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Question clinique
What is the rate of follow-up imaging and procedures in patients who undergo screening for lung cancer using low-dose computed tomography in a real-world setting?
L’Essentiel
Following community screening for lung cancer, the rates of follow-up imaging were lower but the rates of some invasive follow-up tests were higher than in a matched cohort of patients who were not screened. Although the evidence mounts that lung cancer screening with low-dose computed tomography (LDCT) reduces both disease-specific and all-cause mortality, it is important to remain vigilant about harms. 2b
Référence
Plan de l'etude: Cohort (retrospective)
Financement: Govt+Foundation
Cadre: Population-based
Sommaire
These authors used a national database of commercially insured patients to identify persons 55 to 80 years old (matching the US Preventive Services Task Force recommendation for lung cancer screening) who had undergone LDCT in 2016. They also identified a cohort matched by age, sex, and number of comorbidities who did not undergo LDCT to establish the baseline number of these procedures. They then looked for any imaging of the chest (CT, positron emission tomography [PET], or magnetic resonance imaging [MRI]) or any procedures (biopsies, endoscopic procedures, or thoracotomy) that were potentially triggered by follow-up of an abnormal finding on screening LDCT. If someone had more than one of the same test during the year, they were only counted once toward the percentage requiring imaging. The group of 11,520 participants were largely younger than 70 years and were evenly split between men and women. After adjusting using the control group, the rate of any imaging was 17.7%, including 13.8% diagnostic chest CT, 4% LDCT, and 0.13% PET or MRI. Diagnostic procedures included bronchoscopy (2%), percutaneous biopsy (1.3%), thoracoscopy (0.94%), and mediastinoscopy (0.23%); 0.38% underwent thoracotomy. The key comparison is with the National Lung Screening Trial (NLST): Are outcomes in the community as favorable? In the NLST, 21.7% had additional imaging, higher than in this study. However, rates of bronchoscopy (1.2%), percutaneous biopsy (0.6%), and thoracoscopy (0.3%) were lower in the NLST, but the rate of thoracotomy was higher (0.8%).
Reviewer
Mark H. Ebell, MD, MS
Professor
University of Georgia
Athens, GA