Department of Radiology, Duke University Medical Center, Durham, North Carolina; Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina; Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina; Department of Medical Physics Graduate Program, Duke University, Durham, North Carolina.
Department of Medical Physics Graduate Program, Duke University, Durham, North Carolina.
J Am Coll Radiol. 2024 May;21(5):767-777. doi: 10.1016/j.jacr.2023.05.027. Epub 2023 Nov 11.
The aims of this study were to evaluate (1) frequency, type, and lung cancer stage in a clinical lung cancer screening (LCS) population and (2) the association between patient characteristics and Lung CT Screening Reporting & Data System (Lung-RADS®) with lung cancer diagnosis.
This retrospective study enrolled individuals undergoing LCS between January 1, 2015, and June 30, 2020. Individuals' sociodemographic characteristics, Lung-RADS scores, pathology-proven lung cancers, and tumor characteristics were determined via electronic health record and the health system's tumor registry. Associations between the outcome of lung cancer diagnosis within 1 year after LCS and covariates of sociodemographic characteristics and Lung-RADS score were determined using logistic regression.
Of 3,326 individuals undergoing 5,150 LCS examinations, 102 (3.1%) were diagnosed with lung cancer within 1 year of LCS; most of these cancers were screen detected (97 of 102 [95.1%]). Over the study period, there were 118 total LCS-detected cancers in 113 individuals (3.4%). Most LCS-detected cancers were adenocarcinomas (62 of 118 [52%]), 55.9% (65 of 118) were stage I, and 16.1% (19 of 118) were stage IV. The sensitivity, specificity, positive predictive value, and negative predictive value of Lung-RADS in diagnosing lung cancer within 1 year of LCS were 93.1%, 83.8%, 10.6%, and 99.8%, respectively. On multivariable analysis controlling for sociodemographic characteristics, only Lung-RADS score was associated with lung cancer (odds ratio for a one-unit increase in Lung-RADS score, 4.68; 95% confidence interval, 3.87-5.78).
The frequency of LCS-detected lung cancer and stage IV cancers was higher than reported in the National Lung Screening Trial. Although Lung-RADS was a significant predictor of lung cancer, the positive predictive value of Lung-RADS is relatively low, implying opportunity for improved nodule classification.
本研究旨在评估（1）临床肺癌筛查（LCS）人群中肺癌的频率、类型和分期，以及（2）患者特征与 Lung CT Screening Reporting & Data System（Lung-RADS®）与肺癌诊断之间的关联。
本回顾性研究纳入了 2015 年 1 月 1 日至 2020 年 6 月 30 日期间接受 LCS 的个体。通过电子健康记录和医疗系统的肿瘤登记处确定个体的社会人口统计学特征、Lung-RADS 评分、经病理证实的肺癌和肿瘤特征。使用逻辑回归确定 LCS 后 1 年内肺癌诊断结果与社会人口统计学特征和 Lung-RADS 评分的协变量之间的关联。
在 3326 名接受 5150 次 LCS 检查的个体中，有 102 名（3.1%）在 LCS 后 1 年内被诊断为肺癌；其中大多数癌症为筛查发现（97/102 [95.1%]）。在研究期间，113 名个体中有 118 例总共有 LCS 检测到的癌症（3.4%）。大多数 LCS 检测到的癌症为腺癌（62/118 [52%]），55.9%（65/118）为 I 期，16.1%（19/118）为 IV 期。Lung-RADS 在诊断 LCS 后 1 年内肺癌的敏感性、特异性、阳性预测值和阴性预测值分别为 93.1%、83.8%、10.6%和 99.8%。在控制社会人口统计学特征的多变量分析中，只有 Lung-RADS 评分与肺癌相关（Lung-RADS 评分增加一个单位的优势比为 4.68；95%置信区间为 3.87-5.78）。
LCS 检测到的肺癌和 IV 期癌症的频率高于全国肺癌筛查试验的报告。尽管 Lung-RADS 是肺癌的重要预测指标，但 Lung-RADS 的阳性预测值相对较低，这意味着有机会改进结节分类。
