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Mehrad Bastani
Author of
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MA05 - Lung Cancer Screening (ID 174)
- Event: WCLC 2020
- Type: Mini Oral
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 1/30/2021, 11:45 - 12:45, Scientific Program Auditorium
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MA05.09 - Evaluation of Alternative Diagnostic Follow-Up Intervals for Lung-RADs Criteria on the Effectiveness of Lung Cancer Screening (ID 3563)
11:45 - 12:45 | Presenting Author(s): Mehrad Bastani
- Abstract
- Presentation
Introduction
The National Lung Screening Trial (NLST) demonstrated that screening for lung cancer significantly reduces lung cancer specific mortality but reporting high rates of false-positive findings. The American College of Radiology (ACR) developed Lung CT screening reporting and data systems (Lung-RADS) to standardize the management of screening findings by specifying a follow-up interval and disease progression threshold before diagnostic imaging or biopsy of small nodules found on screening CT. While Lung-RADS has been shown to reduce the false-positive rate when applied to NLST dataset (27.3% to 13.4%) through retrospective analysis, the optimality of the proposed follow-up strategies has not been fully established. This study estimates the effectiveness of alternative diagnostic follow-up intervals on lung cancer screening.
Methods
Using Stanford lung cancer outcome simulator (LCOS), we estimate population-level outcomes of alternative diagnostic follow-up intervals for Lung-RADS category 3 and 4A among 1960 US birth cohort on the effectiveness of LCS per the USPSTF, CMS and NLST strategies, by varying the interval of diagnostic follow-ups. Among the evaluated outcomes are percentage of mortality reduction, screens performed, lung cancer deaths averted, screen-detected cases, and average number of screens and follow-ups per death averted.
Results
Implementation of USPSTF screening guideline with 1-month earlier interval for Lung-RADS category 3 individuals yielded in higher mortality reduction (0.08% for males versus 0.05% for females), higher number of death averted (36 vs 27), higher number of screen-detected cases (13 vs 7), and lower number of combined LDCTs and diagnostic follow-ups per death avoided (8 vs 5). Execution of NLST and CMS screening guidelines and sensitivity analysis of nodule progression threshold (up to 3mm for males vs 2.5mm for females) verified the robustness of earlier diagnostic follow-up for Lung-RADS category 3 individuals. Table 1 provides detailed health outcomes of the top three diagnostic follow-up strategies for NLST, CMS, and USPSTF screening guidelines. Findings of this study supports the notion that both individuals and physicians are highly encouraged to schedule the diagnostic follow-up screens for Lung-RADS category 3 earlier than 6-month interval rather than later.
Table 1 - Comparison of alternative follow-up scenarios with higher mortality reduction to current Lung-RADS suggestion ((4-3) and (5-3) vs (6-3)) (1 million population) [X (Y-Z) represents screening guideline X with category 3 and 4A diagnostic follow-up intervals after Y- and Z-months] Gender
Metrics
NLST† (4-3)
NLST (5-3)
NLST (6-3)
CMS+ (4-3)
CMS (5-3)
CMS (6-3)
USPSTF* (4-3)
USPSTF (5-3)
USPSTF (6-3)
Male
Mortality Reduction (%)
5.52%
5.51%
5.47%
6.35%
6.35%
6.29%
6.95%
6.97%
6.89%
# of LDCTs
1,969,189
1,969,051
1,968,984
2,120,532
2,120,373
2,120,295
2,234,489
2,234,306
2,234,222
# of FUPs
124,503
124,483
124,461
132,954
132,931
132,902
139,241
139,217
139,186
# of Death Avoided
2,576
2,573
2,553
2,966
2,965
2,938
3,246
3,253
3,217
# of Screen Detected Cases
11,300
11,300
11,289
13,108
13,099
13,080
14,574
14,582
14,561
# of LDCTs / LC Death Avoided
764
765
771
715
715
721
688
687
695
(# of LDCTs + FUPs) / LC Death Avoided
813
814
820
760
760
767
731
730
738
Life-Year Gained
39,395
39,237
38,576
42,636
42,599
42,336
44,526
44,667
44,068
Female
Mortality Reduction (%)
4.84%
4.85%
4.80%
5.72%
5.73%
5.69%
6.54%
6.54%
6.49%
# of LDCTs
1,665,039
1,664,870
1,664,769
1,812,072
1,811,875
1,811,759
1,927,153
1,926,920
1,926,782
# of FUPs
105,075
105,065
105,045
113,536
113,522
113,496
120,038
120,024
119,993
# of Death Avoided
2,440
2,445
2,420
2,883
2,890
2,869
3,294
3,298
3,271
# of Screen Detected Cases
8,843
8,849
8,843
10,635
10,642
10,631
12,129
12,139
12,132
# of LDCTs / Death Avoided
682
681
688
629
627
631
585
584
589
(# of LDCTs + FUPs) / Death Avoided
725
724
731
668
666
671
621
621
626
Life-Year Gained
40,368
40,323
39,749
44,398
44,446
44,290
47,491
47,650
47,249
†: National Lung Screening Trial screening guideline – Annual low-dose computed tomography (LDCT) for person aged between 55-74 with 30-pack years smoking history and within 15-years of quitting for former smokers
+: Center for Medicare and Medicaid screening guideline – Annual LDCT for person aged between 55-77 with 30-pack years smoking history and within 15-years of quitting for former smokers
*: U.S. Preventive Service Task Force screening guideline – Annual LDCT for person aged between 55-80 with 30-pack years smoking history and within 15-years of quitting for former smokers
Abbreviations- NLST: National Lung Screening Trial, CMS: Center for Medicare and Medicaid, USPSTF: U.S. Preventive Service Task Force, LDCT: Low-dose computed tomography, FUP: diagnostic follow-up
Conclusion
Earlier diagnostic follow-ups for Lung-RADs category 3 individuals may result in higher mortality reduction. Designing optimal follow-up guidelines warrants further investigation.
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