Alain Tremblay1, Niloofar Taghizadeh2, John-Henry MacGregor3, Gavin Armstrong4, Michael S Bristow3, Lancia L Q Guo3, Carmen Lydell3, Raoul Pereira4, Andrew Lee3, Tracy Elliot3, Paul MacEachern2, Andrew Graham5, James A Dickinson6, Rommy Koetzler2, Stephen C Lam7, Huiming Yang8, Eric Lr Bédard9, Martin Tammemagi10, Paul Burrowes3. 1. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: atrembla@ucalgary.ca. 2. Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 3. Department of Diagnostic Imaging, Foothills Medical Center, Alberta Health Services, Calgary, Alberta, Canada. 4. Department of Diagnostic Imaging, Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada. 5. Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. 6. Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. 7. Department of Integrative Oncology, The British Columbia Cancer Research Center, Vancouver, British Columbia, Canada. 8. Alberta Health Services, Calgary, Alberta, Canada. 9. Division of Thoracic Surgery, Royal Alexandra Hospital, Edmonton, Alberta, Canada. 10. Brock University, St Catharines, Ontario, Canada.
Abstract
BACKGROUND: False-positive scans and resultant needless early recalls can increase harms and reduce cost-effectiveness of low-dose CT (LDCT) lung cancer screening. How LDCT scans are interpreted and classified may impact these metrics. METHODS: The Pan-Canadian Early Detection of Lung Cancer risk calculator was used to determine nodule risk of malignancy on baseline screening LDCTs in the Alberta Lung Cancer Screening Study, which were then classified according to Nodule Risk Classification (NRC) categories and ACR Lung Screening Reporting and Data System (Lung-RADS). Test performance characteristics and early recall rates were compared for each approach. RESULTS: In all, 775 baseline screens were analyzed. After a mean of 763 days (±203) of follow-up, lung cancer was detected in 22 participants (2.8%). No statistically significant differences in sensitivity, specificity, or area under the receiver operator characteristic curve occurred between the NRC and Lung-RADS nodule management approaches. Early recall rates were 9.2% and 9.3% for NRC and Lung-RADS, with the NRC unnecessarily recalling some ground glass nodules, and the Lung-RADS recalling many smaller solid nodules with low risk of malignancy. CONCLUSION: Performances of both the NRC and Lung-RADS in this cohort were very good with a trend to higher sensitivity for the NRC. Early recall rates were less than 10% with each approach, significantly lower than rates using the National Lung Screening Trial cutoffs. Further reductions in early recall rates without compromising sensitivity could be achieved by increasing the NRC threshold to 20% for ground glass nodules or by applying the nodule risk calculator with a 5% threshold to 6- to 10-mm solid nodules under Lung-RADS.
BACKGROUND: False-positive scans and resultant needless early recalls can increase harms and reduce cost-effectiveness of low-dose CT (LDCT) lung cancer screening. How LDCT scans are interpreted and classified may impact these metrics. METHODS: The Pan-Canadian Early Detection of Lung Cancer risk calculator was used to determine nodule risk of malignancy on baseline screening LDCTs in the Alberta Lung Cancer Screening Study, which were then classified according to Nodule Risk Classification (NRC) categories and ACR Lung Screening Reporting and Data System (Lung-RADS). Test performance characteristics and early recall rates were compared for each approach. RESULTS: In all, 775 baseline screens were analyzed. After a mean of 763 days (±203) of follow-up, lung cancer was detected in 22 participants (2.8%). No statistically significant differences in sensitivity, specificity, or area under the receiver operator characteristic curve occurred between the NRC and Lung-RADS nodule management approaches. Early recall rates were 9.2% and 9.3% for NRC and Lung-RADS, with the NRC unnecessarily recalling some ground glass nodules, and the Lung-RADS recalling many smaller solid nodules with low risk of malignancy. CONCLUSION: Performances of both the NRC and Lung-RADS in this cohort were very good with a trend to higher sensitivity for the NRC. Early recall rates were less than 10% with each approach, significantly lower than rates using the National Lung Screening Trial cutoffs. Further reductions in early recall rates without compromising sensitivity could be achieved by increasing the NRC threshold to 20% for ground glass nodules or by applying the nodule risk calculator with a 5% threshold to 6- to 10-mm solid nodules under Lung-RADS.
Authors: Alain Tremblay; Nicole Ezer; Paul Burrowes; John Henry MacGregor; Andrew Lee; Gavin A Armstrong; Raoul Pereira; Michael Bristow; Jana L Taylor; Paul MacEachern; Niloofar Taghizadeh; Rommy Koetzler; Eric Bedard Journal: BMC Med Imaging Date: 2022-06-11 Impact factor: 2.795
Authors: Martin C Tammemägi; Mamta Ruparel; Alain Tremblay; Renelle Myers; John Mayo; John Yee; Sukhinder Atkar-Khattra; Ren Yuan; Sonya Cressman; John English; Eric Bedard; Paul MacEachern; Paul Burrowes; Samantha L Quaife; Henry Marshall; Ian Yang; Rayleen Bowman; Linda Passmore; Annette McWilliams; Fraser Brims; Kuan Pin Lim; Lin Mo; Stephen Melsom; Bann Saffar; Mark Teh; Ramon Sheehan; Yijin Kuok; Renee Manser; Louis Irving; Daniel Steinfort; Mark McCusker; Diane Pascoe; Paul Fogarty; Emily Stone; David C L Lam; Ming-Yen Ng; Varut Vardhanabhuti; Christine D Berg; Rayjean J Hung; Samuel M Janes; Kwun Fong; Stephen Lam Journal: Lancet Oncol Date: 2021-12-11 Impact factor: 41.316
Authors: Alain Tremblay; Niloofar Taghizadeh; Paul MacEachern; Paul Burrowes; Andrew J Graham; Stephen C Lam; Huiming Yang; Rommy Koetzler; Martin C Tammemägi; Kathryn Taylor; Eric L R Bédard Journal: JTO Clin Res Rep Date: 2020-09-15
Authors: Nguyen Xuan Thanh; Truong-Minh Pham; Arianna Waye; Alain Tremblay; Huiming Yang; Michelle L Dean; Tracy Wasylak; Randeep Sangha; Douglas Stewart Journal: JTO Clin Res Rep Date: 2022-06-02