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LUSI: Early recall rates decline in subsequent lung cancer screenings
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Early recall rates for suspicious findings demonstrated in the first round of lung cancer screening significantly declined in subsequent screening rounds, according to results of the German Lung Cancer Screening Intervention Trial.
The German Lung Cancer Screening Intervention Trial (LUSI) utilized low-dose multislice CT (MSCT) to screen individuals at high risk for lung cancer. However, findings from LUSI, as well as from the U.S. National Lung Screening Trial (NLST), demonstrated high rates for early recalls and false-positive results after the first round of screening.
“Several randomized trials investigating the effectiveness of lung cancer screening with MSCT are underway in the USA and Europe,” Nikolaus Becker, MD, PhD, of the department of cancer epidemiology at the German Cancer Research Center, and colleagues wrote. “One key result of [LUSI’s] first screening round was the high early recall rate of about 20% early recalls due to suspicious MSCT findings. Most of these were false-positive, which would make MSCT screening questionable for a routine program. However, screening may behave rather differently in the first screening round and subsequent rounds.”
Becker and colleagues evaluated data from 4,052 adults aged 50 to 69 years who smoked at least 15 cigarettes a day for at least 25 years or at least 10 cigarettes a day for at least 30 years.
Researchers randomly assigned participants to a screening intervention arm (n = 2,029) — which was composed of five annual MSCT scans — or no screening (n = 2,023).
Follow-up data were available for at least 3 years since randomization. Nearly 90% of participants in the intervention arm completed at least four MSCT scans.
The number of early recalls — including those at 3 months and 6 months — dropped from 451 participants (22.2%) during the first round of screening to 88 participants (4.7%) during the second screening round. Overall, the recall rate at 3 months and 6 months was significantly lower during the second through the fourth screening rounds compared with the first (range, 3.2%-7%; P < .0001).
Early recall after the first screening round resulted in subsequent MSCT scans in 24 patients, which researchers noted is important when considering radiation exposure.
Sixty-two participants in the intervention arm and 32 in the control arm were diagnosed with lung cancer. The proportion of screen-detected cancers that were detected at an advanced stage did not statistically differ between the first and last screening rounds (26.1% vs. 28.6%).
The researchers said the relatively small population is a limitation to these findings.
“For a screening program to be acceptable, its undesired side effects must be limited to a reasonable minimum,” Becker and colleagues concluded. “Our data indicate that the most prominent side effect ‘false-positive alarm’ cannot be controlled if the choice of the doctor is at the screenee’s discretion at every annual screening visit. Rather, a potential lung cancer screening program must be so organized that all previous images and results are available. With the exception of the first screening round, the false-positive rate and many other parameters important in screening will then be in a range which is comparable to what is seen in breast cancer with mammography.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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