Relationship between nodule count and lung cancer probability in baseline CT lung cancer screening: The NELSON study. (November 2017)

• Record Type: Journal Article
• Authors: Heuvelmans, Marjolein A; Walter, Joan E; Peters, Robin B; Bock, Geertruida H de; Yousaf-Khan, Uraujh; Aalst, Carlijn M van der; Groen, Harry J M; Nackaerts, Kristiaan; Ooijen, Peter MA van; Koning, Harry J de; Oudkerk, Matthijs; Vliegenthart, Rozemarijn
• Is Part Of: Lung cancer. Volume 113(2017)
• Page Start: 45
• Page End: 50
• Publication Date: 2017-11
• Subjects: CT computed tomography -- CI confidence interval -- IQR inter-quartile range -- NELSON Dutch-Belgian randomized lung cancer screening trial -- NLST National Lung Screening Trial -- PanCan Pan-Canadian Early Detection of Lung Cancer Study; Lung neoplasms -- Pulmonary nodule -- Computed tomography -- Mass screening; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2017.08.023
• Languages: English
• ISSNs: 0169-5002

Abstract

Highlights: Nearly half of screenees with lung nodules have more than one nodule. At baseline, malignancy was mostly detected in the largest nodule (63/65 cancers). Lung cancer probability does not significantly change with number of nodules. Baseline nodule count will not help to differentiate benign and malignant nodules. Each nodule found in lung cancer screenees should be assessed separately. Abstract: Objectives: To explore the relationship between nodule count and lung cancer probability in baseline low-dose CT lung cancer screening. Materials and Methods: Included were participants from the NELSON trial with at least one baseline nodule (3392 participants [45% of screen-group], 7258 nodules). We determined nodule count per participant. Malignancy was confirmed by histology. Nodules not diagnosed as screen-detected or interval cancer until the end of the fourth screening round were regarded as benign. We compared lung cancer probability per nodule count category. Results: 1746 (51.5%) participants had one nodule, 800 (23.6%) had two nodules, 354 (10.4%) had three nodules, 191 (5.6%) had four nodules, and 301 (8.9%) had > 4 nodules. Lung cancer in a baseline nodule was diagnosed in 134 participants (139 cancers; 4.0%). Median nodule count in participants with only benign nodules was 1 (Inter-quartile range [IQR]: 1–2), and 2 (IQR 1–3) in participants with lung cancer (p = NS). At baseline, malignancy was detected mostly in the largest nodule (64/66 cancers). Lung cancer probability was 62/1746 (3.6%) in case a participant had one nodule, 33/800 (4.1%) for two nodules, 17/354 (4.8%) for three nodules, 12/191 (6.3%) for four nodules and 10/301 (3.3%) for > 4 nodules (p = NS). Conclusion: In baseline lung cancer CT screening, half of participants with lung nodules have more than one nodule. Lung cancer probability does not significantly change with the number of nodules. Baseline nodule count will not help to differentiate between benign and malignant nodules. Each nodule found in lung cancer screening should be assessed separately independent of the presence of other nodules.