Abstract
Objectives: Differences in results of baseline and subsequent annual repeat rounds provide important information for optimising the regimen of screening. Methods: A prospective cohort study of 65,374 was reviewed to examine the frequency/percentages of the largest noncalcified nodule (NCN), lung cancer cell types and Kaplan–Meier (K-M) survival rates, separately for baseline and annual rounds. Results: Of 65,374 baseline screenings, NCNs were identified in 28,279 (43.3%); lung cancer in 737 (1.1%). Of 74,482 annual repeat screenings, new NCNs were identified in 4959 (7%); lung cancer in 179 (0.24%). Only adenocarcinoma was diagnosed in subsolid NCNs. Percentages of lung cancers by cell type were significantly different (p < 0.0001) in the baseline round compared with annual rounds, reflecting length bias, as were the ratios, reflecting lead times. Long-term K-M survival rate was 100% for typical carcinoids and for adenocarcinomas manifesting as subsolid NCNs; 85% (95% CI 81–89%) for adenocarcinoma, 74% (95% CI 63–85%) for squamous cell, 48% (95% CI 34–62%) for small cell. The rank ordering by lead time was the same as the rank ordering by survival rates. Conclusions: The significant differences in the frequency of NCNs and frequency and aggressiveness of diagnosed cancers in baseline and annual repeat need to be recognised for an optimal regimen of screening. Key Points: • Lung cancer aggressiveness varies considerably by cell type and nodule consistency.• Kaplan–Meier survival rates varied by cell type between 100% and 48%.• The percentages of lung cancers by cell type in screening rounds reflect screening biases.• Rank ordering by cell type survival is consistent with that by lead times.• Empirical evidence provides critical information for the regimen of screening.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1-10 |
| Number of pages | 10 |
| Journal | European Radiology |
| DOIs | |
| State | Accepted/In press - Oct 5 2017 |
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Keywords
- CT screening
- Lead-time bias
- Length bias
- Solid nodules
- Subsolid nodules
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
Cite this
Baseline and annual repeat rounds of screening : implications for optimal regimens of screening. / International Early Lung Cancer Action Program Investigators.
In: European Radiology, 05.10.2017, p. 1-10.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Baseline and annual repeat rounds of screening
T2 - implications for optimal regimens of screening
AU - International Early Lung Cancer Action Program Investigators
AU - Henschke, Claudia I.
AU - Salvatore, Mary
AU - Cham, Matthew
AU - Powell, Charles A.
AU - DiFabrizio, Larry
AU - Flores, Raja
AU - Kaufman, Andrew
AU - Eber, Corey
AU - Yip, Rowena
AU - Yankelevitz, David F.
AU - Henschke, Claudia I.
AU - Yankelevitz, David F.
AU - Yip, Rowena
AU - Xu, Dongming
AU - Salvatore, Mary
AU - Flores, Raja
AU - Wolf, Andrea
AU - McCauley, Dorothy I.
AU - Chen, Mildred
AU - Libby, Daniel M.
AU - Smith, James P.
AU - Pasmantier, Mark
AU - Reeves, Anthony P.
AU - Markowitz, Steven
AU - Miller, Albert
AU - Deval, Jose Cervera
AU - Roberts, Heidi
AU - Patsios, Demetris
AU - Sone, Shusuke
AU - Hanaoka, Takaomi
AU - Zulueta, Javier
AU - De-Torres, Juan P.
AU - Lozano, Maria D.
AU - Aye, Ralph
AU - Manning, Kristin
AU - Bauer, Thomas
AU - Canitano, Stefano
AU - Giunta, Salvatore
AU - Cole, Enser
AU - Klingler, Karl
AU - Austin, John H.M.
AU - Pearson, Gregory D.N.
AU - Shaham, Dorith
AU - Aylesworth, Cheryl
AU - Meyers, Patrick
AU - Andaz, Shahriyour
AU - Vafai, Davood
AU - Naidich, David
AU - McGuinness, Georgeann
AU - Thurer, Richard J
PY - 2017/10/5
Y1 - 2017/10/5
N2 - Objectives: Differences in results of baseline and subsequent annual repeat rounds provide important information for optimising the regimen of screening. Methods: A prospective cohort study of 65,374 was reviewed to examine the frequency/percentages of the largest noncalcified nodule (NCN), lung cancer cell types and Kaplan–Meier (K-M) survival rates, separately for baseline and annual rounds. Results: Of 65,374 baseline screenings, NCNs were identified in 28,279 (43.3%); lung cancer in 737 (1.1%). Of 74,482 annual repeat screenings, new NCNs were identified in 4959 (7%); lung cancer in 179 (0.24%). Only adenocarcinoma was diagnosed in subsolid NCNs. Percentages of lung cancers by cell type were significantly different (p < 0.0001) in the baseline round compared with annual rounds, reflecting length bias, as were the ratios, reflecting lead times. Long-term K-M survival rate was 100% for typical carcinoids and for adenocarcinomas manifesting as subsolid NCNs; 85% (95% CI 81–89%) for adenocarcinoma, 74% (95% CI 63–85%) for squamous cell, 48% (95% CI 34–62%) for small cell. The rank ordering by lead time was the same as the rank ordering by survival rates. Conclusions: The significant differences in the frequency of NCNs and frequency and aggressiveness of diagnosed cancers in baseline and annual repeat need to be recognised for an optimal regimen of screening. Key Points: • Lung cancer aggressiveness varies considerably by cell type and nodule consistency.• Kaplan–Meier survival rates varied by cell type between 100% and 48%.• The percentages of lung cancers by cell type in screening rounds reflect screening biases.• Rank ordering by cell type survival is consistent with that by lead times.• Empirical evidence provides critical information for the regimen of screening.
AB - Objectives: Differences in results of baseline and subsequent annual repeat rounds provide important information for optimising the regimen of screening. Methods: A prospective cohort study of 65,374 was reviewed to examine the frequency/percentages of the largest noncalcified nodule (NCN), lung cancer cell types and Kaplan–Meier (K-M) survival rates, separately for baseline and annual rounds. Results: Of 65,374 baseline screenings, NCNs were identified in 28,279 (43.3%); lung cancer in 737 (1.1%). Of 74,482 annual repeat screenings, new NCNs were identified in 4959 (7%); lung cancer in 179 (0.24%). Only adenocarcinoma was diagnosed in subsolid NCNs. Percentages of lung cancers by cell type were significantly different (p < 0.0001) in the baseline round compared with annual rounds, reflecting length bias, as were the ratios, reflecting lead times. Long-term K-M survival rate was 100% for typical carcinoids and for adenocarcinomas manifesting as subsolid NCNs; 85% (95% CI 81–89%) for adenocarcinoma, 74% (95% CI 63–85%) for squamous cell, 48% (95% CI 34–62%) for small cell. The rank ordering by lead time was the same as the rank ordering by survival rates. Conclusions: The significant differences in the frequency of NCNs and frequency and aggressiveness of diagnosed cancers in baseline and annual repeat need to be recognised for an optimal regimen of screening. Key Points: • Lung cancer aggressiveness varies considerably by cell type and nodule consistency.• Kaplan–Meier survival rates varied by cell type between 100% and 48%.• The percentages of lung cancers by cell type in screening rounds reflect screening biases.• Rank ordering by cell type survival is consistent with that by lead times.• Empirical evidence provides critical information for the regimen of screening.
KW - CT screening
KW - Lead-time bias
KW - Length bias
KW - Solid nodules
KW - Subsolid nodules
UR - http://www.scopus.com/inward/record.url?scp=85030693100&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85030693100&partnerID=8YFLogxK
U2 - 10.1007/s00330-017-5029-z
DO - 10.1007/s00330-017-5029-z
M3 - Article
C2 - 28983713
AN - SCOPUS:85030693100
SP - 1
EP - 10
JO - European Radiology
JF - European Radiology
SN - 0938-7994
ER -