Outcomes of Positive and Suspicious Findings in Clinical Computed Tomography Lung Cancer Screening and the Road Ahead.
Outcomes of Positive and Suspicious Findings in Clinical Computed Tomography Lung Cancer Screening and the Road Ahead.
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DOI：
10.1513/annalsats.202106-733oc
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发表时间：
2022-08
影响因子：
8.3
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中科院分区：
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未来计算机断层扫描(CT)肺癌筛查(CTLS)算法的优化将取决于临床结果数据。报告临床CTLS计划中阳性和可疑发现的结果。我们回顾了我们机构从2012年1月到2018年12月接受肺癌筛查的患者的结果，并进行了跟踪调查，直到2019年12月。所有检查均采用肺-RADS v1.1(LR)进行回顾性评分。评估的指标包括阳性、可能良性和可疑的检查率、护理升级的频率/性质，以及在阳性、可能良性和可疑的检查结果和总体后肺癌的发现率。我们计算了解决可疑检查所需的时间，分为恶性或良性。结果按子类别、阳性/可疑指定原因和筛查轮次细分。在研究期间，4,301人总共接受了10,897次检查。在基线筛查中，阳性(13.9%)、可疑(5.5%)和重大偶发发现(6.4%)的数量显著增加。癌症检测率和假阳性率在基线时分别为2.0%和12.3%，而在随后的筛查中分别为1.3%和5.1%。基线实性结节(S)6~8 mm是唯一可能在12个月内发现肺癌的良性病变。新的固体结节6到8毫米是唯一的LR4A类(LR4A)发现，落在LR预测的癌症检测范围5-15%(12.8%)内。38.5%的LR4A癌是在3个月内发现的。修改阳性和可疑肺癌筛查结果的定义和建议的检查结果似乎是有必要的。
Future optimization of computed tomography (CT) lung cancer screening (CTLS) algorithms will depend on clinical outcomes data. To report the outcomes of positive and suspicious findings in a clinical CTLS program. We retrospectively reviewed results for patients from our institution undergoing lung cancer screening from January 2012 through December 2018, with follow-up through December 2019. All exams were retrospectively rescored using Lung-RADS v1.1 (LR). Metrics assessed included positive, probably benign, and suspicious exam rates, frequency/nature of care escalation, and lung cancer detection rates after a positive, probably benign, and suspicious exam result and overall. We calculated time required to resolve suspicious exams as malignant or benign. Results were broken down by subcategories, reason for positive/suspicious designation, and screening round. During the study period 4,301 individuals underwent a total of 10,897 exams. The number of positive (13.9%), suspicious (5.5%), and significant incidental (6.4%) findings was significantly higher at baseline screening. Cancer detection and false-positive rates were 2.0% and 12.3% at baseline versus 1.3% and 5.1% across subsequent screening rounds, respectively. Baseline solid nodule(s) 6 to <8 mm were the only probably benign findings resulting in lung cancer detection within 12 months. New solid nodules 6 to <8 mm were the only LR category 4A (LR4A) findings falling within the LR predicted cancer detection range of 5–15% (12.8%). 38.5% of LR4A cancers were detected within 3 months. Modification of the definition and suggested workup of positive and suspicious lung cancer screening findings appears warranted.