Volumetric lung cancer screening reduces unnecessary low-dose computed tomography scans: results from a single-centre prospective trial on 4,119 subjects

PurposeTo compare low-dose computed tomography (LDCT) outcome and volume-doubling time (VDT) derived from measured volume (MV) and estimated volume (EV) of pulmonary nodules (PN) detected in a single-centre lung cancer screening trial. Materials and MethodsMV, EV and VDT were obtained for prevalent pulmonary nodules detected at the baseline round of the bioMILD trial. LDCT outcome (based on bioMILD thresholds) and VDT categories were simulated on a PN- and a screenees-based analysis. Weighted Cohens kappa test was used to assess the agreement between diagnostic categories as per MV and EV. Results1,583 screenees displayed 2,715 pulmonary nodules. On a PN-based analysis 40.1% PNs would have been included in different LDCT categories if measured by MV or EV. Agreement between MV and EV was moderate ({kappa} = 0.49) and fair ({kappa} = 0.37) for LDCT outcome and VDT categories, respectively. On a screenees-based analysis, 46% pulmonary nodules would have been included in different LDCT categories if measured by MV or EV. Agreement between MV and EV was moderate ({kappa} = 0.52) and fair ({kappa} = 0.34) for LDCT outcome and VDT categories, respectively. ConclusionsWithin a simulated lung cancer screening based on recommendation by estimated volumetry, the number of LDCT performed for the evaluation of pulmonary nodules would be higher as compared to the prospective volumetric management.