After community lung cancer screening, rates of follow-up imaging are lower but the rates of some procedures are higher

Reference

Nishi SPE, Zhou J, Okereke I, Kuo YF, Goodwin J. Use of imaging and diagnostic procedures after low-dose CT screening for lung cancer. Chest 2020;157(2):427-434.

Synopsis

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%).