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Lung cancer risk to personalise annual and biennial follow-up computed tomography screening
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  • Published on:
    Response to “Prospective randomised controlled trial: fixed 1-year screening interval group versus a tailored intervals group,” letter response by Silva et al

    We thank the authors of the letter in response to our paper for their interest and positive appraisal of our model. Likewise, we appreciate the design of the Multicenter Italian Lung Detection (MILD) trial which, despite its small sample size, demonstrates that annual intervals are unnecessary for the majority of screenees. Once more European data is available to perform cost-effectiveness analyses, we hypothesize that personalised screening intervals will prove to be the preferred design. Furthermore, it is estimated that most inclusion criteria used to select high-risk participants encompass only 70% of all lung cancer cases in the population; reassessing risk and tailoring interval groups after the baseline scan may enable the inclusion of persons of lower risk. As Silva et al mentioned, there is no reason to set the upper limit of follow-up intervals at 2-years. We also agree that volumetric nodule measurements are better suited for determining follow-up procedures than (perpendicular) diameter, and hope to be able to implement this into a future model. Moreover, risk scores may be calculated autonomously by computers in the future, with only a select few dubious cases requiring radiologist attention.

    Conflict of Interest:
    None declared.
  • Published on:
    Prospective randomised controlled trial: fixed 1-year screening interval group versus a tailored intervals group

    In 2011, the National Lung Cancer Screening Trial (NLST) showed that annual low-dose computed tomography (LDCT) improved overall survival (1). More recently, longer interval between LDCT rounds was advocated to improve screening efficiency after baseline (2).
    Schreuder et al reported a comprehensive model for optimization of LDCT by biennial rounds for subjects at lower 2-year risk of lung cancer (3). They built a promising polynomial model including both patient characteristics and nodule descriptors. The retrospective simulation on NLST data provided enough power to test Schreuder’s model (3) as well as other models for selection of subjects to be forwarded to biennial screening (2, 4). We appreciate this approach to parsimonious LDCT administration as we are strongly convinced that annual screening should be tailored to subjects with remarkably high risk of lung cancer. The authors refer that prospective randomized controlled trial with tailored screening intervals would be hardly feasible, however we would like to remind that some experience was already reported in the literature.
    Since 2005, the Multicenter Italian Lung Detection (MILD) trial conducted a prospective comparison between annual (LDCT1 = 1,152 screenees) and biennial LDCT (LDCT2 = 1,151 screenees) (5). The LDCT2 screenees were shifted to annual screening in case of solid nodule > 60 mm^3 and/or subsolid nodules. In other words, the MILD trial prospectively tested a risk model for tailored s...

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    Conflict of Interest:
    None declared.