February 19, 2013Annals of Internal Medicine
Definition of a Positive Test Result in Computed Tomography Screening for Lung Cancer
Authors
Discussion
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Implication
Cohort study finds higher nodule thresholds reduce unnecessary workups in screening participants, suggesting seven or eight millimeter cutoffs balance delays and false positives.
Key Points
- To evaluate the rate of positive test results and potential delays in lung cancer diagnosis during baseline screening when using more restrictive pulmonary nodule size thresholds.
- Prospective cohort study analyzing baseline low-dose computed tomography scans from 21,136 participants in the multi-institutional International Early Lung Cancer Action Program between 2006 and 2010.
- Assessed frequencies of positive scans and diagnostic delays for solid and part-solid noncalcified nodules using the conventional 5.0 mm threshold versus thresholds of 6.0, 7.0, 8.0, and 9.0 mm.
- The conventional threshold (≥5.0 mm) yielded a positive test rate of 16.0% (3,396/21,136), whereas cutoffs of 6.0, 7.0, 8.0, and 9.0 mm reduced positivity rates to 10.2% (95% CI, 9.8% to 10.6%), 7.1% (95% CI, 6.7% to 7.4%), 5.1% (95% CI, 4.8% to 5.4%), and 4.0% (95% CI, 3.7% to 4.2%), respectively.
- Alternative cutoffs of 6.0, 7.0, 8.0, and 9.0 mm reduced diagnostic work-up by 36%, 56%, 68%, and 75%, respectively, while diagnostic delays of at most 9 months occurred in 0%, 5.0% (95% CI, 1.1% to 9.0%), 5.9% (95% CI, 1.7% to 10.1%), and 6.7% (95% CI, 2.2% to 11.2%) of lung cancer cases.
Cite This Study
Claudia I. Henschke (2013) studied this question.