Management of lung nodules detected by volume CT scanning.
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 mm(3) 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.)
van Klaveren
Rob J
RJ
Department of Pulmonology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands. r.j.vanklaveren@erasmusmc.nl
Oudkerk
Matthijs
M
Prokop
Mathias
M
Scholten
Ernst T
ET
Nackaerts
Kristiaan
K
Vernhout
Rene
R
van Iersel
Carola A
CA
van den Bergh
Karien A M
KA
van 't Westeinde
Susan
S
van der Aalst
Carlijn
C
Thunnissen
Erik
E
Xu
Dong Ming
DM
Wang
Ying
Y
Zhao
Yingru
Y
Gietema
Hester A
HA
de Hoop
Bart-Jan
BJ
Groen
Harry J M
HJ
de Bock
Geertruida H
GH
van Ooijen
Peter
P
Weenink
Carla
C
Verschakelen
Johny
J
Lammers
Jan-Willem J
JW
Timens
Wim
W
Willebrand
Dik
D
Vink
Aryan
A
Mali
Willem
W
de Koning
Harry J
HJ
D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012984:Software; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden