RT Journal Article
SR Electronic
T1 Growing small solid nodules in lung cancer screening: safety and efficacy of a 200 mm<sup>3</sup> minimum size threshold for multidisciplinary team referral
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 202
OP 206
DO 10.1136/thorax-2022-219403
VO 78
IS 2
A1 Andrew W Creamer
A1 Carolyn Horst
A1 Jennifer L Dickson
A1 Sophie Tisi
A1 Helen Hall
A1 Priyam Verghese
A1 Ruth Prendecki
A1 Amyn Bhamani
A1 John McCabe
A1 Kylie Gyertson
A1 Anne-Marie Mullin
A1 Jonathan Teague
A1 Laura Farrelly
A1 Allan Hackshaw
A1 Arjun Nair
A1 SUMMIT consortium
A1 Anand Devaraj
A1 Sam M Janes
YR 2023
UL http://thorax.bmj.com/content/78/2/202.abstract
AB The optimal management of small but growing nodules remains unclear. The SUMMIT study nodule management algorithm uses a specific threshold volume of 200 mm3 before referral of growing solid nodules to the multidisciplinary team for further investigation is advised, with growing nodules below this threshold kept under observation within the screening programme. Malignancy risk of growing solid nodules of size &gt;200 mm3 at initial 3-month interval scan was 58.3% at a per-nodule level, compared with 13.3% in growing nodules of size ≤200 mm3 (relative risk 4.4, 95% CI 2.17 to 8.83). The positive predictive value of a combination of nodule growth (defined as percentage volume change of ≥25%), and size &gt;200 mm3 was 65.9% (29/44) at a cancer-per-nodule basis, or 60.5% (23/38) on a cancer-per-participant basis. False negative rate of the protocol was 1.9% (95% CI 0.33% to 9.94%). These findings support the use of a 200 mm3 minimum volume threshold for referral as effective at reducing unnecessary multidisciplinary team referrals for small growing nodules, while maintaining early-stage lung cancer diagnosis.