Cancer Risk in Nodules Detected at Follow-Up Lung Cancer Screening CT.
Cancer Risk in Nodules Detected at Follow-Up Lung Cancer Screening CT.
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DOI：
10.2214/ajr.21.26927
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发表时间：
2022-04
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随访CT上的新结节与早期CT上的结节（“现有”结节）可能具有不同的肺癌风险。基于直径的肺rads和基于体积的NELSON分类在结节风险评估中表现不同。目的评估随访肺癌筛查CT检查中发现结节的lung - rads和NELSON分类。这项回顾性研究包括185名患者（100名女性，85名男性，中位年龄66岁），他们接受了肺癌筛查CT检查，并有既往CT检查。分层随机取样以丰富可疑结节样本，分别得到肺- rads分类为2、3、4A、4B和4X的结节50、45、47、30和13个。从临床报告中记录肺- rads分类。从临床报告中提取结节的线性测量值，使用严格的标准生成肺- rads分类。两名放射科医生使用半自动工具获得结节体积，用于生成NELSON分类。评估肺癌风险。进行ROC分析。在基础筛查队列中，百分比按肺- rads类别频率加权。29例癌症被诊断出来。新发结节的加权癌症风险为5%，稳定的现有结节为1%，正在生长的现有结节为44%。临床2类结节均未为癌。使用严格的Lung-RADS， 34个结节，包括7个癌症，被降级为2类。临床肺- rads诊断癌症的AUC为0.96，严格肺- rads为0.81，NELSON为0.71-0.84（两个读卡器），结节直径为0.89。临床肺- rads在整个样本中的加权敏感性和特异性分别为100%和85%，在新发结节中分别为100%和41%，在已有结节中分别为100%和94%。现有结节的最佳直径阈值为8毫米，而新结节为6毫米。Lung-RADS被放射科医师应用于临床，在随访筛查检查中取得了优异的效果。严格的Lung-RADS将一些癌症降至2级。容积评估的表现弱于临床肺- rads。新发结节需要比现有结节更小的尺寸阈值。研究结果为放射科医生对随访筛查检查中发现的结节的管理提供了见解。
Nodules may have different lung cancer risks when new on follow-up CT versus when present on an earlier CT (“existing” nodules). Diameter-based Lung-RADS and volume-based NELSON categories have shown variable performance in nodule risk assessment. To assess Lung-RADS and NELSON classifications for nodules detected on follow-up lung cancer screening CT examinations. This retrospective study included 185 patients (100 women, 85 men; median age, 66 years) who underwent lung cancer screening CT examinations for which a prior CT was available. Stratified random sampling was performed to enrich the sample with suspicious nodules, yielding 50, 45, 47, 30, and 13 nodules with Lung-RADS categories 2, 3, 4A, 4B, and 4X, respectively. Lung-RADS categories were recorded from clinical reports. Nodules’ linear measurements were extracted from clinical reports to generate Lung-RADS categories using strict criteria. Two radiologists used a semiautomated tool to obtain nodule volumes, which were used to generate NELSON categories. Lung cancer risk was assessed. ROC analysis was performed. Percentages were weighted by Lung-RADS category frequencies in the underlying screening cohort. Twenty-nine cancers were diagnosed. Weighted cancer risk was 5% for new nodules, 1% for stable existing nodules, and 44% for growing existing nodules. No clinical category 2 nodule was cancer. Using strict Lung-RADS, 34 nodules, including 7 cancers, were downgraded to category 2. AUC for cancer was 0.96 for clinical Lung-RADS, 0.81 for strict Lung-RADS, 0.71–0.84 for NELSON (two readers), and 0.89 for nodule diameter. Clinical Lung-RADS achieved weighted sensitivity and specificity of 100% and 85% in the entire sample, 100% and 41% in new nodules, and 100% and 94% in existing nodules. Optimal diameter threshold was 8 mm for existing nodules, versus 6 mm for new nodules. Lung-RADS, as applied by radiologists in clinical practice, achieved excellent performance on follow-up screening examinations. Strict Lung-RADS downgraded some cancers to category 2. Volumetric assessments had weaker performance than clinical Lung-RADS. New nodules warrant smaller size thresholds than existing nodules. The findings provide insight into radiologists’ management of nodules detected on follow-up screening examinations.