European Radiology

, Volume 27, Issue 12, pp 5113–5118 | Cite as

The relationship of cancer characteristics and patient outcome with time to lung cancer diagnosis after an abnormal screening CT

  • Sushilkumar K. Sonavane
  • Paul Pinsky
  • Jubal WattsJr
  • David S. Gierada
  • Reginald Munden
  • Satinder P. Singh
  • Hrudaya Nath



The National Lung Screening Trial (NLST) demonstrated a reduction in lung cancer and all-cause mortality with low-dose CT (LDCT) screening. The aim of our study was to examine the time to diagnosis (TTD) of lung cancer in the LDCT arm of the NLST and assess its relationship with cancer characteristics and survival.


The subjects (N = 462) with a positive baseline screen and subsequent lung cancer diagnosis within 3 years were evaluated by data and image review to confirm the baseline abnormality. The cases were analysed for the relationship between TTD and imaging features, cancer type, stage and survival for 7 years from baseline screen.


Cancer was judged to be present at baseline in 397/462 cases. The factors that showed significant association (p value trend less than 0.05) with longer TTD included smaller nodule size, pure ground glass nodules (GGNs), smooth/lobulated margins, stages I/II, adenocarcinoma, and decreasing lung cancer mortality. The logistic regression model for lung cancer death showed significant inverse relationships with size less than 20 mm (OR = 0.32), pure GGNs (OR = 0.24), adenocarcinoma (OR = 0.57) and direct relationship with age (OR = 1.4).


TTD after a positive LDCT screen in the NLST showed a strong association with imaging features, stage and mortality.

Key Points

NLST observed variable time to lung cancer diagnosis from positive baseline screen.

Time to diagnosis was associated with imaging features, cancer type and stage.

In univariate but not multivariate analysis, longer TTD correlated with decreased mortality.


Lung cancer Screening Computed tomography Diagnosis Mortality 


Compliance with ethical standards


The scientific guarantor of this publication is Dr. Paul Pinsky.

Conflict of interest

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 NIH and our research is a subanalysis from the original data.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study as a part of NLST enrolment.

Ethical approval

Institutional review board approval was obtained.

Study subjects or cohorts overlap

The study subjects or cohorts have not been previously reported.


• Retrospective

• Observational

• Multicentre study


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Sushilkumar K. Sonavane
    • 1
  • Paul Pinsky
    • 2
  • Jubal WattsJr
    • 1
  • David S. Gierada
    • 3
  • Reginald Munden
    • 4
  • Satinder P. Singh
    • 1
  • Hrudaya Nath
    • 1
  1. 1.Department of Radiology- Cardiopulmonary sectionUniversity of Alabama in Birmingham School of MedicineBirminghamUSA
  2. 2.Division of Cancer PreventionNational Cancer InstituteBethesdaUSA
  3. 3.Department of RadiologyWashington University School of MedicineSt. LouisUSA
  4. 4.Department of RadiologyWake Forest School of MedicineWinston SalemUSA

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