RT Journal Article
SR Electronic
T1 Persisting new nodules in incidence rounds of the NELSON CT lung cancer screening study
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 247
OP 253
DO 10.1136/thoraxjnl-2018-212152
VO 74
IS 3
A1 Joan E Walter
A1 Marjolein A Heuvelmans
A1 Kevin ten Haaf
A1 Rozemarijn Vliegenthart
A1 Carlijn M van der Aalst
A1 Uraujh Yousaf-Khan
A1 Peter M A van Ooijen
A1 Kristiaan Nackaerts
A1 Harry J M Groen
A1 Geertruida H De Bock
A1 Harry J de Koning
A1 Matthijs Oudkerk
YR 2019
UL http://thorax.bmj.com/content/74/3/247.abstract
AB Background The US guidelines recommend low-dose CT (LDCT) lung cancer screening for high-risk individuals. New solid nodules after baseline screening are common and have a high lung cancer probability. Currently, no evidence exists concerning the risk stratification of non-resolving new solid nodules at first LDCT screening after initial detection.Methods In the Dutch-Belgian Randomized Lung Cancer Screening (NELSON) trial, 7295 participants underwent the second and 6922 participants the third screening round. We included participants with solid nodules that were registered as new or <15 mm³ (study detection limit) at previous screens and received additional screening after initial detection, thereby excluding high-risk nodules according to the NELSON management protocol (nodules ≥500 mm3).Results Overall, 680 participants with 1020 low-risk and intermediate-risk new solid nodules were included. A total of 562 (55%) new solid nodules were resolving, leaving 356 (52%) participants with a non-resolving new solid nodule, of whom 25 (7%) were diagnosed with lung cancer. At first screening after initial detection, volume doubling time (VDT), volume, and VDT combined with a predefined ≥200 mm3 volume cut-off had high discrimination for lung cancer (VDT, area under the curve (AUC): 0.913; volume, AUC: 0.875; VDT and ≥200 mm3 combination, AUC: 0.939). Classifying a new solid nodule with either ≤590 days VDT or ≥200 mm3 volume positive provided 100% sensitivity, 84% specificity and 27% positive predictive value for lung cancer.Conclusions More than half of new low-risk and intermediate-risk solid nodules in LDCT lung cancer screening resolve. At follow-up, growth assessment potentially combined with a volume limit can be used for risk stratification.Trial registration number ISRCTN63545820; pre-results.