CT screening for lung cancer: comparison of three baseline screening protocols

Clinical Significance of Lung-RADS Category 3 Lesions in the National Lung Screening Trial

“…Regarding nonsolid nodules (ground-glass nodule) greater than or equal to 20 mm, I-ELCAP recommends only annual follow-up, and the European consortium recommends 3-month LDCT. 8 This study has found that eliminating the 6-month CT for CAT3 lesions would result in an increase in lung cancer deaths, estimated to be 0.6% of all patients with CAT3. Most of this predicted mortality increase results from the assumption that early stage cancer survivors diagnosed in the first 6 months would have progressed and died without 6month CT.…”

Review of the future of lung cancer screening

“…Approaches for comparisons of different regimens of screening are needed to determine the optimal work-up for nodules detected on baseline and annual repeat rounds of screening, by nodule consistency. One such approach was developed to compare the International Early Lung Cancer Action Protocol with those of the American College of Radiology LungRADS and the European Protocol (110). Continuous update of protocols to incorporate advancing technology and knowledge will minimize unnecessary diagnostic work-ups and biopsies/surgeries.…”

Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe

“…The primary outcome is the efficiency of the protocol (proportion of positive findings vs. lung cancer) by nodule type at baseline and repeat scans; secondary outcomes are the number of lung cancers detected per invasive work-ups, benign resection rate, and false-positive rate. Of the 9629 potential articles identified, only nine articles on eight separate studies qualified for inclusion: these included an international multi-institute study on 25,506 participants [ 79 ], a single institution study in Korea on 6406 participants [ 80 ], a single institution study in Ireland on 449 participants [ 81 ], a single institution study in Italy on 5201 participants [ 82 ], a 12-institute study in New York State on 6295 participants [ 83 ], a single institution study in Israel on 842 participants [ 84 ], a single institution study in Germany on 187 participants [ 85 ], and a single institution study in Taiwan on 3339 participants [ 86 ]. Three studies [ 79 , 83 , 84 ] used the I-ELCAP nodule-management protocol, whereas the others used separate study-specific management protocols.…”

“…In Europe, the four main protocols that have been used are the European consortium protocol based on the NELSON trial [ 2 ]; the I-ELCAP protocol [ 87 ], which has been used in Italy, Spain, and Switzerland; the American College of Radiology’s LungRADS; the British Thoracic Society Guideline (BTS) [ 88 ], which does not distinguish between incidental and screen-detected nodules [ 89 ]. A comparison of the baseline round of screenings of three of these protocols has been performed [ 79 ]. It determined the efficiency ratio (ER) of each recommendation by dividing the number of participants recommended for that work-up by the number of resulting lung-cancer diagnoses, a lower ER indicating that fewer participants undergo additional procedures for each diagnosis of lung cancer.…”