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. 2021 Oct 31;18(16):3861-3869.
doi: 10.7150/ijms.64648. eCollection 2021.

The BUILT study: a single-center 5-year experience of Lung Cancer screening in Taiwan

Chih-Wei Wu  1   2 , Yen-Te Ku  3 , Chun-Yao Huang  1 , Po-Chun Hsieh  4 , Kun-Eng Lim  5 , I-Shiang Tzeng  6 , Chou-Chin Lan  1 , Yao-Kuang Wu  1 , Yi-Chiung Hsu  2
Affiliations

The BUILT study: a single-center 5-year experience of Lung Cancer screening in Taiwan

Chih-Wei Wu et al. Int J Med Sci. .

Abstract

Background: There are no uniform guidelines on low-dose computed tomography (LDCT) follow-up in lung cancer screening. Few studies have analyzed the incidental abnormalities and role of tumor markers in lung cancer screening. The purpose of this study was to investigate the diagnostic performance of LDCT, optimal follow-up duration, incidental findings, and role of tumor markers in diagnosing lung cancer. Methods: We retrospectively analyzed subjects who underwent their first LDCT in Taipei Tzu Chi Hospital between September 1, 2015, and August 31, 2016. All chest CT scans until August 31, 2020, were recorded. A non-calcified nodule with a diameter ≥2 mm on LDCT was defined as a positive result. We extracted the data, including possible risk factors of lung cancer and follow-up outcomes. Results: A total of 1502 subjects were recruited. Of the 38 subjects who underwent biopsy, 31 had confirmed lung cancer. Lung cancer in all patients was diagnosed within 4 years. Univariate logistic regression analysis revealed that a family history of lung cancer in first-degree relatives and abnormal serum carcinoembryonic antigen (CEA) levels were the significant risk factors for lung cancer. A cumulative lung cancer incidence of 54.7 patients per 1000 person-years was determined solely via radiological follow-up. In total, 271 (18%) subjects exhibited incidental findings on baseline LDCT. Conclusion: The overall lung cancer detection rate in this study was 2.1% in the 5-year study period. A family history of lung cancer and abnormal serum CEA levels are important risk factors for lung cancer. A minimum of 4-year follow-up is required to track suspicious nodules. A purely radiological follow-up detects a high incidence of lung cancer.

Keywords: low dose CT; lung cancer; pulmonary nodule; screening.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
The study protocol. We enrolled subjects who received the baseline low-dose computed tomography (LDCT) scan from September 1, 2015 to August 31, 2016. The dates of all follow-up chest CT scans (LDCT or conventional CT) are recorded from September 1, 2015 to August 31, 2020.
Figure 2
Figure 2
The definition of follow-up duration. In the BUILT study, the follow-up length is the time from the baseline low-dose computed tomography (LDCT) scan to biopsy (Group A, B) or the last CT scan (Group C). The duration of clinical follow-up is included in the total follow-up length of the NLST and NELSON trial, but not in the BUILT study.
Figure 3
Figure 3
Flowchart of subjects' enrollment and diagnostic outcomes. Abbreviations: PNA, pneumonia.
Figure 4
Figure 4
The Kaplan-Meier plot of cumulative proportions of subjects with diagnosis. The date of diagnosis in Group C is the date of the last CT scan during the study period. The date of diagnosis for Groups A or B is the biopsy date.
See this image and copyright information in PMC

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