Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado.
Center for Integrated Healthcare Research, Kaiser Permanente Hawaii, Oahu, Hawaii.
Ann Am Thorac Soc. 2022 Mar;19(3):433-441. doi: 10.1513/AnnalsATS.202011-1413OC.
Lung-RADS classification was developed to standardize reporting and management of lung cancer screening using low-dose computed tomographic (LDCT) imaging. Although variation in Lung-RADS distribution between healthcare systems has been reported, it is unclear if this is explained by patient characteristics, radiologist experience with lung cancer screening, or other factors. Our objective was to determine if patient or radiologist factors are associated with Lung-RADS score. In the Population-based Research to Optimize the Screening Process (PROSPR) Lung consortium, we conducted a study of patients who received their first screening LDCT imaging at one of the five healthcare systems in the PROSPR Lung Research Center from May 1, 2014, through December 31, 2017. Data on LDCT scans, patient factors, and radiologist characteristics were obtained via electronic health records. LDCT scan findings were categorized using Lung-RADS (negative [1], benign [2], probably benign [3], or suspicious [4]). We used generalized estimating equations with a multinomial distribution to compare the odds of Lung-RADS 3, and separately Lung-RADS 4, versus Lung-RADS 1 or 2 and estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between Lung-RADS assignment and patient and radiologist characteristics. Analyses included 8,556 patients; 24% were assigned Lung-RADS 1, 60% Lung-RADS 2, 10% Lung-RADS 3, and 5% Lung-RADS 4. Age was positively associated with Lung-RADS 3 (OR, 1.02; 95% CI, 1.01-1.03) and 4 (OR, 1.03; 95% CI, 1.01-1.05); chronic obstructive pulmonary disease (COPD) was positively associated with Lung-RADS 4 (OR, 1.78; 95% CI, 1.45-2.20); obesity was inversely associated with Lung-RADS 3 (OR, 0.70; 95% CI, 0.58-0.84) and 4 (OR, 0.58; 95% CI, 0.45-0.75). There was no association between sex, race, ethnicity, education, or smoking status and Lung-RADS assignment. Radiologist volume of interpreting screening LDCT scans, years in practice, and thoracic specialty were also not associated with Lung-RADS assignment. Healthcare systems that are comprised of patients with an older age distribution or higher levels of COPD will have a greater proportion of screening LDCT scans with Lung-RADS 3 or 4 findings and should plan for additional resources to support appropriate and timely management of noted positive findings.
肺结节放射学报告和数据系统（Lung-RADS）分类旨在规范使用低剂量计算机断层扫描（LDCT）进行肺癌筛查的报告和管理。尽管已经报道了不同医疗系统之间 Lung-RADS 分布的差异，但尚不清楚这是由患者特征、放射科医生的肺癌筛查经验还是其他因素导致的。我们的目的是确定患者或放射科医生的因素是否与 Lung-RADS 评分相关。在基于人群的优化筛查过程研究（PROSPR）肺部研究中心的五个医疗系统中，我们对 2014 年 5 月 1 日至 2017 年 12 月 31 日期间接受首次筛查 LDCT 成像的患者进行了一项研究。通过电子健康记录获得 LDCT 扫描、患者特征和放射科医生特征的数据。使用 Lung-RADS（阴性[1]、良性[2]、可能良性[3]或可疑[4]）对 LDCT 扫描结果进行分类。我们使用具有多项分布的广义估计方程来比较 Lung-RADS 3 和单独的 Lung-RADS 4 与 Lung-RADS 1 或 2 的比值比（OR），并估计 Lung-RADS 分配与患者和放射科医生特征之间的关联的调整 OR 和 95%置信区间（CI）。分析包括 8556 名患者；24%被分配 Lung-RADS 1，60% Lung-RADS 2，10% Lung-RADS 3，5% Lung-RADS 4。年龄与 Lung-RADS 3（OR，1.02；95%CI，1.01-1.03）和 4（OR，1.03；95%CI，1.01-1.05）呈正相关；慢性阻塞性肺疾病（COPD）与 Lung-RADS 4 呈正相关（OR，1.78；95%CI，1.45-2.20）；肥胖与 Lung-RADS 3（OR，0.70；95%CI，0.58-0.84）和 4（OR，0.58；95%CI，0.45-0.75）呈负相关。性别、种族、民族、教育程度或吸烟状况与 Lung-RADS 分配无关。放射科医生解读筛查 LDCT 扫描的数量、从业年限和胸部专业也与 Lung-RADS 分配无关。由年龄分布较大或 COPD 水平较高的患者组成的医疗系统将有更大比例的筛查 LDCT 扫描结果为 Lung-RADS 3 或 4，并且需要计划额外的资源来支持对发现的阳性结果进行适当和及时的管理。
