Department of Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.
University Thoracic Surgeons, 1725 W. Harrison St., Suite 774, Chicago, IL, 60612, USA.
Lung. 2019 Jun;197(3):327-332. doi: 10.1007/s00408-019-00217-4. Epub 2019 Apr 12.
Concern over high false-positive rates and the potential for unintended harm to patients is a critical component of the lack of widespread adoption of lung cancer screening.
An institutional database was used to identify patients who underwent lung cancer screening between 2/2015 and 2/2018 at Rush University Medical Center and Rush Oak Park Hospital. Reads were executed by dedicated thoracic radiologists and communicated using the Lung Imaging Reporting and Data System (Lung-RADS V.1).
Six hundred and four patients were screened over the study period. We identified 21 primary lung cancers and 8 incidental cancers. We identified a false-positive rate of 17.5%. Only 9 patients underwent further investigative workup for benign disease (5.3%); however, only 4 (2.9%) of those patients were found to have inflammatory or infectious lesions, which are common mimickers of lung cancer. Excluding Lung-RADS category 3 for the purpose of quantifying risk of unintended harm from unnecessary procedures, we found a 6.9% false-positive rate, while diagnosing 25% of all Lung-RADS category 4 patients with primary lung cancer.
False-positive rates in lung cancer screening programs continue to decline with improved radiologic expertise. Additionally, false-positive reporting overestimates the risk of unintended harm from further investigative procedures as only a percentage of positive findings are generally considered for tissue diagnosis (i.e., Lung-RADS category 4).
对高假阳性率以及对患者造成意外伤害的潜在风险的担忧，是肺癌筛查未能广泛应用的关键因素。
本研究使用机构数据库，确定了 2015 年 2 月至 2018 年 2 月在拉什大学医学中心和拉什橡树公园医院接受肺癌筛查的患者。采用专用的胸部放射科医生进行读片，并使用肺影像报告和数据系统（Lung-RADS V.1）进行沟通。
在研究期间，有 604 名患者接受了筛查。我们发现了 21 例原发性肺癌和 8 例偶发性癌症。我们发现假阳性率为 17.5%。仅有 9 名患者因良性疾病接受了进一步的调查性检查（5.3%）；然而，只有 4 名（2.9%）患者被发现患有炎症或感染性病变，这些病变是肺癌的常见模拟病变。为了量化不必要程序造成意外伤害的风险，我们排除了 Lung-RADS 类别 3，结果发现假阳性率为 6.9%，同时诊断出 25%的 Lung-RADS 类别 4 患者患有原发性肺癌。
随着放射学专业知识的提高，肺癌筛查计划中的假阳性率继续下降。此外，假阳性报告高估了进一步调查程序造成意外伤害的风险，因为只有一部分阳性发现通常被认为需要进行组织诊断（即 Lung-RADS 类别 4）。
