Identification of candidates for longer lung cancer screening intervals following a negative low-dose computed tomography result
Menée aux Etats-Unis à partir de données portant sur 23 328 personnes participant à un programme annuel de dépistage du cancer du poumon par tomographie numérique à faible dose de rayonnements et dont les résultats du premier examen se sont révélés négatifs (absence de nodule de taille supérieure ou égale à 4 mm), cette étude évalue, à l'aide d'un modèle prédictif, la possibilité d'allonger le délai entre deux examens de dépistage afin de réduire les risques liés aux rayonnements ionisants
Lengthening the annual low-dose computed tomography (CT) screening interval for individuals at lowest risk of lung cancer could reduce harms and improve efficiency. We analyzed 23,328 participants in the National Lung Screening Trial who had a negative CT screen (no ≥ 4mm nodules) to develop an individualized model for lung-cancer risk after a negative CT. The Lung Cancer Risk Assessment Tool + CT (LCRAT+CT) updates “pre-screening risk” (calculated using traditional risk factors) with selected CT features. At the next annual screen following a negative CT, risk of cancer detection was reduced among the 70% of participants with neither CT-detected emphysema nor consolidation (median-risk=0.2%, IQR=0.1%-0.3%). However, risk increased for the 30% with CT-emphysema (median-risk=0.5%, IQR=0.3%-0.8%) and the 0.6% with consolidation (median=1.6%, IQR=1.0%-2.5%). As one example, a threshold of next-screen risk below 0.3% would lengthen the interval for 57.8% of screen-negatives, thus averting 49.8% of next-screen false-positives among screen-negatives but delaying diagnosis for 23.9% of cancers. Our results support that many, but not all, screen-negatives might reasonably lengthen their CT screening interval.
Journal of the National Cancer Institute , résumé, 2018