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En-Kuei Tang
Author of
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P2.11 - Screening and Early Detection (Not CME Accredited Session) (ID 960)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Track:
- Presentations: 1
- Moderators:
- Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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P2.11-29a - Modified Lung-RADS Improves Performance of Screening LDCT in a Population with High Prevalence of Non–Smoking-Related Lung Cancer (ID 12093)
16:45 - 18:00 | Presenting Author(s): En-Kuei Tang
- Abstract
Background
We proposed a modification of the ACR Lung Imaging Reporting and Data System (Lung-
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RADS) to clarify the characteristics of subsolid nodules with categories 1–11, and to compare the
diagnostic accuracy with Lung-RADS and National Lung Screening Trial criteria in an Asian popula-
tion with high prevalence of adenocarcinoma.
We analyzed a retrospective cohort of 1978 consecutive healthy subjects (72.8% non-
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smoker) who underwent low-dose computed tomography from August 2013 to October 2014 (1084
men, 894 women). Lung-RADS categories 2 and 3 were modified to include subcategories of 2A/2B/2C
and 3A/3B/3C, respectively. Clinical information and nodule characteristics were recorded. Receiver
operating characteristic curves were used to compare diagnostic accuracy at different cutoffs.
Thirty-two subjects (30 nonsmokers) had pathology-proven adenocarcinoma spectrum lesions
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in the follow-up period (1.6 ± 0.5 years). Modified Lung-RADS, using modified Lung-RADS category
2C as cutoff, had an area under the curve (AUC) of 0.973 in predicting adenocarcinoma spectrum
lesions (sensitivity of 100%, specificity of 89.3%), which was significantly higher than that of Lung-
RADS (AUC = 0.815, P < .001) and National Lung Screening Trial (AUC = 0.906, P < .001). Furthermore,
modified Lung-RADS showed an AUC of 0.992 in predicting invasive adenocarcinoma (sensitivity of
95%, specificity of 97.8%) when category 3B was used as cutoff.
Modified Lung-RADS may substantially improve sensitivity while maintaining specific-
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ity for detection of adenocarcinoma spectrum lesions in an Asian population. Compared to Lung-
RADS, it has enhanced ability to differentiate invasive from indolent adenocarcinoma by more refined
subclassification of subsolid nodules using two cutoff values of category 2C and 3B. The effect of
using modified Lung-RADS in clinical practice must be carefully studied in prospective large cohort
studies.