University of Queensland Thoracic Research Centre and Department of Thoracic Medicine, The Prince Charles Hospital, Queensland, Australia.
Thorax. 2017 Dec;72(12):1147-1150. doi: 10.1136/thoraxjnl-2016-209624. Epub 2017 Mar 22.
High false-positive (FP) scan rates associated with low-dose computed tomography (LDCT) lung cancer screening result in unnecessary follow-up tests and exposure to harm. The definition of a 'positive' scan can impact FP rates and screening performance. We explored the effect of Lung Imaging Reporting and Data System (Lung-RADS) criteria, PanCan Nodule Malignancy Probability Model and varying nodule size thresholds (≥4 mm, ≥6 mm, ≥8 mm) on diagnostic accuracy and screening performance compared with original trial definitions (National Lung Screening Trial (NLST) criteria) in a secondary analysis of a lung cancer screening cohort. We found Lung-RADS criteria and the PanCan Nodule Malignancy Probability Model could substantially improve screening performance and reduce FP scan rates compared with NLST definitions of positivity but that this needs to be balanced against possible risk of false-negative results.
Australian New Zealand Clinical Trials Registry, ACTRN12610000007033.
目的：与低剂量计算机断层扫描（LDCT）肺癌筛查相关的高假阳性（FP）扫描率导致不必要的随访检查和潜在危害。扫描阳性的定义可能会影响 FP 率和筛查性能。我们通过肺癌筛查队列的二次分析，探讨了 Lung Imaging Reporting and Data System（Lung-RADS）标准、PanCan 结节恶性概率模型和不同结节大小阈值（≥4mm、≥6mm、≥8mm）对诊断准确性和筛查性能的影响，并与原始试验定义（National Lung Screening Trial [NLST] 标准）进行了比较。
结果：与 NLST 阳性标准相比，Lung-RADS 标准和 PanCan 结节恶性概率模型可以显著提高筛查性能并降低 FP 扫描率，但这需要与可能的假阴性结果风险相平衡。
临床试验注册：澳大利亚新西兰临床试验注册，ACTRN12610000007033。
