Strategies for Reducing False-Positive Screening Results for Intermediate-Size Nodules Evaluated Using Lung-RADS: A Secondary Analysis of National Lung Screening Trial Data.
Strategies for Reducing False-Positive Screening Results for Intermediate-Size Nodules Evaluated Using Lung-RADS: A Secondary Analysis of National Lung Screening Trial Data.
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DOI：
10.2214/ajr.22.27595
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发表时间：
2022-09
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Lung-RADS版本1.1（v1.1）将所有<6 mm的实性结节分类为2类。肺RADS v1.1也将中等大小（6至<10 mm）的实性结节分类为2类，如果是裂隙周围的，并且具有三角形、多边形或卵形（指示肺内淋巴结）。额外的第2类标准可以减少筛选检查的假阳性结果。评价减少中等大小结节假阳性结果的建议策略对使用Lung-RADS v1.1进行肺癌筛查CT评价的影响。这项回顾性研究需要对国家肺筛查试验（NLST）数据进行二次分析。在NLST基线筛查CT检查中测量6.0-9.5 mm的1387个实性结节中，选择发生癌症的患者的所有38个结节和未发生癌症的患者的200个结节的随机样本进行进一步评价。要求癌症与人工检查的基线结节相对应。排除后，样本包括223名患者（中位年龄62岁; 143名男性，53名女性; 196个良性结节，27个恶性结节）。两名胸部放射科医生独立审查基线检查，使用半自动软件记录结节直径和体积，并对结节是否具有裂隙周围位置、其他胸膜下位置以及三角形、多边形或卵形进行分类。对不同的第2类分配方案进行了比较。在阅片者中，Lung-RADS v1.1的灵敏度为89-93%，特异性为26- 31%。将其他胸膜下位置（仅与裂周位置相比）的三角形、多边形或卵圆形<10 mm的结节指定为2类的修改敏感性为85-93%，特异性为47- 51%。在Lung-RADS v1.1中使用容量截止值的灵敏度为89-93%，特异性为37%（两名阅片员）。两种方案的敏感性与Lung-RADS v1.1无显著差异（所有p> 0.05）。两种方案的特异性均显著优于Lung-RADS v1.1（所有p<0.05）。结合这两种策略，敏感性为85-93%，特异性为58- 59%。将任何胸膜下位置（不仅仅是裂周）的三角形、多边形或卵形中等大小结节分类为2类，并使用基于体积而不是基于直径的测量，可提高Lung-RADS特异性，而不会降低灵敏度。这些发现可以帮助减少假阳性结果，减少良性结果的6个月随访检查。
Lung-RADS version 1.1 (v1.1) classifies all solid nodules <6 mm as category 2. Lung-RADS v1.1 also classifies solid intermediate-size (6 to <10 mm) nodules as category 2 if perifissural and having triangular, polygonal, or ovoid shape (indicative of intrapulmonary lymph nodes). Additional category 2 criteria could reduce false-positive results of screening examinations. To evaluate the impact of proposed strategies to reduce false-positive results for intermediate-size nodules on lung cancer screening CT evaluated using Lung-RADS v1.1. This retrospective study entailed secondary analysis of National Lung Screening Trial (NLST) data. Of 1387 solid nodules measuring 6.0–9.5 mm on baseline screening CT examinations in NLST, all 38 nodules in patients who developed cancer, and a random sample of 200 nodules in patients who did not develop cancer, were selected for further evaluation. Cancers were required to correspond with the baseline nodule on manual review. After exclusions, the sample included 223 patients (median age, 62 years; 143 men, 53 women; 196 benign nodules, 27 malignant nodules). Two thoracic radiologists independently reviewed baseline examinations to record nodule diameter and volume using semiautomated software and classify whether nodules had perifissural location, other subpleural location, and triangular, polygonal, or ovoid shape. Different schemes for category 2 assignment were compared. Across readers, Lung-RADS v1.1 had sensitivity of 89–93% and specificity of 26–31%. A modification assigning nodules <10 mm with triangular, polygonal, or ovoid shape in other subpleural locations (vs only perifissural location) as category 2 had sensitivity of 85–93% and specificity of 47–51%. Using volume cutoffs in Lung-RADS v1.1 had sensitivity of 89–93% and specificity of 37% (both readers). Both schemes’ sensitivity was not significantly different from Lung-RADS v1.1 (all p>.05). Both schemes’ specificity was significantly better than Lung-RADS v1.1 (all p<.05). Combining the two strategies yielded sensitivity of 85–93% and specificity of 58–59%. Classifying intermediate-size nodules with triangular, polygonal, or ovoid shape in any subpleural location (not just perifissural) as category 2, and use of volume- rather than diameter-based measurements, improves Lung-RADS specificity without decreased sensitivity. The findings can help reduce false-positives results, reducing 6-month follow-up examinations for benign findings.