Clinical Implications and Added Costs of Incidental Findings in an Early Detection Study of Lung Cancer by Using Low-Dose Spiral Computed Tomography
Clinical Implications and Added Costs of Incidental Findings in an Early Detection Study of Lung Cancer by Using Low-Dose Spiral Computed Tomography
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DOI：
10.1016/j.cllc.2012.05.005
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发表时间：
2013-03-01
影响因子：
3.6
通讯作者：
Cardinale, Luciano
中科院分区：
文献类型：
--
作者：
Priola, Adriano M.;Priola, Sandro M.;Cardinale, Luciano
我们评估了519名参加5年肺癌筛查的志愿者偶然发现的频率和额外费用。42例有临床意义的偶然发现（6例为恶性肿瘤）。额外的影像学检查主要是超声（63.2%,43/68），主要是甲状腺和肾脏，额外费用（sic）5696.86（8064.72美元）。这种适度的增量成本可能会对患者护理产生积极影响。前言：前瞻性评估5年肺癌低剂量螺旋CT筛查项目中意外发现（IF）的频率和频谱，并估计后续放射学随访评估所产生的影像学检查的额外费用。材料与方法：共纳入519名无症状志愿者。所有IFs均被报告，如果需要进一步评估，则被认为具有临床相关性；如果需要一项以上的额外诊断测试来表征或进行医疗和/或手术干预，则被认为具有临床意义。结果：IFs很常见（59.2%，基线时307/519名参与者，5年随访中每年5.3%[随访期间进行了2341例LDsCT检查的123名参与者]，总体发生率为26.3%）。52例（10.0%）患者在基线时被归类为先前未知的临床相关性。其中，36人（6.9%）患有具有临床意义的IFs（在随后的5年随访中检测到10例临床相关，其中6例具有临床意义）。最常见的建议是对甲状腺和肾脏进行额外的影像学检查。附加影像学检查以超声为主（43/68[63.2%]）。7例（1.5%）受试者因这些发现而进行手术干预。诊断出6例恶性肿瘤（发病率，每年0.2%）。后续放射学随访研究的费用计算为（sic）4644.56[美国]基准价6575.04美元和（原文如此）1052.30[美国5年随访(每位参与者的平均增加成本（原文如此）8.95[美国]12.67美元]和（原文如此）2.25[美国3.19美元),分别)。结论：低剂量螺旋CT对IFs的检测较为普遍。其中一些需要进一步调查以评估其临床相关性。尽管这些IFs对筛查干预的临床益处不大，但考虑到对患者护理的潜在积极影响，短期随访期间产生的额外放射学程序会产生适度的增量成本。临床肺癌，Vol. 14, No. 2, 139-48 (c) 2013 Elsevier Inc.。版权所有。
We evaluated the frequency and additional costs of incidental findings in 519 volunteers enrolled in a 5-year lung cancer screening. Forty-two individuals had incidental findings with clinical implications (6 malignancies). Additional imaging was performed mainly by ultrasound (63.2%, 43/68), mostly for thyroid and kidneys, with added cost of (sic)5696.86 (U.S. $8064.72). Such moderate incremental cost gives the potential for positive effects on patient care.Introduction: To prospectively evaluate the frequency and spectrum of incidental findings (IF) in a 5-year lung cancer screening program with low-dose spiral computed tomography (CT) and to estimate the additional costs of their imaging workup incurred from subsequent radiologic follow-up evaluation. Materials and Methods: A total of 519 asymptomatic volunteers were enrolled. All IFs were reported and were considered clinically relevant if they required further evaluations or with clinical implications if they required more than one additional diagnostic test for characterization or medical and/or surgical intervention. Results: IFs were commonly found (59.2%, 307/519 participants at baseline and 5.3% per year at 5-year follow-up [123 participants of 2341 LDsCT exams performed during follow-up], with an overall rate of 26.3%). IFs were categorized as previously unknown clinically relevant in 52 (10.0%) individuals at baseline. Of these, 36 (6.9%) individuals had IFs with clinical implications (10 clinically relevant, of which 6 had clinical implications, detected during the subsequent 5-year follow-up). The most common recommendations were for additional imaging of the thyroid and kidneys. Additional imaging was mainly performed by ultrasound (43/68 [63.2%]). Subsequent surgical intervention resulted from these findings in 7 (1.5%) subjects. Six malignancies were diagnosed (rate, 0.2% per year). Costs of subsequent radiologic follow-up studies were calculated as (sic)4644.56 [U.S. $6575.04] at baseline and (sic)1052.30 [U.S. $1489.69] at 5-year follow-up (average added costs per participant (sic)8.95 [U.S. $12.67] and (sic)2.25 [U.S. $3.19], respectively). Conclusions: Low-dose spiral CT commonly detects IFs. Some of these require further investigations to assess their clinical relevance. Although such IFs add little clinical benefit to the screening intervention, moderate incremental costs are incurred based on additional radiologic procedures generated during short-term follow-up, given the potential for positive effects on patient care. Clinical Lung Cancer, Vol. 14, No. 2, 139-48 (c) 2013 Elsevier Inc. All rights reserved.