Interval lung cancer after a negative CT screening examination: CT findings and outcomes in National Lung Screening Trial participants

• Published in: European radiology Vol. 27; no. 8; pp. 3249 - 3256
• Main Authors: Gierada, David S., Pinsky, Paul F., Duan, Fenghai, Garg, Kavita, Hart, Eric M., Kazerooni, Ella A., Nath, Hrudaya, Watts, Jubal R., Aberle, Denise R.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2017; Springer Nature B.V
• Subjects: Abnormalities; Aged; Cancer; Chest; Classification; Computed tomography; Criteria; Diagnosis; Diagnostic Errors - prevention & control; Diagnostic Radiology; Early Detection of Cancer - standards; Female; Humans; Imaging; Internal Medicine; Interventional Radiology; Lesions; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung nodules; Male; Mass Screening - standards; Medical diagnosis; Medical screening; Medicine; Medicine & Public Health; Middle Aged; Multiple Pulmonary Nodules - diagnostic imaging; Neuroradiology; Nodules; Patients; Radiology; Retrospective Studies; Tomography, X-Ray Computed; Ultrasound; Diagnostic errors; Computed tomography; False-negative reactions; Mass screening; Lung cancer
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-016-4705-8

Objectives This study retrospectively analyses the screening CT examinations and outcomes of the National Lung Screening Trial (NLST) participants who had interval lung cancer diagnosed within 1 year after a negative CT screen and before the next annual screen. Methods The screening CTs of all 44 participants diagnosed with interval lung cancer (cases) were matched with negative CT screens of participants who did not develop lung cancer (controls). A majority consensus process was used to classify each CT screen as positive or negative according to the NLST criteria and to estimate the likelihood that any abnormalities detected retrospectively were due to lung cancer. Results By retrospective review, 40/44 cases (91%) and 17/44 controls (39%) met the NLST criteria for a positive screen ( P  < 0.001). Cases had higher estimated likelihood of lung cancer ( P  < 0.001). Abnormalities included pulmonary nodules ≥4 mm ( n  = 16), mediastinal ( n  = 8) and hilar ( n  = 6) masses, and bronchial lesions ( n  = 6). Cancers were stage III or IV at diagnosis in 32/44 cases (73%); 37/44 patients (84%) died of lung cancer, compared to 225/649 (35%) for all screen-detected cancers ( P  < 0.0001). Conclusion Most cases met the NLST criteria for a positive screen. Awareness of missed abnormalities and interpretation errors may aid lung cancer identification in CT screening. Key points • Lung cancer within a year of a negative CT screen was rare. • Abnormalities likely due to lung cancer were identified retrospectively in most patients. • Awareness of error types may help identify lung cancer sooner.