Department of Surgery, Division of Thoracic Surgery, The George Washington University Hospital.
The George Washington University School of Medicine and Health Sciences, Washington, DC.
Am J Clin Oncol. 2021 Jun 1;44(6):264-268. doi: 10.1097/COC.0000000000000817.
Low-dose computed tomography (LDCT) screening is an important tool for reducing lung cancer mortality. This study describes a single center's experience with LDCT and attempts to identify any barriers to compliance with standard guidelines.
This is a retrospective review of a single university-based hospital system from 2015 to 2019. All individuals who met eligibility for lung cancer screening were entered into a database. The definition of adherence with the screening program was determined by the recommended timeline for the follow-up LDCT. Cohorts were split by adherence and demographics were compared.
A total of 203 LDCTs were performed in 121 patients who met eligibility for LDCT and had appropriate surveillance from 2015 to 2019. The average age was 64 years old. The overall adherence rate for prescribed LDCTs was 59.1%. Patients with Lung-RADS score 2 had 2.43 times higher odds of adherence relative to patients with Lung-RADS score 1 (odds ratio [OR]=2.43; 95% confidence interval [CI]: 1.23-4.83; P=0.011). African American patients had 42% lower odds of adherence relative to white patients (OR=0.58; 95% CI: 0.32-1.06; P=0.076). Patients with non-District of Columbia zip codes had 57% higher odds of adherence relative to those with District of Columbia zip codes, although this did not reach statistical significance (OR=1.57; 95% CI: 0.87-2.82; P=0.136).
Despite the implementation of a multidisciplinary, academic LDCT screening program, overall adherence rate to prescribed follow-up scans was suboptimal. Socioeconomic disparities and African American race may negatively affect adherence to lung cancer screening LDCT guidelines. Patients with concerning findings on initial LDCT had a higher association of adherence to guidelines.
低剂量计算机断层扫描（LDCT）筛查是降低肺癌死亡率的重要手段。本研究描述了一家单中心的 LDCT 经验，并试图确定与标准指南相符的任何障碍。
这是对 2015 年至 2019 年期间一家大学附属医院系统的回顾性研究。所有符合肺癌筛查条件的个体都被纳入数据库。筛查方案的依从性定义为根据推荐的随访 LDCT 时间表进行的检查。根据依从性和人口统计学数据对队列进行了划分。
2015 年至 2019 年期间，共有 121 名符合 LDCT 条件且有适当监测的患者进行了 203 次 LDCT。平均年龄为 64 岁。规定 LDCT 的总体依从率为 59.1%。Lung-RADS 评分 2 的患者比 Lung-RADS 评分 1 的患者依从性高 2.43 倍（优势比[OR]=2.43；95%置信区间[CI]：1.23-4.83；P=0.011）。与白人患者相比，非非洲裔美国患者的依从性低 42%（OR=0.58；95% CI：0.32-1.06；P=0.076）。与哥伦比亚特区邮政编码的患者相比，非哥伦比亚特区邮政编码的患者的依从性高 57%，尽管这没有达到统计学意义（OR=1.57；95% CI：0.87-2.82；P=0.136）。
尽管实施了多学科的学术 LDCT 筛查计划，但规定的随访扫描的总体依从率仍不理想。社会经济差异和非洲裔美国人种可能会对肺癌筛查 LDCT 指南的依从性产生负面影响。在初始 LDCT 检查中发现有问题的患者更符合指南的要求。
