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Characteristics of new solid nodules detected in incidence screening rounds of low-dose CT lung cancer screening: The NELSON study

Walter, J. E., Heuvelmans, M. A., de Bock, G. H., Yousaf-Khan, U., Groen, H. J. M., van der Aalst, C. M., Nackaerts, K., van Ooijen, P. M. A., de Koning, H. J., Vliegenthart, R. & Oudkerk, M., Aug-2018, In : Thorax. 73, 8, p. 741-747 7 p.

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  • Characteristics of new solid nodules detected in incidence screening rounds of low-dose CT lung cancer screening

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DOI

Purpose New nodules after baseline are regularly found in low-dose CT lung cancer screening and have a high lung cancer probability. It is unknown whether morphological and location characteristics can improve new nodule risk stratification by size.

Methods Solid non-calcified nodules detected during incidence screening rounds of the randomised controlled Dutch-Belgian lung cancer screening (NELSON) trial and registered as new or previously below detection limit (15 mm(3)) were included. A multivariate logistic regression analysis with lung cancer as outcome was performed, including previously established volume cut-offs (<30 mm(3), 30-= 200 mm(3)) and nodule characteristics (location, distribution, shape, margin and visibility <15 mm(3) in retrospect).

Results Overall, 1280 new nodules were included with 73 (6%) being lung cancer. Of nodules >= 30 mm(3) at detection and visible <15 mm(3) in retrospect, 22% (6/27) were lung cancer. Discrimination based on volume cut-offs (area under the receiver operating characteristic curve (AUC): 0.80, 95% CI 0.75 to 0.84) and continuous volume (AUC: 0.82, 95% CI 0.77 to 0.87) was similar. After adjustment for volume cut-offs, only location in the right upper lobe (OR 2.0, P=0.012), central distribution (OR 2.4, P=0.001) and visibility <15 mm(3) in retrospect (OR 4.7, P=0.003) remained significant predictors for lung cancer. The Hosmer-Lemeshow test (P=0.75) and assessment of bootstrap calibration curves indicated adequate model fit. Discrimination based on the continuous model probability (AUC: 0.85, 95% CI 0.81 to 0.89) was superior to volume cut-offs alone, but when stratified into three risk groups (AUC: 0.82, 95% CI 0.78 to 0.86), discrimination was similar. Conclusion

Contrary to morphological nodule characteristics, growth-independent characteristics may further improve volume-based new nodule lung cancer prediction, but in a three-category stratification approach, this is limited.

Original languageEnglish
Pages (from-to)741-747
Number of pages7
JournalThorax
Volume73
Issue number8
Publication statusPublished - Aug-2018

    Keywords

  • SMALL PULMONARY NODULES, SERVICES TASK-FORCE, SOCIETY GUIDELINES, PREDICTION MODELS, BASE-LINE, TRIAL, MANAGEMENT, PROBABILITY, STATEMENT, BENEFITS

ID: 64157699