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. 2021 Dec;13(12):6855-6865.
doi: 10.21037/jtd-21-1312.

Comparison of National Comprehensive Cancer Network and European Position Statement protocols for nodule management in low-dose computed tomography lung cancer screening in a general Chinese population

Yihui Du #  1 , Yanju Li #  2 , Monique D Dorrius  1   3 , Grigory Sidorenkov  1 , Marleen Vonder  1 , Rozemarijn Vliegenthart  3 , Marjolein A Heuvelmans  1 , Xiaonan Cui  2 , Zhaoxiang Ye  2 , Geertruida H de Bock  1
Affiliations

Comparison of National Comprehensive Cancer Network and European Position Statement protocols for nodule management in low-dose computed tomography lung cancer screening in a general Chinese population

Yihui Du et al. J Thorac Dis. 2021 Dec.

Abstract

Background: Low-dose computed tomography (LDCT) lung cancer screening often refers individuals to unnecessary examinations. This study aims to compare the European Position Statement (EUPS) and National Comprehensive Cancer Network (NCCN) protocols in management of participants at baseline screening round.

Methods: LDCT lung cancer screening was prospectively performed in a Chinese asymptomatic population aged 40-74 years. A total of 1,000 consecutive baseline LDCT scans were read twice independently. All screen-detected lung nodules by the first reader were included. The first reader manually measured the diameter of lung nodules (NCCN protocol), and the second reader semi-automatically measured the volume and diameter (EUPS volume and diameter protocols). The protocols were used to classify the participants into three management groups: next screening round, short-term repeat LDCT scan and referral to a pulmonologist. Groups were compared using Wilcoxon test for paired samples. Number of lung cancers by protocols was provided.

Results: Of the 1,000 participants (61.4±6.7 years old), 168 lung nodules in 124 participants were visually detected and manually measured in the first reading, and re-measured semi-automatically. Applying the NCCN protocol, EUPS volume and diameter protocol, the proportion of referrals among all participants was 0.6%, 1.9%, and 1.4%, respectively. The proportion of short-term repeat scans was 4.5%, 9.7% and 4.5%, respectively. Among the 10 lung cancer patients, one would have been diagnosed earlier if the EUPS volume protocol would have been followed.

Conclusions: In a first round screening in a Chinese general population, the lower threshold for referral in the EUPS protocol as compared to the NCCN protocol, leads to more referrals to a pulmonologist, with the potential of earlier cancer diagnosis. The EUPS volume protocol recommends fewer participants to short-term repeat LDCT scan than the EUPS diameter protocol. Follow-up studies should show the impact of both protocols on (interval) cancer diagnosis.

Keywords: Lung nodule; diameter; low-dose computed tomography (LDCT); mass screening; volume.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/jtd-21-1312). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
CT image with manual diameter measurement (A) and semi-automated volume and diameter measurement (B). CT, computed tomography.
Figure 2
Figure 2
Management of screen-detected NCNs at initial LDCT scan in NCCN and EUPS protocols (6,7,9). *, EUPS proposed the volume thresholds for solid nodule only. In this study, the volume thresholds were also applied for part-solid nodules. NCNs, non-calcified nodules; LDCT, low-dose computed tomography; NCCN, National Comprehensive Cancer Network; EUPS, European Position Statement.
Figure 3
Figure 3
The actual management for all participants and lung cancer diagnosis until (including) the second round screening. *, suspected lung cancer according to the radiologist but without confirmation from histopathology. LDCT, low-dose computed tomography.
See this image and copyright information in PMC

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