CT screening for lung cancer: the value of short-term CT follow-up.
BACKGROUND
Although CT screening for lung cancer results in a diagnosis of stage I > 80% of the time, benign noncalcified nodules are also found. We recognized that some nodules appeared to represent infectious bronchopneumonia or other inflammatory processes, as they resolved on follow-up CT, sometimes after antibiotic therapy. To determine the extent to which short-term CT radiographic follow-up might shorten the workup of nodules, we reviewed our experience with baseline and annual repeat CT screenings performed subsequent to the original Early Lung Cancer Action Project series.


METHODS
The initial CT of 1,968 consecutive baseline and 2,343 annual repeat screenings performed from 1999 to 2002 was reviewed. We identified all those recommended for antibiotics on the initial CT who had a follow-up CT within 2 months and determined whether the nodule(s) resolved, decreased in size, remained unchanged, or grew. We then determined whether further follow-up resulted in a diagnosis of cancer.


RESULTS
At baseline, among the 41 individuals who had follow-up CT within 2 months of the initial CT, 12 patients (29%) had complete or partial resolution; none of them subsequently received a diagnosis of lung cancer. On annual repeat screening, among the 39 individuals who had follow-up CT within 2 months of the initial CT, 29 patients (74%) had complete or partial resolution; none of them subsequently received a diagnosis of lung cancer. Among the 29 patients with nodules at baseline that were unchanged or grew, a total of 15 cancers were subsequently diagnosed; among the 10 patients on annual repeat scanning, there were 2 cancers.


CONCLUSIONS
In asymptomatic individuals undergoing CT screening for lung cancer, short-term follow-up CT within 2 months with or without antibiotics may circumvent the need for further evaluation in some individuals, particularly on annual repeat screening.
Libby
Daniel M
DM
Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical Center, 407 East Seventieth St, New York, NY 10021, USA. dmlibby00@aol.com
Wu
Ning
N
Lee
In-Jae
IJ
Farooqi
Ali
A
Smith
James P
JP
Pasmantier
Mark W
MW
McCauley
Dorothy
D
Yankelevitz
David F
DF
Henschke
Claudia I
CI
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000188:drug therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents