New nodules at incidence low-dose CT lung cancer screening
Lung cancer is deadly. With 1.6 million annual deaths, it is the leading cause of cancer-related death. An early diagnosis is essential for survival and the survival rates range from 12-90% depending on the lung cancer stage. During lung cancer screening with low-dose computed tomography, participants receive computed tomography examinations of the lung in regular intervals to evaluate whether an anomaly or lung nodule is visible. This form of screening is already recommended in the United States and European stakeholders are awaiting the final results of the Dutch-Belgian lung cancer screening (NELSON) trial with 15000 participants. This thesis is based on the NELSON trial and is focused on new nodules that were not visible during the first computed tomography examination. The aim is to identify new lung cancer nodules as early as possible and distinguish them from harmless lung nodules. This thesis shows that new lung nodules are regularly found during low-dose computed tomography lung cancer screening and are often lung cancer, even when they are very small. Consequently, an improved management strategy was developed to enable the early identification of lung cancer in new nodules. The appropriate management strategy determines the success of a lung cancer screening program, since most lung cancers will be found in new nodules eventually.