The decision to biopsy in a lung cancer screening program: Potential impact of risk calculators.

Publication Title

Journal of medical screening

Authors

Christopher R Gilbert, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA.
Alexander S Carlson
Candice L. Wilshire, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, 1101 Madison Street, Suite 900, Seattle, WA, 98104, USA.Follow
Ralph W Aye, Division of Thoracic Surgery, Swedish Medical Center and Cancer Institute, Seattle, WashingtonFollow
Alexander S Farivar, Division of Thoracic Surgery, Swedish Cancer Institute, 1101 Madison Street Suite 900, Seattle, WA 98104, USA.Follow
Adam J Bograd, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA.Follow
Jed A Gorden, Division of Thoracic Surgery and Interventional Pulmonology, Swedish Cancer Institute, Seattle, WA, USA.Follow

Document Type

Article

Publication Date

11-12-2018

Keywords

Lung cancer screening; lung cancer screening outcomes; malignancy risk calculator; multidisciplinary risk assessment

Abstract

OBJECTIVE: The National Lung Screening Trial demonstrated the benefits of lung cancer screening, but the potential high incidence of unnecessary invasive testing for ultimately benign radiologic findings causes concern. We aimed to review current biopsy patterns and outcomes in our community-based program, and retrospectively apply malignancy prediction models in a lung cancer screening population, to identify the potential impact these calculators could have on biopsy decisions.

METHODS: Retrospective review of lung cancer-screening program participants from 2013 to 2016. Demographic, biopsy, and outcome data were collected. Malignancy risk calculators were retrospectively applied and results compared in patients with positive imaging findings.

RESULTS: From 520 individuals enrolled in the screening program, pulmonary nodule(s) ≥6 mm were identified in 166, with biopsy in 30. Malignancy risk probabilities were significantly higher (Brock p < 0.00001; Mayo p < 0.00001) in those undergoing diagnostic sampling than those not undergoing sampling. However, there was no difference in the Brock ( p = 0.912) or Mayo ( p = 0.435) calculators when discriminating a final diagnosis of cancer from not cancer in those undergoing sampling.

CONCLUSIONS: In our screening program, 5.7% of individuals undergo invasive testing, comparable with the National Lung Screening Trial (6.1%). Both Brock and Mayo calculators perform well in indicating who may be at risk of malignancy, based on clinical and radiologic factors. However, in our invasive testing group, the Brock and Mayo calculators and Lung Cancer Screening Program clinical assessment all lacked clarity in distinguishing individuals who have a cancer from those with a benign abnormality.

Area of Special Interest

Cancer

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery

Specialty/Research Institute

Pulmonary Medicine

DOI

10.1177/0969141318811362