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Clinical Significance of Lung-RADS Category 3 Lesions in the National Lung Screening Trial.

Publication ,  Journal Article
Han, DH; Duan, F; Wu, Y; Goo, JM; Kim, HY; Patz, EF
Published in: J Thorac Oncol
July 2021

INTRODUCTION: To determine the clinical significance of category 3 (CAT3) abnormalities and the necessity of a 6-month follow-up computed tomography (CT). We also explored features associated with increased lung cancer risk. METHODS: From the National Lung Screening Trial database, we identified participants with CAT3 lesions at prevalence screen. Rates of lung cancer and lung cancer-specific deaths (LSDs) were compared between those who underwent first follow-up CT before 6 months (early diagnostic group) and those who underwent annual screening (annual diagnostic group). We estimated the change in LSD if the 6-month CT was eliminated. Regression analysis was performed to identify features associated with participants with CAT3 who developed lung cancer. RESULTS: A total of 1763 CAT3s were identified (6.6% of all participants who had low-dose CT), with 108 lung cancers (6.1%) and 41 LSDs (2.3%) in a 7-year period. Rates of lung cancer (7.5% versus 3.1%) and LSD (4.0% versus 1.0%) were higher in the early diagnostic group than in the annual diagnostic group. We estimated an increase in LSD of 0.6% of all participants with CAT3 (24.4% of all LSDs) if the 6-month CT was not performed. Multivariate regression analysis found that increased age, emphysema, and a part-solid nodule greater than 5 mm were associated with participants with CAT3 who developed lung cancer. CONCLUSIONS: CAT3 lesions are uncommon, and eliminating the 6-month CT would potentially increase LSD by 0.6% of all patients with CAT3. Age, emphysema, and part-solid nodule greater than 5 mm may be useful in risk prediction models to determine which participants with CAT3 are more likely to develop lung cancer and suggest which patients may need more intense follow-up.

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Published In

J Thorac Oncol

DOI

EISSN

1556-1380

Publication Date

July 2021

Volume

16

Issue

7

Start / End Page

1118 / 1126

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Oncology & Carcinogenesis
  • Mass Screening
  • Lung Neoplasms
  • Lung
  • Humans
  • Early Detection of Cancer
  • 3211 Oncology and carcinogenesis
  • 3202 Clinical sciences
  • 1112 Oncology and Carcinogenesis
 

Citation

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Han, D. H., Duan, F., Wu, Y., Goo, J. M., Kim, H. Y., & Patz, E. F. (2021). Clinical Significance of Lung-RADS Category 3 Lesions in the National Lung Screening Trial. J Thorac Oncol, 16(7), 1118–1126. https://doi.org/10.1016/j.jtho.2021.02.025
Han, Dae Hee, Fenghai Duan, Yanning Wu, Jin Mo Goo, Hyae Young Kim, and Edward F. Patz. “Clinical Significance of Lung-RADS Category 3 Lesions in the National Lung Screening Trial.J Thorac Oncol 16, no. 7 (July 2021): 1118–26. https://doi.org/10.1016/j.jtho.2021.02.025.
Han DH, Duan F, Wu Y, Goo JM, Kim HY, Patz EF. Clinical Significance of Lung-RADS Category 3 Lesions in the National Lung Screening Trial. J Thorac Oncol. 2021 Jul;16(7):1118–26.
Han, Dae Hee, et al. “Clinical Significance of Lung-RADS Category 3 Lesions in the National Lung Screening Trial.J Thorac Oncol, vol. 16, no. 7, July 2021, pp. 1118–26. Pubmed, doi:10.1016/j.jtho.2021.02.025.
Han DH, Duan F, Wu Y, Goo JM, Kim HY, Patz EF. Clinical Significance of Lung-RADS Category 3 Lesions in the National Lung Screening Trial. J Thorac Oncol. 2021 Jul;16(7):1118–1126.
Journal cover image

Published In

J Thorac Oncol

DOI

EISSN

1556-1380

Publication Date

July 2021

Volume

16

Issue

7

Start / End Page

1118 / 1126

Location

United States

Related Subject Headings

  • Tomography, X-Ray Computed
  • Oncology & Carcinogenesis
  • Mass Screening
  • Lung Neoplasms
  • Lung
  • Humans
  • Early Detection of Cancer
  • 3211 Oncology and carcinogenesis
  • 3202 Clinical sciences
  • 1112 Oncology and Carcinogenesis