Dataset Information

Procedural complications associated with invasive diagnostic procedures after lung cancer screening with low-dose computed tomography.

ABSTRACT:

Introduction

Although the National Lung Screening Trial (NLST) has proven low-dose computed tomography (LDCT) is effective for lung cancer screening, little is known about complication rates from invasive diagnostic procedures (IDPs) after LDCT in real-world settings. In this study, we used the real-world data from a large clinical research network to estimate the complication rates associated with IDPs after LDCT.

Methods

Using 2014-2021 electronic health records and claims data from the OneFlorida clinical research network, we identified case individuals who underwent an IDP (i.e., cytology or needle biopsy, bronchoscopy, thoracic surgery, and other surgery) within 12 months of their first LDCT. We matched each case with one control individual who underwent an LDCT but without any IDPs. We calculated 3-month incremental complication rates as the difference in the complication rate between the case and control groups by IDP and complication severity.

Results

Among 7,041 individuals who underwent an LDCT, 301 (4.3%) subsequently had an IDP within 12 months following the LDCT. The overall 3-month incremental complication rate was 16.6% (95% confidence interval [CI]: 9.9% - 23.1%), higher than that reported in the NLST (9.4%). The overall incremental complication rate was 5.6% (95% CI: 1.9% - 9.6%) for major, 8.6% (95% CI: 3.1% - 14.1%) for intermediate, and 13.2% (95% CI: 8.1% - 18.5%) for minor complications.

Conclusions

It is important to ensure adherence to clinical guidelines for nodule management and downstream work-up to minimize potential harms from screening.

SUBMITTER: Yang S

PROVIDER: S-EPMC9250944 | biostudies-literature | 2022 Mar

REPOSITORIES: biostudies-literature

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Publications

Procedural complications associated with invasive diagnostic procedures after lung cancer screening with low-dose computed tomography.

Yang Shuang S Shih Ya-Chen Tina YT Huo Jinhai J Mehta Hiren J HJ Wu Yonghui Y Salloum Ramzi G RG Alvarado Michelle M Zhang Dongyu D Braithwaite Dejana D Guo Yi Y Bian Jiang J

Lung cancer (Amsterdam, Netherlands) 20220104

<h4>Introduction</h4>Although the National Lung Screening Trial (NLST) has proven low-dose computed tomography (LDCT) is effective for lung cancer screening, little is known about complication rates from invasive diagnostic procedures (IDPs) after LDCT in real-world settings. In this study, we used the real-world data from a large clinical research network to estimate the complication rates associated with IDPs after LDCT.<h4>Methods</h4>Using 2014-2021 electronic health records and claims data ...[more]

PMID: 35124410

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Project description:ImportanceScreening for lung cancer has the potential to reduce mortality, but in addition to detecting aggressive tumors, screening will also detect indolent tumors that otherwise may not cause clinical symptoms. These overdiagnosis cases represent an important potential harm of screening because they incur additional cost, anxiety, and morbidity associated with cancer treatment.ObjectiveTo estimate overdiagnosis in the National Lung Screening Trial (NLST).Design, setting, and participantsWe used data from the NLST, a randomized trial comparing screening using low-dose computed tomography (LDCT) vs chest radiography (CXR) among 53 452 persons at high risk for lung cancer observed for 6.4 years, to estimate the excess number of lung cancers in the LDCT arm of the NLST compared with the CXR arm.Main outcomes and measuresWe calculated 2 measures of overdiagnosis: the probability that a lung cancer detected by screening with LDCT is an overdiagnosis (PS), defined as the excess lung cancers detected by LDCT divided by all lung cancers detected by screening in the LDCT arm; and the number of cases that were considered overdiagnosis relative to the number of persons needed to screen to prevent 1 death from lung cancer.ResultsDuring follow-up, 1089 lung cancers were reported in the LDCT arm and 969 in the CXR arm of the NLST. The probability is 18.5% (95% CI, 5.4%-30.6%) that any lung cancer detected by screening with LDCT was an overdiagnosis, 22.5% (95% CI, 9.7%-34.3%) that a non-small cell lung cancer detected by LDCT was an overdiagnosis, and 78.9% (95% CI, 62.2%-93.5%) that a bronchioalveolar lung cancer detected by LDCT was an overdiagnosis. The number of cases of overdiagnosis found among the 320 participants who would need to be screened in the NLST to prevent 1 death from lung cancer was 1.38.Conclusions and relevanceMore than 18% of all lung cancers detected by LDCT in the NLST seem to be indolent, and overdiagnosis should be considered when describing the risks of LDCT screening for lung cancer.

Project description:ObjectiveTo evaluate the diagnostic performance of Ultra-Low-Dose Chest CT (ULD CT) for the detection of any asbestos-related lesions (primary endpoint) and specific asbestos-related abnormalities, i.e. non-calcified and calcified pleural plaques, diffuse pleural thickening, asbestosis and significant lung nodules (secondary endpoints).Material and methods55 male patients (55.7±8.1 years old) with occupational asbestos exposure for at least 15 years and where CT screening was indicated were prospectively included. They all underwent a standard unenhanced chest CT (120kV, automated tube current modulation), considered as the reference, and an ULD CT (135kV, 10mA), both with iterative reconstruction. Two chest radiologists independently and blindly read the examinations, following a detailed protocol. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy and error rate of ULD CT were calculated using the exact method of Pearson with a confidence interval of 95%.ResultsRadiation dose was 17.9±1.2mGy.cm (0.25mSv) for the ULD-CT versus 288.8 ±151mGy.cm (4mSv); p <2.2e-16. Prevalence of abnormalities was 20%. The ULD CT's diagnostic performance in joint reading was high for the primary endpoint (sensitivity = 90.9%, specificity = 100%, positive predictive value = 100%, negative predictive value = 97.8%), high for lung nodules, diffuse pleural thickening and calcified pleural plaques (sensitivity, specificity, PPV and NPV = 100%) and fair for asbestosis (sensitivity = 75%, specificity = 100%, PPV = 00%, NPV = 98.1%). Intra-reader accuracy between the ULD CT and the reference CT for the primary endpoint was 98% for the senior and 100% for the junior radiologist. Inter-reader agreement for the primary endpoint was almost perfect (Cohen's Kappa of 0.81).ConclusionULD CT in the screening of asbestos exposure related diseases has 90.9% sensitivity and 100% specificity, and could therefore be proposed as a first line examination.

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Project description:ImportanceDespite the recommendations of lung cancer screening guidelines and the evidence supporting the effectiveness of population-based lung screening, a common barrier to effective lung cancer screening is that the participation rates of low-dose computed tomography (LDCT) screening among individuals with the highest risk are not large. There are limited data from clinical practice regarding whether opportunistic LDCT screening is associated with reduced lung-cancer mortality.ObjectiveTo evaluate whether opportunistic LDCT screening is associated with improved prognosis among adults with lung cancer in mainland China.Design, setting, and participantsThis cohort study included patients diagnosed with lung cancer at Weihai Municipal Hospital Healthcare Group, Weihai City, China, from 2016 to 2021. Data were analyzed from January 2022 to February 2023.ExposuresData collected included demographic indicators, tumor characteristics, comorbidities, blood indexes, and treatment information. Patients were classified into screened and nonscreened groups on the basis of whether or not their lung cancer diagnosis occurred through opportunistic screening.Main outcomes and measuresFollow-up outcome indicators included lung cancer-specific mortality and all-cause mortality. Propensity score matching (PSM) was adopted to account for potential imbalanced factors between groups. The associations between LDCT screening and outcomes were analyzed using Cox regression models based on the matched data. Propensity score regression adjustment and inverse probability treatment weighting were used for sensitivity analysis.ResultsA total of 5234 patients (mean [SD] baseline age, 61.8 [9.8] years; 2518 [48.1%] female) with complete opportunistic screening information were included in the analytical sample, with 2251 patients (42.91%) receiving their lung cancer diagnosis through opportunistic screening. After 1:1 PSM, 2788 patients (1394 in each group) were finally included. The baseline characteristics of the matched patients were balanced between groups. Opportunistic screening with LDCT was associated with a 49% lower risk of lung cancer death (HR, 0.51; 95% CI, 0.42-0.62) and 46% lower risk of all-cause death (HR, 0.54; 95% CI, 0.45-0.64).Conclusions and relevanceIn this cohort study of patients with lung cancer, opportunistic lung cancer screening with LDCT was associated with lower lung cancer mortality and all-cause mortality. These findings suggest that opportunistic screening is an important supplement to population screening to improve prognosis of adults with lung cancer.

Dataset Information

Procedural complications associated with invasive diagnostic procedures after lung cancer screening with low-dose computed tomography.

Introduction

Methods

Results

Conclusions

Publications

Procedural complications associated with invasive diagnostic procedures after lung cancer screening with low-dose computed tomography.

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