Cardiothoracic Radiology Fellowship Director; Research Director, Duke Lung Cancer Screening Program; and Associate Professor, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
Department of Obstetrics and Gynecology, University of Michigan Health, Ann Arbor, Michigan.
J Am Coll Radiol. 2023 Oct;20(10):969-978. doi: 10.1016/j.jacr.2023.08.003. Epub 2023 Aug 14.
(1) Evaluate downstream procedures after lung cancer screening (LCS), including imaging and invasive procedures, in screened individuals without screen-detected lung cancer. (2) Determine the association between repeat LCS and downstream procedures and patient characteristics.
Individuals receiving LCS between January 1, 2015, and November 30, 2020, from Optum's deidentified Clinformatics Data Mart Database were included. Individuals with lung cancer after LCS were excluded. We determined frequency and costs of downstream procedures after LCS, including diagnostic imaging (chest CT, PET, or CT using fluorine-18-2-fluoro-2-deoxy-D-glucose imaging) and invasive procedures (bronchoscopy, needle biopsy, thoracic surgery). A generalized estimating equation was used to model repeat LCS as a function of downstream procedures and patient characteristics. The primary outcome was repeat screening within 1 year of index LCS, and a secondary analysis evaluated the outcome of repeat screening with 2 years of index LCS.
In all, 23,640 individuals receiving 30,521 LCS examinations were included in the primary analysis; 17.7% of LCS examinations (5,414 of 30,521) prompted downstream testing, with chest CT within 4 months being most common (9.1%, 2,769 of 30,521). At multivariable analysis adjusted for patient characteristics, the occurrence of a downstream diagnostic imaging test or invasive procedure was associated with a decreased likelihood of repeat annual LCS (adjusted odds ratio, 95% confidence interval: 0.38, 0.34-0.44; adjusted odds ratio, 95% confidence interval: 0.75, 0.63-0.90, respectively).
Downstream imaging and invasive procedures after LCS are potential barriers to LCS adherence. Efforts to reduce false-positives at LCS and reduce patient costs from downstream procedures are likely necessary to ensure that downstream workup after LCS does not discourage screening adherence.
(1)评估肺癌筛查（LCS）后未检出肺癌的筛查个体的后续程序，包括影像学和侵入性程序。(2)确定重复 LCS 与下游程序和患者特征之间的关联。
纳入 2015 年 1 月 1 日至 2020 年 11 月 30 日期间从 Optum 的匿名 Clinformatics Data Mart 数据库中接受 LCS 的个体。排除 LCS 后患有肺癌的个体。我们确定了 LCS 后的下游程序的频率和成本，包括诊断性影像学（胸部 CT、PET 或氟-18-2-氟-2-脱氧-D-葡萄糖成像的 CT）和侵入性程序（支气管镜检查、针吸活检、胸外科手术）。使用广义估计方程将重复 LCS 作为下游程序和患者特征的函数进行建模。主要结局是在索引 LCS 后 1 年内重复筛查，二次分析评估索引 LCS 后 2 年内重复筛查的结果。
在总共纳入的 23640 名接受 30521 次 LCS 检查的个体中，有 17.7%（5414 次/30521 次）的 LCS 检查提示进行了下游检测，其中最常见的是 4 个月内进行胸部 CT（9.1%，2769 次/30521 次）。在调整了患者特征后的多变量分析中，进行下游诊断性影像学检查或侵入性程序与重复年度 LCS 的可能性降低相关（调整后的优势比，95%置信区间：0.38，0.34-0.44；调整后的优势比，95%置信区间：0.75，0.63-0.90）。
LCS 后进行影像学和侵入性检查是影响 LCS 依从性的潜在障碍。为了减少 LCS 的假阳性率并降低患者的下游程序成本，可能需要努力确保 LCS 后的下游检查不会阻碍筛查的依从性。
