Management of Lung Nodules Detected by Volume CT Scanning

• Published in: The New England journal of medicine Vol. 361; no. 23; pp. 2221 - 2229
• Main Authors: van Klaveren, Rob J, Oudkerk, Matthijs, Prokop, Mathias, Scholten, Ernst T, Nackaerts, Kristiaan, Vernhout, Rene, van Iersel, Carola A, van den Bergh, Karien A.M, van 't Westeinde, Susan, van der Aalst, Carlijn, Thunnissen, Erik, Xu, Dong Ming, Wang, Ying, Zhao, Yingru, Gietema, Hester A, de Hoop, Bart-Jan, Groen, Harry J.M, de Bock, Geertruida H, van Ooijen, Peter, Weenink, Carla, Verschakelen, Johny, Lammers, Jan-Willem J, Timens, Wim, Willebrand, Dik, Vink, Aryan, Mali, Willem, de Koning, Harry J
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 03.12.2009
• Subjects: Biological and medical sciences; Follow-Up Studies; General aspects; Humans; Investigative techniques of respiratory function; Investigative techniques, diagnostic techniques (general aspects); Lung - diagnostic imaging; Lung Neoplasms - diagnostic imaging; Measurement errors; Medical sciences; Middle Aged; Mortality; Pneumology; Prognosis; Risk Factors; Sensitivity and Specificity; Software; Solitary Pulmonary Nodule - diagnostic imaging; Solitary Pulmonary Nodule - pathology; Tomography; Tomography, X-Ray Computed - methods; Tumor Burden; Tumors of the respiratory system and mediastinum; Medicine; Lung volume; Lung disease; Clinical management; Radiodiagnosis; Respiratory disease; Lung nodule; Medical imagery; Computerized axial tomography
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa0906085

Participants who were at an increased risk for lung cancer were enrolled in a trial to determine whether CT screening reduces mortality from lung cancer. In this study, volume measurements and volume doubling times were used to evaluate the noncalcified lung nodules that were detected by CT scanning at baseline and at years 1, 2, and 4 of the trial. With the use of these volumetric methods, the authors found that the chances of finding lung cancer by CT scanning 1 and 2 years after a negative baseline test were 1 in 1000 and 3 in 1000, respectively. With the use of volumetric methods, the authors found that the chances of finding lung cancer by CT scanning 1 and 2 years after a negative baseline test were 1 in 1000 and 3 in 1000, respectively. The use of multidetector computed tomography (CT) has increased the chance of finding noncalcified pulmonary nodules, 1 , 2 and as a result, clinicians often face the problem of deciding on the best course of action with respect to such nodules when they are found in asymptomatic subjects who have an increased risk for lung cancer. 3 This difficulty is especially evident in CT-based screening programs for lung cancer. The current practice is to refer participants in these programs for additional diagnostic evaluation if they have a noncalcified nodule that is larger than 5 mm in diameter. 4 – 9 In designing the Dutch–Belgian randomized . . .