Improving selection criteria for lung cancer screening. The potential role of emphysema

Am J Respir Crit Care Med. 2015 Apr 15;191(8):924-31. doi: 10.1164/rccm.201410-1848OC.

Abstract

Rationale: Lung cancer (LC) screening using low-dose chest computed tomography is now recommended in several guidelines using the National Lung Screening Trial (NLST) entry criteria (age, 55-74; ≥30 pack-years; tobacco cessation within the previous 15 yr for former smokers). Concerns exist about their lack of sensitivity.

Objectives: To evaluate the performance of NLST criteria in two different LC screening studies from Europe and the United States, and to explore the effect of using emphysema as a complementary criterion.

Methods: Participants from the Pamplona International Early Lung Action Detection Program (P-IELCAP; n = 3,061) and the Pittsburgh Lung Screening Study (PLuSS; n = 3,638) were considered. LC cumulative frequencies, incidence densities, and annual detection rates were calculated in three hypothetical cohorts, including subjects who met NLST criteria alone, those with computed tomography-detected emphysema, and those who met NLST criteria and/or had emphysema.

Measurements and main results: Thirty-six percent and 59% of P-IELCAP and PLuSS participants, respectively, met NLST criteria. Among these, higher LC incidence densities and detection rates were observed. However, applying NLST criteria to our original cohorts would miss as many as 39% of all LC. Annual screening of subjects meeting either NLST criteria or having emphysema detected most cancers (88% and 95% of incident LC of P-IELCAP and PLuSS, respectively) despite reducing the number of screened participants by as much as 52%.

Conclusions: LC screening based solely on NLST criteria could miss a significant number of LC cases. Combining NLST criteria and emphysema to select screening candidates results in higher LC detection rates and a lower number of cancers missed.

Keywords: National Lung Screening Trial; emphysema; low-dose computed tomography; lung cancer screening.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Comorbidity
  • Early Detection of Cancer / methods
  • Europe / epidemiology
  • Female
  • Humans
  • Incidence
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / epidemiology*
  • Male
  • Mass Screening / methods*
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Patient Selection*
  • Pulmonary Emphysema / diagnostic imaging*
  • Pulmonary Emphysema / epidemiology*
  • Tomography, X-Ray Computed / methods
  • Tomography, X-Ray Computed / statistics & numerical data
  • United States / epidemiology