.

AU - Smith, James P.

AU - Pasmantier, Mark

AU - Reeves, A. P.

AU - Markowitz, Steven

AU - Miller, Albert

AU - Deval, Jose Cervera

AU - Roberts, Heidi

AU - Patsios, Demetris

AU - Sone, Shusuke

AU - Hanaoka, Takaomi

AU - Montuenga, Luis

AU - Lozano, Maria D.

AU - Aye, Ralph

AU - Bauer, Thomas

AU - Canitano, Stefano

AU - Giunta, Salvatore

AU - Cole, Enser

AU - Klingler, Karl

AU - Austin, John H.M.

AU - Pearson, Gregory D.N.

AU - Shaham, Dorith

AU - Aylesworth, Cheryl

AU - Meyers, Patrick

AU - Andaz, Shahriyour

AU - Vafai, Davood

AU - Naidich, David

AU - McGuinness, Georgeann

AU - Sheppard, Barry

AU - Rifkin, Matthew

AU - Thorsen, M. Kristin

AU - Hansen, Richard

AU - Kopel, Samuel

AU - Mayfield, William

AU - Luedke, Dan

AU - Klippenstein, Donald

AU - Widmann, Mark

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: Clinical management decisions arising from the baseline round for lung cancer screening are the most challenging, as findings have accumulated over a lifetime and may be of no clinical concern. To minimize unnecessary harms and costs of workup prior to the first, annual repeat screening, workup should be limited to participants with the highest suspicion of lung cancer while still aiming to identify small, early lung cancers. Methods: We compared recommendations for immediate, delayed (by 3 or 6 months) workup to assess growth at a malignant rate, and the resulting overall and potential biopsies of three baseline screening protocols: I-ELCAP, the two scenarios of ACR-LungRADS, and the European Consortium. For each protocol, the efficiency ratio (ER) of each recommendation was calculated by dividing the number of participants recommended for that workup by the number of resulting lung cancer diagnoses. The ER for potential biopsies was calculated, assuming that biopsies were performed on all participants recommended for immediate workup as well as those diagnosed with lung cancer after delayed workup. Results: For I-ELCAP, ACR-LungRADS Scenario 1, ACR-LungRADS Scenario 2, and the European consortium, the overall ER was 13.9, 18.3, 18.3, and 31.9, respectively, and for potential biopsies, it was 2.2, 8.1, 3.2, and 4.4, respectively. ER for immediate workup was 2.9, 8.6, 3.9, and 5.6, respectively, and for delayed workup was 36.1, 160.3, 57.8, and 111.9, respectively. Conclusions: I-ELCAP recommendations had the lowest ER values for overall, immediate, and delayed workup, and for potential biopsies. Key Points: • Small differences in protocol thresholds can lead to many unnecessary diagnostic workups. • I-ELCAP recommendations were the most efficient for immediate and overall workup, and potential biopsies. • Definition of a “positive result” and recommendations for further workup in the baseline round needs to be continually reevaluated and updated.

AB - Purpose: Clinical management decisions arising from the baseline round for lung cancer screening are the most challenging, as findings have accumulated over a lifetime and may be of no clinical concern. To minimize unnecessary harms and costs of workup prior to the first, annual repeat screening, workup should be limited to participants with the highest suspicion of lung cancer while still aiming to identify small, early lung cancers. Methods: We compared recommendations for immediate, delayed (by 3 or 6 months) workup to assess growth at a malignant rate, and the resulting overall and potential biopsies of three baseline screening protocols: I-ELCAP, the two scenarios of ACR-LungRADS, and the European Consortium. For each protocol, the efficiency ratio (ER) of each recommendation was calculated by dividing the number of participants recommended for that workup by the number of resulting lung cancer diagnoses. The ER for potential biopsies was calculated, assuming that biopsies were performed on all participants recommended for immediate workup as well as those diagnosed with lung cancer after delayed workup. Results: For I-ELCAP, ACR-LungRADS Scenario 1, ACR-LungRADS Scenario 2, and the European consortium, the overall ER was 13.9, 18.3, 18.3, and 31.9, respectively, and for potential biopsies, it was 2.2, 8.1, 3.2, and 4.4, respectively. ER for immediate workup was 2.9, 8.6, 3.9, and 5.6, respectively, and for delayed workup was 36.1, 160.3, 57.8, and 111.9, respectively. Conclusions: I-ELCAP recommendations had the lowest ER values for overall, immediate, and delayed workup, and for potential biopsies. Key Points: • Small differences in protocol thresholds can lead to many unnecessary diagnostic workups. • I-ELCAP recommendations were the most efficient for immediate and overall workup, and potential biopsies. • Definition of a “positive result” and recommendations for further workup in the baseline round needs to be continually reevaluated and updated.

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U2 - 10.1007/s00330-018-5857-5

DO - 10.1007/s00330-018-5857-5

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JF - European Radiology

SN - 0938-7994

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