The impact of radiologists’ expertise on screen results decisions in a CT lung cancer screening trial
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To evaluate the impact of radiological expertise on screen result decisions in a CT lung cancer screening trial.
In the NELSON lung cancer screening trial, the baseline CT result was based on the largest lung nodule’s volume. The protocol allowed radiologists to manually adjust screen results in cases of high suspicion of benign or malignant nodule nature. Participants whose baseline CT result was based on a solid or part-solid nodule were included in this study. Adjustments by radiologists at baseline were evaluated. Histology was the reference for diagnosis or to confirm benignity and stability on subsequent CT examinations.
A total of 3,318 participants (2,796 male, median age 58.0 years) were included. In 195 participants (5.9 %) the initial baseline screen result was adjusted by the radiologist. Adjustment was downwards from positive or indeterminate to negative in two and 119 participants, respectively, and from positive to indeterminate in 65 participants. None of these nodules turned out to be malignant. In 9/195 participants (4.6 %) the screen result was adjusted upwards from negative to indeterminate or indeterminate to positive; two nodules were malignant.
In one in 20 cases of baseline lung cancer screening, nodules were reclassified by the radiologist, leading to a reduction of false-positive screen results.
• The NELSON study allowed radiologists to manually adjust the screen result
• At baseline, radiologists adjusted the result in about one in 20 cases (95.4 % downwards)
• Radiologists’ adjustments led to a 22 % reduction of false-positive screen results
• Radiologists’ expertise can improve nodule classification in addition to a nodule protocol
KeywordsPulmonary nodule Lung neoplasms Mass screening Protocol compliance Computed tomography
National Lung Screening Trial
The scientific guarantor of this publication is Prof. Dr. M. Oudkerk. 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. This study has received funding by The NELSON trial was sponsored by: Netherlands Organisation for Health Research and Development (ZonMw); Dutch Cancer Society Koningin Wilhelmina Fonds (KWF); Stichting Centraal Fonds Reserves van Voormalig Vrijwillige Ziekenfondsverzekeringen (RvvZ); Siemens Germany; Rotterdam Oncologic Thoracic Steering committee (ROTS); G.Ph.Verhagen Trust, Flemish League Against Cancer, Foundation Against Cancer and Erasmus Trust Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported (N Engl J Med 361:2221–2229, 2009). Other substudies were published in Radiology, European Radiology, Am J Respir Crit Care Med and Eur Resp Journal amongst others. Methodology: retrospective, randomised controlled trial, multicenter study. The work was performed at the following institutions: University of Groningen / University Medical Center Groningen, Groningen, The Netherlands; University Medical Center Utrecht, Utrecht, The Netherlands; Kennemer Gasthuis, Haarlem, The Netherlands; University Hospital Gasthuisberg Leuven, Leuven, Belgium.
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