title: Management of lung nodules detected by volume CT scanning.
abstract: 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.)
authors: Department of Pulmonology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands. r.j.vanklaveren@erasmusmc.nl
authors: Rob J
authors: RJ
authors: van Klaveren
authors: Matthijs
authors: M
authors: Oudkerk
authors: Mathias
authors: M
authors: Prokop
authors: Ernst T
authors: ET
authors: Scholten
authors: Kristiaan
authors: K
authors: Nackaerts
authors: Rene
authors: R
authors: Vernhout
authors: Carola A
authors: CA
authors: van Iersel
authors: Karien A M
authors: KA
authors: van den Bergh
authors: Susan
authors: S
authors: van 't Westeinde
authors: Carlijn
authors: C
authors: van der Aalst
authors: Erik
authors: E
authors: Thunnissen
authors: Dong Ming
authors: DM
authors: Xu
authors: Ying
authors: Y
authors: Wang
authors: Yingru
authors: Y
authors: Zhao
authors: Hester A
authors: HA
authors: Gietema
authors: Bart-Jan
authors: BJ
authors: de Hoop
authors: Harry J M
authors: HJ
authors: Groen
authors: Geertruida H
authors: GH
authors: de Bock
authors: Peter
authors: P
authors: van Ooijen
authors: Carla
authors: C
authors: Weenink
authors: Johny
authors: J
authors: Verschakelen
authors: Jan-Willem J
authors: JW
authors: Lammers
authors: Wim
authors: W
authors: Timens
authors: Dik
authors: D
authors: Willebrand
authors: Aryan
authors: A
authors: Vink
authors: Willem
authors: W
authors: Mali
authors: Harry J
authors: HJ
authors: de Koning
mesh_terms: 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