Incidental lung nodule program spots early lung cancer more frequently than low-dose CT
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An incidental lung nodule program detected early-stage lung cancer with higher frequency than most low-dose CT programs, according to a poster presented at the virtual 2021 ASCO Annual Meeting.
“We know early detection of lung cancer improves survival by diagnosing lung cancers at earlier stages,” Matthew Smeltzer, PhD, associate professor in the division of epidemiology, biostatistics, and environmental health at the University of Memphis, said in the presentation. “And risk-based low-dose CT screening, while incredibly valuable, still only identifies a minority of patients.”
Between 2015 and 2020, patients were examined through an incidental lung nodule program (ILNP), and those with lung lesions detected during routine study were indicated by radiologists for further evaluation. Demographics, clinical features, procedures, complications and outcomes were recorded, according to the abstract.
Investigators analyzed each participant for eligibility for typical low-dose CT (LDCT) using standards from the National Lung Screening Trial, Center for Medicaid Services, NEderlands Leuvens Screening ONderzoek, U.S. Preventive Services Task Force criteria from 2013 and 2020 and National Comprehensive Cancer Network risk groups 1 through 3.
Of the 13,710 screened participants, 667 were diagnosed with lung cancer. Most patients diagnosed had either adenocarcinoma or squamous cell lung cancer, and 48% had stage I lung cancer.
Invasive diagnostic testing was performed on 832 participants, the most frequent being CT-guided biopsy, bronchoscopy and endobronchial ultrasound. The most observed complications from these procedures included pneumothorax and chest tube placement, according to Smeltzer.
When analyzed for LDCT eligibility, patients diagnosed via the ILNP qualified less than 50% of the time using NLST, CMS, NELSON, USPSTF and NCCN group 1 standards. Less than 60% qualified for LDCT with the NCCN group 2 and 3 criteria.
The survival rate of lung cancer patients diagnosed with ILNP was 76% at 1 year and 64% at 3 years, which Smeltzer said was promising.
“Even with new expanded criteria for LDCT, structured incidental nodule programs are necessary to expand early detection,” Smeltzer said.
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Smeltzer M. et al. Abstract 8553. Presented at: 2021 ASCO Annual Meeting; June 4-8, 2021 (virtual meeting).
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