Real-World Lung Cancer CT Screening Performance, Smoking Behavior, and Adherence to Recommendations: Lung-RADS Category and Smoking Status Predict Adherence
Real-World Lung Cancer CT Screening Performance, Smoking Behavior, and Adherence to Recommendations: Lung-RADS Category and Smoking Status Predict Adherence
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DOI：
10.2214/ajr.20.23637
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发表时间：
2021-04-01
影响因子：
5
通讯作者：
Hershman, Michelle
中科院分区：
文献类型：
--
作者：
Barbosa, Eduardo J. Mortani, Jr.;Yang, Rochelle;Hershman, Michelle
背景低剂量CT（LDCT）肺癌筛查（LCS）已被证明可以降低有显著吸烟史的人的死亡率。然而，在现实世界的LCS项目的依从性显着低于随机对照试验。这篇文章的目的是评估现实世界的LDCT LCS性能和因素的预测坚持LCS的解释。我们回顾性地确定了2014年至2019年至少接受过两次LCS检查的所有人。记录患者人口统计学资料、吸烟史和行为变化、肺RADS分类、PPV、NPV和对筛选建议的依从性。通过单变量比较和多变量Logistic回归评估依从性的预测因素。共有260人返回进行后续LDCT检查（57.7%有两次，34.2%有三次，7.7%有四次，0.4%有五次LDCT检查）。260人中共有43人（16.5%）扫描呈阳性（肺RADS 3级或以上），其中260人中有27人（10.3%）被评为肺RADS 3级，260人中有8人（3.1%）为4A级，260人中有6人（2.3%）为4 B级，260人中有2人（0.8%）为4X级。260人中有4人被诊断出癌症（3人患有肺癌，1人患有转移性黑色素瘤）。基线时，260例受试者中共有143例（55.0%）为当前吸烟者，最后一轮LCS时，260例受试者中有121例（46.5%）为当前吸烟者。LCS的敏感性为100.0%，特异性为84.8%，PPV为9.3%，NPV为100%。总体依从性为43.0%，但随着肺-RADS分类的升高而逐渐增加（肺-RADS 1：33.2%;肺-RADS 2：46.3%;肺-RADS 3：53.8%;肺-RADS 4A：77.8%;肺- RADS 4 B：83.3%;肺-RADS 4X：100%; P
BACKGROUND. Low-dose CT (LDCT) lung cancer screening (LCS) has been shown to decrease mortality in persons with a significant smoking history. However, adherence in real-world LCS programs is significantly lower than in randomized controlled trials.OBJECTIVE. The purpose of this article is to assess real-world LDCT LCS performance and factors predictive of adherence to LCS recommendations.METHODS. We retrospectively identified all persons who underwent at least two LCS examinations from 2014 to 2019. Patient demographics, smoking history and behavior changes, Lung-RADS category, PPV, NPV, and adherence to screening recommendations were recorded. Predictors of adherence were assessed via univariate comparisons and multivariate logistic regression.RESULTS. A total of 260 persons returned for follow-up LDCT (57.7% had two, 34.2% had three, 7.7% had four, and 0.4% had five LDCT examinations). A total of 43 of 260 (16.5%) had positive (Lung-RADS category 3 or above) scans, of which 27 of 260 persons (10.3%) were graded as Lung-RADS category 3, eight of 260 (3.1%) were category 4A, six of 260 (2.3%) were category 4B, and two of 260 (0.8%) were category 4X. Cancer was diagnosed in four of the 260 (three with lung cancer and one with metastatic melanoma). A total of 143 of 260 (55.0%) persons were current smokers at baseline and 121 of 260 (46.5%) were current smokers at the last round of LCS. LCS had sensitivity of 100.0%, specificity of 84.8%, PPV of 9.3%, and NPV of 100%. Overall adherence was 43.0% but increased progressively with higher Lung-RADS category (Lung-RADS 1: 33.2%; Lung-RADS 2: 46.3%; Lung-RADS 3: 53.8%; Lung-RADS 4A: 77.8%; Lung- RADS 4B: 83.3%; Lung-RADS 4X: 100%; p