Two-Year Results of a NCCN Guideline–Based CT Lung Screening Program

Purpose/Objective(s)To report 2 year results of a National Comprehensive Cancer Network (NCCN) Guideline-based CT lung screening program with comparison to results from the National Lung Screening Trial (NLST).Materials/MethodsWe retrospectively reviewed results of CT lung screening exams performed from 1/2012 through 12/2013. All exams were performed on 64+ MDCT scanners at 100 kV and 30-70 mA. Patients were required to be asymptomatic, fulfill the NCCN high-risk criteria for lung cancer, and have an order for screening from a health care provider. Patients with a diagnosis of lung cancer within the past 5 years or known metastatic disease were excluded. Credentialed radiologists using the structured reporting system, “LungRADS,” performed image interpretation. A positive exam was defined as a solid nodule > 4 mm, a groundglass nodule > 5 mm, or a mediastinal/hilar lymph node > 1 cm not stable for more than 2 years. Clinically significant incidental findings including findings suspicious for pulmonary infection were recorded.ResultsA total of 2079/2391 (88%) of self (26%) or MD (74%) referred individuals met NCCN high-risk criteria for lung screening and 1760/2079 (85%) underwent a prevalence CT lung screening exam during the study interval. Four hundred eighty-one of 1760 (27.3%) were positive (27.3% in the NLST). One hundred eight of 1760 (6.1%) had at least 1 clinically significant incidental finding (10.2% in the NLST). One hundred fourteen of 1760 (6.5%) had findings suspicious for pulmonary infection or inflammation (not reported in the NLST). Twenty-three of 1328 (1.6%) with complete follow-up were diagnosed with lung cancer with average follow-up of 12.5 months (1% in the NLST). Seventy-four percent of malignancies detected were stage I or II (70% in the NLST). Three of 23(13%) were treated with stereotactic body radiation therapy for presumed lung cancer in patients unable to undergo biopsy.ConclusionsOur NCCN Guideline-based clinical CT lung screening program closely reproduced several key metrics reported by the NLST supporting the theory that the lung cancer specific mortality benefit observed in the NLST may be achievable in clinical practice. Purpose/Objective(s)To report 2 year results of a National Comprehensive Cancer Network (NCCN) Guideline-based CT lung screening program with comparison to results from the National Lung Screening Trial (NLST). To report 2 year results of a National Comprehensive Cancer Network (NCCN) Guideline-based CT lung screening program with comparison to results from the National Lung Screening Trial (NLST). Materials/MethodsWe retrospectively reviewed results of CT lung screening exams performed from 1/2012 through 12/2013. All exams were performed on 64+ MDCT scanners at 100 kV and 30-70 mA. Patients were required to be asymptomatic, fulfill the NCCN high-risk criteria for lung cancer, and have an order for screening from a health care provider. Patients with a diagnosis of lung cancer within the past 5 years or known metastatic disease were excluded. Credentialed radiologists using the structured reporting system, “LungRADS,” performed image interpretation. A positive exam was defined as a solid nodule > 4 mm, a groundglass nodule > 5 mm, or a mediastinal/hilar lymph node > 1 cm not stable for more than 2 years. Clinically significant incidental findings including findings suspicious for pulmonary infection were recorded. We retrospectively reviewed results of CT lung screening exams performed from 1/2012 through 12/2013. All exams were performed on 64+ MDCT scanners at 100 kV and 30-70 mA. Patients were required to be asymptomatic, fulfill the NCCN high-risk criteria for lung cancer, and have an order for screening from a health care provider. Patients with a diagnosis of lung cancer within the past 5 years or known metastatic disease were excluded. Credentialed radiologists using the structured reporting system, “LungRADS,” performed image interpretation. A positive exam was defined as a solid nodule > 4 mm, a groundglass nodule > 5 mm, or a mediastinal/hilar lymph node > 1 cm not stable for more than 2 years. Clinically significant incidental findings including findings suspicious for pulmonary infection were recorded. ResultsA total of 2079/2391 (88%) of self (26%) or MD (74%) referred individuals met NCCN high-risk criteria for lung screening and 1760/2079 (85%) underwent a prevalence CT lung screening exam during the study interval. Four hundred eighty-one of 1760 (27.3%) were positive (27.3% in the NLST). One hundred eight of 1760 (6.1%) had at least 1 clinically significant incidental finding (10.2% in the NLST). One hundred fourteen of 1760 (6.5%) had findings suspicious for pulmonary infection or inflammation (not reported in the NLST). Twenty-three of 1328 (1.6%) with complete follow-up were diagnosed with lung cancer with average follow-up of 12.5 months (1% in the NLST). Seventy-four percent of malignancies detected were stage I or II (70% in the NLST). Three of 23(13%) were treated with stereotactic body radiation therapy for presumed lung cancer in patients unable to undergo biopsy. A total of 2079/2391 (88%) of self (26%) or MD (74%) referred individuals met NCCN high-risk criteria for lung screening and 1760/2079 (85%) underwent a prevalence CT lung screening exam during the study interval. Four hundred eighty-one of 1760 (27.3%) were positive (27.3% in the NLST). One hundred eight of 1760 (6.1%) had at least 1 clinically significant incidental finding (10.2% in the NLST). One hundred fourteen of 1760 (6.5%) had findings suspicious for pulmonary infection or inflammation (not reported in the NLST). Twenty-three of 1328 (1.6%) with complete follow-up were diagnosed with lung cancer with average follow-up of 12.5 months (1% in the NLST). Seventy-four percent of malignancies detected were stage I or II (70% in the NLST). Three of 23(13%) were treated with stereotactic body radiation therapy for presumed lung cancer in patients unable to undergo biopsy. ConclusionsOur NCCN Guideline-based clinical CT lung screening program closely reproduced several key metrics reported by the NLST supporting the theory that the lung cancer specific mortality benefit observed in the NLST may be achievable in clinical practice. Our NCCN Guideline-based clinical CT lung screening program closely reproduced several key metrics reported by the NLST supporting the theory that the lung cancer specific mortality benefit observed in the NLST may be achievable in clinical practice.