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Low-dose CT screening in an Asian population with diverse risk for lung cancer: A retrospective cohort study

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Abstract

Objectives

To evaluate the performance of low-dose CT (LDCT) screening for lung cancer (LCA) detection in an Asian population with diverse risks for LCA.

Materials and methods

LCA screening was performed in 12,427 symptomless Asian subjects using either LDCT (5,771) or chest radiography (CXR) (6,656) in a non-trial setting. Subjects were divided into high-risk and non-high-risk groups. Data were collected on the number of patients with screening-detected LCAs and their survival in order to compare outcomes between LDCT and CXR screening with the stratification of risks considering age, sex and smoking status.

Results

In the non-high-risk group, a significant difference was observed for the detection of lung cancer (adjusted OR, 5.07; 95 % CI, 2.72–9.45) and survival (adjusted HR of LCA survival between LDCT vs. CXR group, 0.08; 95 % CI, 0.01–0.62). No difference in detection or survival of LCA was noticed in the high-risk group. LCAs in the non-high-risk group were predominantly adenocarcinomas (96 %), and more likely to be part-solid or non-solid compared with those in the high-risk group (p = 0.023).

Conclusions

In the non-high-risk group, LDCT helps detect more LCAs and offers better survival than CXR screening, due to better detection of part solid or non-solid lung adenocarcinomas.

Key Points

• In an Asian non-high-risk group, LDCT helps detect more early-staged LCAs.

• CT-detected lung cancers in non-high-risk subjects demonstrate better survival than CXR-detected cancers.

• CT-detected lung cancers in non-high-risk subjects are predominantly part-solid or non-solid adenocarcinomas.

• Mortality benefit of LDCT screening in non-high-risk subjects needs to be investigated.

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Abbreviations

LDCT:

Low-dose CT

NLST:

National Lung Screening Trial

CXR:

Chest radiography

OR:

Odds ratio

CI:

Confidence interval

ELCAP:

Early Lung Cancer Action Project

HR:

Hazard ratio

AIS:

Adenocarcinoma in situ

MIA:

Minimally invasive adenocarcinoma

EGFR:

Epithelial growth factor receptor

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Acknowledgments

The scientific guarantor of this publication is Kyung Soo Lee. This study received funding from the Korean Foundation for Cancer Research, KFCR-CB-201103. Myung-Hee Shin has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. This is a retrospective case-control study performed at one institution.

Author information

Author notes

  1. Kyung Eun Shin

    Present address: Department of Diagnostic Radiology, Kyung Hee University Hospital, Seoul, 130-702, Korea

Authors and Affiliations

  1. Department of Radiology and Center for Imaging Science, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea

    Chin A. Yi, Kyung Soo Lee & Kyung Eun Shin

  2. Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea

    Myung-Hee Shin & Yun Yung Cho

  3. Center for Health Promotion, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea

    Yoon-Ho Choi

  4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 135-710, Korea

    O Jung Kwon

  5. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea

    Kyung Soo Lee

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  1. Chin A. Yi
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Correspondence to Kyung Soo Lee.

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Yi, C.A., Lee, K.S., Shin, MH. et al. Low-dose CT screening in an Asian population with diverse risk for lung cancer: A retrospective cohort study. Eur Radiol 25, 2335–2345 (2015). https://doi.org/10.1007/s00330-015-3620-8

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  • DOI: https://doi.org/10.1007/s00330-015-3620-8

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