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Lung

, Volume 197, Issue 3, pp 327–332 | Cite as

Improved False-Positive Rates and the Overestimation of Unintended Harm from Lung Cancer Screening

  • Justin KarushEmail author
  • Andrew Arndt
  • Palmi Shah
  • Nicole Geissen
  • Linda Dowling
  • Ashley Levitan
  • Gary Chmielewski
  • Christopher Seder
  • Michael Liptay
LUNG CANCER
  • 46 Downloads

Abstract

Background

Concern over high false-positive rates and the potential for unintended harm to patients is a critical component of the lack of widespread adoption of lung cancer screening.

Methods

An institutional database was used to identify patients who underwent lung cancer screening between 2/2015 and 2/2018 at Rush University Medical Center and Rush Oak Park Hospital. Reads were executed by dedicated thoracic radiologists and communicated using the Lung Imaging Reporting and Data System (Lung-RADS V.1).

Results

Six hundred and four patients were screened over the study period. We identified 21 primary lung cancers and 8 incidental cancers. We identified a false-positive rate of 17.5%. Only 9 patients underwent further investigative workup for benign disease (5.3%); however, only 4 (2.9%) of those patients were found to have inflammatory or infectious lesions, which are common mimickers of lung cancer. Excluding Lung-RADS category 3 for the purpose of quantifying risk of unintended harm from unnecessary procedures, we found a 6.9% false-positive rate, while diagnosing 25% of all Lung-RADS category 4 patients with primary lung cancer.

Conclusion

False-positive rates in lung cancer screening programs continue to decline with improved radiologic expertise. Additionally, false-positive reporting overestimates the risk of unintended harm from further investigative procedures as only a percentage of positive findings are generally considered for tissue diagnosis (i.e., Lung-RADS category 4).

Keywords

Lung cancer Lung cancer screening Lung-RADS Lung nodule 

Abbreviations

LCS

Lung cancer screening

LDCT

Low-dose computed tomography

NLST

National Lung Screening Trial

Lung-RADS

Lung Imaging Reporting and Data System

USPSTF

United Stages Preventative Services Task Force

VA

Veterans Administration

VATS

Video-assisted thoracoscopic surgery

NCCN

National comprehensive care network

CRT

Chemotherapy and radiation treatment

NND

Number needed to diagnose

Notes

Acknowledgements

All authors had full access to the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Justin Karush
    • 1
    • 4
    Email author
  • Andrew Arndt
    • 1
  • Palmi Shah
    • 2
  • Nicole Geissen
    • 1
  • Linda Dowling
    • 3
  • Ashley Levitan
    • 3
  • Gary Chmielewski
    • 1
  • Christopher Seder
    • 1
  • Michael Liptay
    • 1
  1. 1.Department of Thoracic SurgeryRush University Medical CenterChicagoUSA
  2. 2.Department of RadiologyRush University Medical CenterChicagoUSA
  3. 3.Rush University Cancer Center, University Thoracic SurgeonsChicagoUSA
  4. 4.University Thoracic SurgeonsChicagoUSA

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