TY - JOUR
T1 - Results of the two incidence screenings in the National Lung Screening Trial
AU - Aberle, Denise R
AU - DeMello, Sarah
AU - Berg, Christine D
AU - Black, William C
AU - Brewer, Brenda
AU - Church, Timothy R
AU - Clingan, Kathy L
AU - Duan, Fenghai
AU - Fagerstrom, Richard M
AU - Gareen, Ilana F
AU - Gatsonis, Constantine A
AU - Gierada, David S
AU - Jain, Amanda
AU - Jones, Gordon C
AU - Mahon, Irene
AU - Marcus, Pamela M
AU - Rathmell, Joshua M
AU - Sicks, JoRean
AU - National Lung Screening Trial Research Team
AU - Munden, Reginald F.
PY - 2013/9/5
Y1 - 2013/9/5
N2 - BACKGROUND: The National Lung Screening Trial was conducted to determine whether three annual screenings (rounds T0, T1, and T2) with low-dose helical computed tomography (CT), as compared with chest radiography, could reduce mortality from lung cancer. We present detailed findings from the first two incidence screenings (rounds T1 and T2).METHODS: We evaluated the rate of adherence of the participants to the screening protocol, the results of screening and downstream diagnostic tests, features of the lung-cancer cases, and first-line treatments, and we estimated the performance characteristics of both screening methods.RESULTS: At the T1 and T2 rounds, positive screening results were observed in 27.9% and 16.8% of participants in the low-dose CT group and in 6.2% and 5.0% of participants in the radiography group, respectively. In the low-dose CT group, the sensitivity was 94.4%, the specificity was 72.6%, the positive predictive value was 2.4%, and the negative predictive value was 99.9% at T1; at T2, the positive predictive value increased to 5.2%. In the radiography group, the sensitivity was 59.6%, the specificity was 94.1%, the positive predictive value was 4.4%, and the negative predictive value was 99.8% at T1; both the sensitivity and the positive predictive value increased at T2. Among lung cancers of known stage, 87 (47.5%) were stage IA and 57 (31.1%) were stage III or IV in the low-dose CT group at T1; in the radiography group, 31 (23.5%) were stage IA and 78 (59.1%) were stage III or IV at T1. These differences in stage distribution between groups persisted at T2.CONCLUSIONS: Low-dose CT was more sensitive in detecting early-stage lung cancers, but its measured positive predictive value was lower than that of radiography. As compared with radiography, the two annual incidence screenings with low-dose CT resulted in a decrease in the number of advanced-stage cancers diagnosed and an increase in the number of early-stage lung cancers diagnosed. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.).
AB - BACKGROUND: The National Lung Screening Trial was conducted to determine whether three annual screenings (rounds T0, T1, and T2) with low-dose helical computed tomography (CT), as compared with chest radiography, could reduce mortality from lung cancer. We present detailed findings from the first two incidence screenings (rounds T1 and T2).METHODS: We evaluated the rate of adherence of the participants to the screening protocol, the results of screening and downstream diagnostic tests, features of the lung-cancer cases, and first-line treatments, and we estimated the performance characteristics of both screening methods.RESULTS: At the T1 and T2 rounds, positive screening results were observed in 27.9% and 16.8% of participants in the low-dose CT group and in 6.2% and 5.0% of participants in the radiography group, respectively. In the low-dose CT group, the sensitivity was 94.4%, the specificity was 72.6%, the positive predictive value was 2.4%, and the negative predictive value was 99.9% at T1; at T2, the positive predictive value increased to 5.2%. In the radiography group, the sensitivity was 59.6%, the specificity was 94.1%, the positive predictive value was 4.4%, and the negative predictive value was 99.8% at T1; both the sensitivity and the positive predictive value increased at T2. Among lung cancers of known stage, 87 (47.5%) were stage IA and 57 (31.1%) were stage III or IV in the low-dose CT group at T1; in the radiography group, 31 (23.5%) were stage IA and 78 (59.1%) were stage III or IV at T1. These differences in stage distribution between groups persisted at T2.CONCLUSIONS: Low-dose CT was more sensitive in detecting early-stage lung cancers, but its measured positive predictive value was lower than that of radiography. As compared with radiography, the two annual incidence screenings with low-dose CT resulted in a decrease in the number of advanced-stage cancers diagnosed and an increase in the number of early-stage lung cancers diagnosed. (Funded by the National Cancer Institute; NLST ClinicalTrials.gov number, NCT00047385.).
KW - Early Detection of Cancer
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Incidence
KW - Lung
KW - Lung Neoplasms
KW - Male
KW - Middle Aged
KW - Multiple Pulmonary Nodules
KW - Predictive Value of Tests
KW - Radiography, Thoracic
KW - Sensitivity and Specificity
KW - Solitary Pulmonary Nodule
KW - Tomography, Spiral Computed
U2 - 10.1056/NEJMoa1208962
DO - 10.1056/NEJMoa1208962
M3 - Article
C2 - 24004119
VL - 369
SP - 920
EP - 931
JO - New England Journal of Medicine
JF - New England Journal of Medicine
SN - 0028-4793
IS - 10
ER -