High false-positive (FP) scan rates associated with low-dose computed tomography (LDCT) lung cancer screening result in unnecessary follow-up tests and exposure to harm. The definition of a ‘positive’ scan can impact FP rates and screening performance. We explored the effect of Lung Imaging Reporting and Data System (Lung-RADS) criteria, PanCan Nodule Malignancy Probability Model and varying nodule size thresholds (≥4 mm, ≥6 mm, ≥8 mm) on diagnostic accuracy and screening performance compared with original trial definitions (National Lung Screening Trial (NLST) criteria) in a secondary analysis of a lung cancer screening cohort. We found Lung-RADS criteria and the PanCan Nodule Malignancy Probability Model could substantially improve screening performance and reduce FP scan rates compared with NLST definitions of positivity but that this needs to be balanced against possible risk of false-negative results.
Trial registration number Australian New Zealand Clinical Trials Registry, ACTRN12610000007033.
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Contributors HMM had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: HMM, KMF, IAY, RVB. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: HMM, HZ. Critical revision of the manuscript for important intellectual content: KMF, IAY, RVB. Statistical analysis: HMM, HZ. Obtained funding: KMF, IAY, RVB. Study supervision: KMF, IAY, RVB.
Funding National Health and Medical Research Council (Practitioner Fellowship 1019891 (KMF); Career Development Fellowship 1026215 (IAY); Medical PhD Scholarship 631306 (HMM)); Smart State Project Grant, Queensland Health; National Centre for Asbestos Related Diseases Project Grant and The Prince Charles Hospital Foundation.
Competing interests None declared.
Ethics approval The Prince Charles Hospital human research ethics committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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