Journal
NEW ENGLAND JOURNAL OF MEDICINE
Volume 361, Issue 23, Pages 2221-2229Publisher
MASSACHUSETTS MEDICAL SOC
DOI: 10.1056/NEJMoa0906085
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Funding
- Zorg Onderzoek Nederland-Medische Wetenschappen
- KWF Kankerbestrijding
- Stichting Centraal Fonds Reserves van Voormalig Vrijwillige Ziekenfondsverzekeringen
- G. Ph. Verhagen Foundation
- Rotterdam Oncologic Thoracic Study Group
- Erasmus Trust
- Foundation against Cancer
- Flemish League against Cancer
- Lokaal Gezondheids Overleg (LOGO) Leuven and Hageland
- Eli Lilly
- Roche Pharmaceuticals
- Roche Diagnostics
- Mundipharma
- Novartis
- Utrecht University
- GlaxoSmithKline
- Nycomed
- AstraZeneca
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BACKGROUND The use of multidetector computed tomography (CT) in lung-cancer screening trials involving subjects with an increased risk of lung cancer has highlighted the problem for the clinician of deciding on the best course of action when noncalcified pulmonary nodules are detected by CT. METHODS A total of 7557 participants underwent CT screening in years 1, 2, and 4 of a randomized trial of lung-cancer screening. We used software to evaluate a noncalcified nodule according to its volume or volume-doubling time. Growth was defined as an increase in volume of at least 25% between two scans. The first-round screening test was considered to be negative if the volume of a nodule was less than 50 mm(3), if it was 50 to 500 mm3 but had not grown by the time of the 3-month follow-up CT, or if, in the case of those that had grown, the volume-doubling time was 400 days or more. RESULTS In the first and second rounds of screening, 2.6% and 1.8% of the participants, respectively, had a positive test result. In round one, the sensitivity of the screen was 94.6% (95% confidence interval [CI], 86.5 to 98.0) and the negative predictive value 99.9% (95% CI, 99.9 to 100.0). In the 7361 subjects with a negative screening result in round one, 20 lung cancers were detected after 2 years of follow-up. CONCLUSIONS Among subjects at high risk for lung cancer who were screened in three rounds of CT scanning and in whom noncalcified pulmonary nodules were evaluated according to volume and volume-doubling time, the chances of finding lung cancer 1 and 2 years after a negative first-round test were 1 in 1000 and 3 in 1000, respectively. (Current Controlled Trials number, ISRCTN63545820.)
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