LDCT lung screening shown not to increase unnecessary intervention

After retroactively implementing ACR’s 2014 LungRADS classification criteria, an academic medical center increased the positive predictive value in a CT lung-screening cohort of more than 1,600 patients by a factor of 2.5—without driving an increase in surgeries following false negatives.

Researchers at Lahey Hospital & Medical Center in Burlington, Mass., centered their analysis on a retrospective review of surgical outcomes in patients who underwent low-dose CT (LDCT) lung screening from January 2012 through June 2014. The full results are published in the October edition of The Annals of Thoracic Surgery.

Pointless treatments have been the biggest bone of contention against LDCT lung screening, which Medicare approved for reimbursement in select patients and under certain criteria last winter.

Led by Bryan L. Walker of Tufts University and Christina Williamson, MD, of Lahey, the team used a prospectively collected database of patients who met the high-risk criteria of the National Comprehensive Cancer Network’s lung cancer screening guidelines.

Of 1,654 patients screened during the study interval and followed up with at Lahey, 25 (1.5 percent) had surgery.

The incidence of surgery for non-lung cancer diagnosis was only 0.30 percent (5 of 1,654).

The incidence of surgery for benign disease was just 0.24 percent (4 of 1,654)—a rate comparable to that of the National Lung Screening Trial.  

Of the 20 patients with cancer, 18 were early stage and two were late stage. None died from surgery-related causes, and there was one major surgical complication at 30 days.

The authors conclude from their study that lung cancer screening programs using LDCT can be safely and effectively adopted in clinical practice with low rates of unnecessary surgery ordered over false positives.

In a published statement, Williamson stresses the criticality of the team’s use of a standardized reporting system, along with its inclusion of board-certified cardiothoracic surgeons as part of a multidisciplinary team evaluating LDCT scan findings.

“Lung cancer screening saves lives, and our study serves as a model for how to set up a screening program that is safe and effective for patients,” she says. “It is only by minimizing the number of operations for benign disease and maintaining a low morbidity and mortality for surgical resection that the full benefit of lung cancer screening can be realized in its widespread adoption in clinical practice.” 

The American College of Radiology describes LungRADS as “a quality assurance tool designed to standardize lung cancer screening CT reporting and management recommendations, reduce confusion in lung cancer screening CT interpretations and facilitate outcome monitoring.”

A news release publicizing the study notes that previous research has shown LDCT lung screening to reduce mortality in high-risk patients by 20 percent.