Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening

医学 肺癌 结核(地质) 逻辑回归 放射科 癌症 肺癌筛查 入射(几何) 全国肺筛查试验 内科学 核医学 生物 光学 物理 古生物学
作者
Nanda Horeweg,Joost van Rosmalen,Marjolein A. Heuvelmans,Carlijn M. van der Aalst,Rozemarijn Vliegenthart,Ernst T. Scholten,Kevin ten Haaf,Kristiaan Nackaerts,Jan‐Willem J. Lammers,Carla Weenink,Harry J.M. Groen,Peter M. A. van Ooijen,Pim A. de Jong,Geertruida H. de Bock,Willem P.Th.M. Mali,Harry J. de Koning,Matthijs Oudkerk
出处
期刊:Lancet Oncology [Elsevier BV]
卷期号:15 (12): 1332-1341 被引量:460
标识
DOI:10.1016/s1470-2045(14)70389-4
摘要

The main challenge in CT screening for lung cancer is the high prevalence of pulmonary nodules and the relatively low incidence of lung cancer. Management protocols use thresholds for nodule size and growth rate to determine which nodules require additional diagnostic procedures, but these should be based on individuals' probabilities of developing lung cancer. In this prespecified analysis, using data from the NELSON CT screening trial, we aimed to quantify how nodule diameter, volume, and volume doubling time affect the probability of developing lung cancer within 2 years of a CT scan, and to propose and evaluate thresholds for management protocols.Eligible participants in the NELSON trial were those aged 50-75 years, who have smoked 15 cigarettes or more per day for more than 25 years, or ten cigarettes or more for more than 30 years and were still smoking, or had stopped smoking less than 10 years ago. Participants were randomly assigned to low-dose CT screening at increasing intervals, or no screening. We included all participants assigned to the screening group who had attended at least one round of screening, and whose results were available from the national cancer registry database. We calculated lung cancer probabilities, stratified by nodule diameter, volume, and volume doubling time and did logistic regression analysis using diameter, volume, volume doubling time, and multinodularity as potential predictor variables. We assessed management strategies based on nodule threshold characteristics for specificity and sensitivity, and compared them to the American College of Chest Physicians (ACCP) guidelines. The NELSON trial is registered at www.trialregister.nl, number ISRCTN63545820.Volume, volume doubling time, and volumetry-based diameter of 9681 non-calcified nodules detected by CT screening in 7155 participants in the screening group of NELSON were used to quantify lung cancer probability. Lung cancer probability was low in participants with a nodule volume of 100 mm(3) or smaller (0·6% [95% CI 0·4-0·8]) or maximum transverse diameter smaller than 5 mm (0·4% [0·2-0·7]), and not significantly different from participants without nodules (0·4% [0·3-0·6], p=0·17 and p=1·00, respectively). Lung cancer probability was intermediate (requiring follow-up CT) if nodules had a volume of 100-300 mm(3) (2·4% [95% CI 1·7-3·5]) or a diameter 5-10 mm (1·3% [1·0-1·8]). Volume doubling time further stratified the probabilities: 0·8% (95% CI 0·4-1·7) for volume doubling times 600 days or more, 4·0% (1·8-8·3) for volume doubling times 400-600 days, and 9·9% (6·9-14·1) for volume doubling times of 400 days or fewer. Lung cancer probability was high for participants with nodule volumes 300 mm(3) or bigger (16·9% [95% CI 14·1-20·0]) or diameters 10 mm or bigger (15·2% [12·7-18·1]). The simulated ACCP management protocol yielded a sensitivity and specificity of 90·9% (95% CI 81·2-96·1), and 87·2% (86·4-87·9), respectively. A diameter-based protocol with volumetry-based nodule diameter yielded a higher sensitivity (92·4% [95% CI 83·1-97·1]), and a higher specificity (90·0% [89·3-90·7). A volume-based protocol (with thresholds based on lung cancer probability) yielded the same sensitivity as the ACCP protocol (90·9% [95% CI 81·2-96·1]), and a higher specificity (94·9% [94·4-95·4]).Small nodules (those with a volume <100 mm(3) or diameter <5 mm) are not predictive for lung cancer. Immediate diagnostic evaluation is necessary for large nodules (≥300 mm(3) or ≥10 mm). Volume doubling time assessment is advocated only for intermediate-sized nodules (with a volume ranging between 100-300 mm(3) or diameter of 5-10 mm). Nodule management protocols based on these thresholds performed better than the simulated ACCP nodule protocol.Zorgonderzoek Nederland Medische Wetenschappen and Koningin Wilhelmina Fonds.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
YamDaamCaa应助科研通管家采纳,获得30
刚刚
刚刚
领导范儿应助科研通管家采纳,获得10
刚刚
香蕉觅云应助科研通管家采纳,获得10
刚刚
刚刚
大个应助科研通管家采纳,获得10
刚刚
czh应助科研通管家采纳,获得20
刚刚
科研通AI2S应助科研通管家采纳,获得10
刚刚
酷波er应助科研通管家采纳,获得10
刚刚
纯情的天奇完成签到 ,获得积分10
2秒前
顺利一德发布了新的文献求助10
3秒前
潇湘雪月发布了新的文献求助10
3秒前
3秒前
胡萝卜发布了新的文献求助10
4秒前
哈哈哈发布了新的文献求助10
5秒前
5秒前
汉堡包应助果粒多采纳,获得10
6秒前
10秒前
华仔发布了新的文献求助20
10秒前
10秒前
科研通AI2S应助杜杜采纳,获得10
12秒前
量子星尘发布了新的文献求助10
13秒前
JK发布了新的文献求助10
13秒前
打打应助顺利一德采纳,获得10
14秒前
法外狂徒完成签到,获得积分10
15秒前
Orange应助十九岁的时差采纳,获得10
15秒前
科研通AI2S应助steam采纳,获得10
17秒前
潇湘雪月发布了新的文献求助10
17秒前
18秒前
青青子衿完成签到,获得积分10
18秒前
18秒前
18秒前
20秒前
crazy发布了新的文献求助10
23秒前
杜杜发布了新的文献求助10
24秒前
嗯嗯发布了新的文献求助10
25秒前
老大蒂亚戈完成签到,获得积分10
27秒前
宝安完成签到,获得积分10
31秒前
JamesPei应助动听的老鼠采纳,获得10
31秒前
31秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3989263
求助须知:如何正确求助?哪些是违规求助? 3531418
关于积分的说明 11253814
捐赠科研通 3270066
什么是DOI,文献DOI怎么找? 1804884
邀请新用户注册赠送积分活动 882084
科研通“疑难数据库(出版商)”最低求助积分说明 809136