Barbosa Eduardo J Mortani, Yang Rochelle, Hershman Michelle
Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, Ground Fl Founders Bldg, Philadelphia, PA 19104.
AJR Am J Roentgenol. 2021 Apr;216(4):919-926. doi: 10.2214/AJR.20.23637. Epub 2021 Feb 17.
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. The purpose of this article is to assess real-world LDCT LCS performance and factors predictive of adherence to LCS recommendations. 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. 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%; < .001). was also higher in former versus current smokers (50.0% vs 36.2%; < .001). Being a former smoker and having a nodule that is Lung-RADS category 3 or greater were the only significant independent predictors of adherence. Our real-world LCS program showed very high sensitivity and NPV, but moderate specificity and very low PPV. Adherence to LCS recommendations increased with former versus current smokers and in those with positive (Lung-RADS categories 3, 4A, 4B, or 4X) LCS examinations. Adherence was less than 50.0% in current smokers and persons with negative (Lung-RADS categories 1 or 2) LCS examinations. Our results offer a road map for targeted performance improvement by focusing on LCS subjects less likely to remain in the program, such as persons with negative LCS examinations and persons who continue to smoke, potentially improving LCS cost effectiveness and maximizing its societal benefits.
低剂量CT（LDCT）肺癌筛查（LCS）已被证明可降低有显著吸烟史人群的死亡率。然而，现实世界中LCS项目的依从性显著低于随机对照试验。本文旨在评估现实世界中LDCT LCS的表现以及预测LCS建议依从性的因素。我们回顾性地确定了2014年至2019年期间接受至少两次LCS检查的所有人员。记录了患者的人口统计学信息、吸烟史和行为变化、Lung-RADS类别、阳性预测值（PPV）、阴性预测值（NPV）以及对筛查建议的依从性。通过单因素比较和多因素逻辑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%进行了两次检查，34.2%进行了三次检查，7.7%进行了四次检查，0.4%进行了五次LDCT检查）。260人中共有43人（16.5%）的扫描结果为阳性（Lung-RADS类别为3级或以上），其中260人中的27人（10.3%）被评为Lung-RADS 3级，260人中的8人（3.1%）为4A级，260人中的6人（2.3%）为4B级，260人中的2人（0.8%）为4X级。260人中有4人被诊断出患有癌症（3人患有肺癌，1人患有转移性黑色素瘤）。260人中有143人（55.0%）在基线时为当前吸烟者，260人中有121人（46.5%）在最后一轮LCS时为当前吸烟者。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.
