Virtual Library

Start Your Search

Matthijs Oudkerk



Author of

  • +

    JCSE01 - Perspectives for Lung Cancer Early Detection (ID 779)

    • Event: WCLC 2018
    • Type: Joint IASLC/CSCO/CAALC Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • +

      JCSE01.03 - CT Screening for Early Detection (NLST, UKLS, NELSON, ITALUNG, DANTE, Others) (Now Available) (ID 11396)

      08:20 - 08:40  |  Presenting Author(s): Matthijs Oudkerk

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    MA03 - Lung Cancer Screening - Next Step (ID 896)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • +

      MA03.05 - New Subsolid Pulmonary Nodules in Lung Cancer Screening: The NELSON Trial (Now Available) (ID 11998)

      11:00 - 11:05  |  Author(s): Matthijs Oudkerk

      • Abstract
      • Presentation
      • Slides

      Background

      A central challenge in low-dose computed tomography (LDCT) lung cancer screening is the identification of clinically relevant lung cancer, while preventing overdiagnosis and overtreatment. Subsolid nodules are particularly challenging as they carry a relatively high malignancy rate but possess a slow growth rate. Current guidelines propose a watchful waiting approach with CT surveillance. While new solid nodules after baseline screening have a high lung cancer probability at small size and require lower size cutoff values than baseline nodules, there only is limited evidence on management of new subsolid nodules. Aim of this study was to assess the occurrence and lung cancer frequency of new subsolid nodules and to determine whether a more aggressive follow-up approach is necessary for new subsolid nodules.

      Method

      Within the Dutch-Belgian randomized controlled LDCT lung cancer screening trial (NELSON), 7557 participants underwent baseline screening between April 2004 and December 2006. Three incidence screening rounds took place 1 year, 3 years, and 5.5 years after baseline screening. Participants with new subsolid nodules detected after the baseline screening round were included. A nodule was classified as (pre-)malignancy when it was diagnosed as lung cancer during diagnostic workup including histologic assessment.

      Result

      In the three incidence screening rounds 60 new subsolid nodules not visible in retrospect (43 [72%] part-solid, 17 [28%] nonsolid) were detected in 51 participants (0.7% [51/7295] of participants with at least one incidence screening). Eventually, 6% (3/51) of participants with a new subsolid nodule was diagnosed with a (pre-)malignancy in such a nodule. The (pre-)malignancies were adenocarcinoma (in situ) and diagnostic work-up (referral 950, 364, and 366 days after first detection respectively) showed favorable staging (stage I). Overall, 65% (33/49) of subsolid nodules with follow-up screening were resolving.

      Conclusion

      Less than 1% of participants in LDCT lung cancer screening presents with a new subsolid nodule after baseline. Contrary to new solid nodules, new subsolid nodules do not require a more aggressive follow-up approach than baseline nodules.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    MA20 - Implementation of Lung Cancer Screening (ID 923)

    • Event: WCLC 2018
    • Type: Mini Oral Abstract Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • +

      MA20.10 - Lung Cancer Prediction Using Deep Learning Software: Validation on Independent Multi-Centre Data (Now Available) (ID 14022)

      16:20 - 16:25  |  Author(s): Matthijs Oudkerk

      • Abstract
      • Presentation
      • Slides

      Background

      Artificial Intelligence software has shown promise in predicting malignancy in indeterminate CT detected pulmonary nodules. This study aimed to assess the accuracy of a convolutional neural network (CNN) based lung cancer prediction software on an independent dataset of indeterminate incidentally detected nodules in a retrospective European multicentre trial.

      Method

      The software was trained using the US National Lung Screening Trial (NLST) dataset which was manually curated, such that each reported nodule and cancer was located, contoured and diagnostically characterised (9310 benign nodule patients; 1058 cancer patients). From this complete dataset, a training set was built by selecting all patients with solid and part-solid lesions of 6mm and above, where benign nodules and cancers could be confidently identified by clinicians (5972 patients, of which 575 were cancer patients). A CNN classifier was trained using Deep Learning on this data to produce a malignancy score per nodule. We defined a benign nodule rule-out test by calculating thresholds on the malignancy score that achieve 100% and 99.5% sensitivity on the NLST data.

      The study was set up so that a malignancy score for each nodule was generated. Overall performance was evaluated using Area-Under-the-ROC-Curve analysis (AUC) and rule-out performance measured the specificity at the two thresholds, i.e. the proportion of benign nodules correctly stratified at each threshold.

      There were 2201 nodules, measuring between 5-15mm from 1719 patients from three tertiary referral centres in the UK, Germany and Netherlands. The CT data included heterogeneous scan parameters, scanner manufacturers and clinical indications. Diagnostic ground-truth was established according to Fleischner or British Thoracic Society guidelines. The dataset contained 222 unique cancers from 215 patients.

      Result

      AUC on all-site data was 0.92 (95%CI = 0.89-0.93) and broken down per-site the AUC was 0.97 (Netherlands, n=883, 26 cancers), 0.93 (UK, n= 698, 51 cancers), and 0.84 (Germany, 620, 145 cancers).

      The score thresholds used for the target sensitivity of 100% and 99.5% were the same and achieved an overall sensitivity on the data of 99.1% with a specificity of 25.0%. Per-site results were 25.6% (Netherlands), 27.8% (UK) and 20.6% (Germany) specificity with 100%, 100% and 98.6% sensitivity respectively.

      Conclusion

      Performance of the AI software on independent European multicentre data was comparable to that achieved on the NLST training data, although there was some variability in the performance of the system across the three centres, potentially providing an opportunity for further optimisation.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    MTE14 - Nodule Management (Pro Con Debate and Case Presentations) (Ticketed Session) (ID 824)

    • Event: WCLC 2018
    • Type: Meet the Expert Session
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/25/2018, 07:00 - 08:00, Room 206 F
    • +

      MTE14.01 - Nodule Management (Pro Con Debate and Case Presentations) (Now Available) (ID 11570)

      07:00 - 08:00  |  Presenting Author(s): Matthijs Oudkerk

      • Abstract
      • Presentation
      • Slides

      Abstract

      A recent observation study on the management of lung nodules 8 mm to 20 mm by community pulmonologists in the US showed a high benign biopsy rate of 62% and benign surgical resection rate of 35%. Furthermore, the surgical resection rates were similar irrespective of the pre-test probability of malignancy risk.1 The study suggested there is a lack of adherence to nodule management guidelines. However, there are a number of lung nodule management guidelines and lung nodule malignancy risk prediction tools.2-6 Some are based on 2D diameter size measurement while others used volumetric measurement or a combination of both. New nodules with a prior negative CT have a higher probability of malignancy even at a smaller size. 7-9 Compares to baseline screen, the malignancy risk of new nodules is higher for nodules <8mm.9 Computer assisted diagnostic (CAD) tools facilitates volume measurement and reduce inter-observer variability but they may not be generally available. Volumetric measurement is particularly useful for comparison of serial scans for evidence of growth. Growth independent nodule characteristics such as right upper lung and central distribution may further improve volume based new nodule malignancy prediction. Nodule size and growth are the most important parameters for malignancy.

      To measure size accurately especially to determine changes in volume, it is necessary to address standardization of technical requirements related to the scanners and image acquisition protocols.10 The action thresholds for early recall CT imaging study, PET/CT or biopsy vary in different guidelines with major differences for non-solid nodules making it difficult for clinicians to remember or apply. Therefore, a lack of adherence to guideline recommendations could be related to a lack of clarity of guidelines. To facilitate implementation, there is a need to have an integrated nodule malignancy risk tool that takes into account prior LDCT history when there is more than a baseline LDCT.

      In this session, the important issues regarding which risk model should be applied and which nodule management approach should be used (e.g. diameter or volume) for baseline and new nodules will be discussed through case presentations.

      References:

      1. Tanner NT, Aggarwal J, Gould MK, Kearney P, Diette G, Anil Vachani A, Fang KC, Silvestri GA. Management of Pulmonary Nodules by Community Pulmonologists. A Multicenter Observational Study. Chest 2015:148(6):1405-1414.

      2. MacMahon H, Naidich DP, Goo JM, et al (2017). Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017. Radiology; 284; 228-243.

      3. American College of Radiology. Lung CT Screening Reporting and Data System (Lung-RADS). Accessed 23rd June 2017 from www.acr.og/quality-saftey/resources/lungRADS.

      4. Callister MEJ, Baldwin DR, Akram AR et al (2015). BTS guidelines for investigation and management of pulmonary nodules. Thorax; 70:ii1-ii54. Doi: 10.1136/thoraxjnl-2015-207168.

      5. Horeweg N, van der Aalst CM, Vliegenthart R, et al. Volumetric computed tomography screening for lung cancer: three rounds of the NELSON trial. Eur Respir J 2013;42:1659-67.

      6. McWilliams AM, Tammemägi MC, Mayo JR, et al (2013). Probability of cancer in pulmonary nodules detected on first screening CT. N Eng J Med; 369: 910-919.

      7. Walter JE, Heuvelmans MA, Bock GH, Yousaf-Khan U, Groen HJM, Aalst CMV, Nackaerts K, Ooijen PMAV, Koning HJ, Vliegenthart R, Oudkerk M. Characteristics of new solid nodules detected in incidence screening rounds of low-dose CT lung cancer screening: the NELSON study.Thorax. 2018 Apr 16. pii: thoraxjnl-2017-211376. doi: 10.1136/thoraxjnl-2017-211376. [Epub ahead of print]

      8. Walter JE, Heuvelmans MA, de Jong PA, Vliegenthart R, van Ooijen PMA, Peters RB, Ten Haaf K, Yousaf-Khan U, van der Aalst CM, de Bock GH, Mali W, Groen HJM, de Koning HJ, Oudkerk M. Occurrence and lung cancer probability of new solid nodules at incidence screening with low-dose CT: analysis of data from the randomised, controlled NELSON trial. Lancet Oncol. 2016 Jul;17(7):907-916.

      9. Paul F. Pinsky PF, Gierada DF, Nath PH, Munden R. Lung Cancer Risk Associated With New Solid Nodules in the National Lung Screening Trial. AJR 2017; 209:1009–1014.

      10. Alexander A. Bankier AA, MacMahon H, Goo JM, Rubin GD, Schaefer-Prokop CM, Naidich DP. Recommendations for measuring pulmonary nodules at CT: A Statement from the Fleischner Society. Radiology 2017 Nov;285(2):584-600.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    P1.11 - Screening and Early Detection (Not CME Accredited Session) (ID 943)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P1.11-06 - Lung Cancer Probability in New Perifissural Nodules Detected in a Lung Cancer Screening Study (ID 13427)

      16:45 - 18:00  |  Author(s): Matthijs Oudkerk

      • Abstract

      Background

      In incidence lung cancer screening rounds, new lung nodules are a regular finding, with a higher lung cancer probability than baseline nodules. A substantial number of screen-detected nodules is classified as perifissural nodule (PFN). Previous studies showed that baseline PFNs and PFNs in clinical settings represent non-malignant lesions such as intrapulmonary lymph nodes. Whether this is also the case for incident PFNs is unknown. This study evaluates all newly detected nodules in the Dutch-Belgian randomized-controlled NELSON study with respect to perifissural classification and lung cancer probability.

      Method

      All NELSON participants with a new solid nodule detected in screening round 2, 3 or 4 (1, 3, and 5.5 years after baseline, respectively), were enrolled in this substudy. Nodules were classified into three groups: intraparenchymal, vessel attached or fissure attached. Screening CT scans of participants with lung cancer based on a nodule classified as fissure attached, were re-evaluated by two radiologists (4 and 6 years of experience) to check whether this nodule was a typical, atypical or non-PFN. The fissure-attached cancers were matched based on size with benign cases (1:4), and the radiologists were blinded for the final nodule outcome. In case of discrepancy, a third radiologist (13 years of experience) arbitered.

      Result

      1,484 new nodules were detected in the second, third and final NELSON screening round in 949 participants (77.4% male, median age 59 [interquartile range: 55-63]). 1,393 nodules (93.8%) were benign based on 2 year follow-up or pathology; 96 of these (6.9%) were fissure attached. Lung cancer diagnosis was made in 74 new nodules in 74 participants (7.8% of participants with a new nodule). Nine lung cancers (12.1%) were fissure attached and re-evaluated by the radiologists. None of the fissure attached malignant new nodules was classified as a typical or atypical PFN.

      Conclusion

      None of the lung cancers that originated from a new nodule in the NELSON study was classified as a typical or atypical PFN. Our results suggest that also in the case of a new PFN, it is highly unlikely that these PFNs will be diagnosed as lung cancer.

  • +

    P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 2
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
    • +

      P2.11-02 - Direct Comparison of New Solid Nodules Detected in Women and Men During Incidence Screening Rounds of the NELSON Trial (ID 12512)

      16:45 - 18:00  |  Author(s): Matthijs Oudkerk

      • Abstract

      Background

      Low-dose computed tomography (LDCT) lung cancer screening is recommended by US guidelines. Women are commonly underrepresented in lung cancer screening trials and evidence is derived from a predominantly male population. New solid nodules that develop after baseline screening have a high lung cancer probability. There is very limited evidence concerning the potential differences of new solid nodules detected in women and men.

      Method

      In the randomized Dutch-Belgian Lung Cancer Screening (NELSON) Trial, 7,557 participants (16% female) underwent baseline screening. Three incidence rounds took place after intervals of 1year, 2years and 2.5years respectively. We included participants with solid non-calcified nodules registered after baseline as new and not visible in retrospect on a previous screen. Continuous variables were compared using the Mann–Whitney U test or student's t test and are presented as medians with interquartile range (IQR) or means with standard deviation (±) respectively. Nominal variables were compared using the chi-squared test.

      Result

      In total, 699 participants (149 [21%] women, 550 [79%] men) with 1,130 new solid nodules (241 [21%] in women, 889 [79%] in men) were included. Eventually, 5.4% of women with a new solid nodule and 10.4% of men with a new solid nodule were diagnosed with lung cancer (P=0.063), corresponding to 3.3% of new solid nodules being malignant in women and 6.5% being malignant in men (P=0.060). The female participants were significantly younger than the male participants (58±5 years vs. 60±5 years, P=0.008), while there was no significant difference in smoking pack-years (39 years [IQR 30-49] vs. 39 years [IQR 30-52], P=0.696). Comparing new nodule size at initial detection in women and men, there was a significant difference for benign new nodules (51mm3, IQR: 29-128mm3 vs. 66mm3, IQR: 35-177mm3, P=0.019), but not for lung cancers (449mm3, IQR: 52-1050mm3 vs. 447mm3, IQR: 196-1135mm3, P=0.553). The currently advocated cutoff of ≥30mm3 (about 3.9mm) reached >95% sensitivity in both genders. At first follow-up after detection, new solid nodules in women had resolved significantly more frequent than in men (69% vs. 58%, P=0.003). Adenocarcinomas were significantly more common in women than in men (88% of lung cancers vs. 31% of lung cancers, P=0.002), whereas the stage I detection rate was comparable (67% of lung cancers vs. 63% of lung cancers, P=0.789).

      Conclusion

      While there are significant differences between new solid nodules detected after baseline in women and men, there is no indication for a sex specific nodule management approach in LDCT lung cancer screening.

    • +

      P2.11-24 - Impact of Screening Interval Length on New Nodules Detected in Incidence Rounds of CT Lung Cancer Screening: the NELSON Trial (ID 12511)

      16:45 - 18:00  |  Author(s): Matthijs Oudkerk

      • Abstract

      Background

      Low-dose computed tomography lung cancer screening is recommended by US guidelines. New solid nodules are regularly found in incidence screening rounds and have a higher lung cancer probability than baseline nodules. Contrary to baseline nodules, new nodules develop within a known screening interval (time between previous screen and new nodule detection). There is limited evidence concerning the impact of varying screening interval lengths on new solid nodules.

      Method

      In the randomized Dutch-Belgian Lung Cancer Screening (NELSON) Trial, 7,557 participants underwent baseline screening. Three incidence rounds took place after intervals of 12months, 24months and 30months respectively and follow-up intervals ranged from 2-12months. We included solid non-calcified nodules registered after baseline as new and not visible in retrospect. Using logistic regression, screening interval length was assessed as predictor for lung cancer whilst adjusting for nodule size. The correlation of screening interval length and new nodule size was assessed with Spearman's rank correlation. Discriminative performance for lung cancer was quantified as area under the receiver operating characteristics curve (AUC).

      Result

      Overall, 1,130 new solid nodules were included with 6% being lung cancer. Of the nodules, 13% were detected after a screening interval of <10months, 28% after 10-14months, 4% after 15-21months, 37% after 22-26months, and 20% after >26months. While the proportion of new solid nodules that subsequently resolved until first follow-up decreased with longer screening interval (76%, 70%, 59%, 57%, 41% respectively, p<0.001), the lung cancer proportion significantly increased (2%, 3%, 3%, 7%, 11% respectively, p=0.001). The screening interval length was a significant predictor for lung cancer when assessed in all nodules (p=0.018). However, there was no significant association when only assessed in nodules that persisted on first follow-up (p=0.223). Compared to benign nodules, lung cancer size at initial detection correlated stronger with screening interval length (spearman's rho 0.106 vs. 0.320) and the discriminative performance of volume for lung cancer increased with screening interval length (AUC: 0.71 at 10-14months vs. 0.84 at >26months). Comparing malignant nodules detected after 10-14months, 22-26months or >26months, the proportion of stage IA lung cancers decreased (73%, 63%, 39% respectively, p=0.139) and all IIIb/IV cancers were found after >22months.

      Conclusion

      The longer the screening interval prior to new nodule detection, the lower the nodule’s probability to resolve and the higher the nodule’s lung cancer probability. While a longer screening interval might facilitate the discrimination between benign and malignant new solid nodules, there was a trend for less favorable staging.

  • +

    PL02 - Presidential Symposium - Top 5 Abstracts (ID 850)

    • Event: WCLC 2018
    • Type: Plenary Session
    • Track: Advanced NSCLC
    • Presentations: 1
    • Now Available
    • +

      PL02.05 - Effects of Volume CT Lung Cancer Screening: Mortality Results of the NELSON Randomised-Controlled Population Based Trial (Now Available) (ID 14722)

      08:45 - 08:55  |  Author(s): Matthijs Oudkerk

      • Abstract
      • Presentation
      • Slides

      Abstract

      The NELSON-trial is a population-based RCT using nodule volume management for referral, initiated to show a 25% LC mortality reduction in males at 10-years of follow-up.

      606,409 persons, aged 50-74, in the Netherlands and Leuven were sent a general questionnaire about risk factors, leading to 150,920 responders. 30,959 responders were eligible and invited to participate, of which 15,822 gave informed consent and were randomized (1:1). CT-screening was offered to study arm participants at baseline and 1, 3 and 5.5 years after randomization, whereas no screening was offered to control arm participants. Participant’s records were linked to national registries with 100% coverage regarding cancer diagnosis (Netherlands Cancer Registry), date of death (Centre for Genealogy) and cause of death (Statistics Netherlands). Medical files for deceased lung cancer patients up to 2013 were reviewed by an expert panel (blinded to study arm); cause of death reported by Statistics Netherlands was used thereafter. Follow up to 31.12.2015 comprised a minimum duration of 10 years for 98.7% enrolled (unless deceased). A pre-determined 9-year analysis was also considered due to dilution effects by screening design given growth rate of LC.

      CT screening compliance was 94% on average, leading to a total of 29,736 scans. In 9.1% of the participants additional CT scans within 2 months were performed to estimate nodule Volume Doubling Time, leading to an overall referral rate of 2.1% for suspicious nodules. Detection rates across the rounds varied between 0.8-1.0%, and 69% of screen-detected LC were detected at stage IA or B. 261 lung cancers (52 interval cancers) were detected before the 4th round. In a subset of analyzed patients, surgical treatment was 3 times significantly more prevalent in study LC patients than in control arm patients (67.7% versus 24.5%, p<0,001). In total 934 participants have died in the control arm (NL), versus 904 in the study arm (NL). In the Dutch female enrolled participants, the rate-ratio of dying from lung cancer was 0.73 at 10-years, and 0.58 at 9-years FU.

      The minimum 10-year FU for NELSON has been realized, and full data on incidence, mortality and cause of death are equally available for both arms. A (non- significant) 41.8% lung cancer mortality reduction has been achieved in the small subset of 2,382 Dutch women. Post-hoc analysis shows a 51.4% (p=0.04) LC mortality reduction at 8 years of FU. Data for the full cohort will be presented on behalf of NELSON-investigators.

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.

  • +

    S01 - IASLC CT Screening Symposium: Forefront Advances in Lung Cancer Screening (Ticketed Session) (ID 853)

    • Event: WCLC 2018
    • Type: Symposium
    • Track: Screening and Early Detection
    • Presentations: 1
    • Now Available
    • +

      S01.10 - EU Position Statement on Lung Cancer Screening (Now Available) (ID 11891)

      09:00 - 09:20  |  Presenting Author(s): Matthijs Oudkerk

      • Abstract
      • Presentation
      • Slides

      Abstract not provided

      Only Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login, select "Add to Cart" and proceed to checkout. If you would like to become a member of IASLC, please click here.

      Only Active Members that have purchased this event or have registered via an access code will be able to view this content. To view this presentation, please login or select "Add to Cart" and proceed to checkout.