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Interval lung cancer after a negative CT screening examination: CT findings and outcomes in National Lung Screening Trial participants

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Abstract

Objectives

This study retrospectively analyses the screening CT examinations and outcomes of the National Lung Screening Trial (NLST) participants who had interval lung cancer diagnosed within 1 year after a negative CT screen and before the next annual screen.

Methods

The screening CTs of all 44 participants diagnosed with interval lung cancer (cases) were matched with negative CT screens of participants who did not develop lung cancer (controls). A majority consensus process was used to classify each CT screen as positive or negative according to the NLST criteria and to estimate the likelihood that any abnormalities detected retrospectively were due to lung cancer.

Results

By retrospective review, 40/44 cases (91%) and 17/44 controls (39%) met the NLST criteria for a positive screen (P < 0.001). Cases had higher estimated likelihood of lung cancer (P < 0.001). Abnormalities included pulmonary nodules ≥4 mm (n = 16), mediastinal (n = 8) and hilar (n = 6) masses, and bronchial lesions (n = 6). Cancers were stage III or IV at diagnosis in 32/44 cases (73%); 37/44 patients (84%) died of lung cancer, compared to 225/649 (35%) for all screen-detected cancers (P < 0.0001).

Conclusion

Most cases met the NLST criteria for a positive screen. Awareness of missed abnormalities and interpretation errors may aid lung cancer identification in CT screening.

Key points

Lung cancer within a year of a negative CT screen was rare.

Abnormalities likely due to lung cancer were identified retrospectively in most patients.

Awareness of error types may help identify lung cancer sooner.

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Acknowledgments

The National Lung Screening Trial was supported by the following NIH grants and contracts: U01-CA-80098, U01-CA-79778, N01-CN-25522, N01-CN-25511, N01-CN-25512, N01-CN-25513, N01-CN-25514, N01-CN-25515, N01-CN-25516, N01-CN-25518, N01-CN-25524, N01-CN-75022, N01-CN-25476, and N02-CN-63300. Data for this study were obtained through the Cancer Data Access System of the National Cancer Institute (https://biometry.nci.nih.gov/cdas/). We thank Joshua Rathmell and Brett Thomas of Information Management Services for assistance with data retrieval.

The scientific guarantor of this publication is DSG.

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Two of the authors have significant statistical expertise.

Institutional Review Board approval was not required because only previously acquired, de-identified, publicly available data were used.

Written informed consent was obtained from all subjects (patients) in this study.

Methodology:

• retrospective

• case-control study/observational

• multicentre study

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Correspondence to David S. Gierada.

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Gierada, D.S., Pinsky, P.F., Duan, F. et al. Interval lung cancer after a negative CT screening examination: CT findings and outcomes in National Lung Screening Trial participants. Eur Radiol 27, 3249–3256 (2017). https://doi.org/10.1007/s00330-016-4705-8

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  • DOI: https://doi.org/10.1007/s00330-016-4705-8

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