title: Diagnostic work-up and surgery in participants of the Gdansk lung cancer screening programme: the incidence of surgery for non-malignant conditions.
abstract: OBJECTIVE
  Low-dose computed tomography (LDCT) screening improves lung cancer prognosis but also results in diagnostic work-up and surgical treatment in many individuals without cancer. Therefore, we analysed the procedures that screening participants underwent to better understand the extent of overdiagnosis.
  
  
  METHODS
  Between 2009 and 2011, 8649 healthy volunteers aged 50-75 years with a 20 pack-year smoking history underwent LDCT screening, of whom individuals with detected lung nodules had 2 years control. Participants with a nodule >10 mm in diameter or with suspected tumour morphology underwent diagnostic work-up: 283 (6%)/4694 (54%) screened participants had detected lung nodules. One hundred and four individuals underwent surgery, 27 underwent oncological treatment and 152 without a cancer diagnosis underwent further follow-up with LDCT.
  
  
  RESULTS
  In 75% of participants accepted for diagnostic work-up and 25% of surgical patients, the procedures were unnecessary. In 70 (24.7%) participants, a specific diagnosis was obtained mainly due to the low efficacy of fine needle aspiration biopsy [sensitivity, 65.2%; negative predictive value (NPV), 95.9%] and bronchofiberoscopy (sensitivity, 71.4%; NPV, 50%) caused by overinterpretation of LDCT [positive predictive value (PPV), 2%]. Of 104 (36.7%) surgical patients, 43 (41.4%) had a preoperative cancer diagnosis, and 61 (58.6%) underwent surgery without pathological examination. In the latter group, intervention was justified in 35 (57.3%) patients. Complications occurred in 49 (17.3%) participants subjected to diagnostic work-up. In surgical patients, 67 (64.4%) malignant and 37 (35.6%) benign lesions were resected. In the latter group, intervention was justified in only 11 (29.7%) patients. No patient died because of diagnostic or treatment procedures during the study. The complication rate was 14.5% in the malignant and 10.8% in the benign groups. A neoplasm was found in 94 screening participants, of whom 67 (71.3%) underwent surgery; the remaining 27 (28.7%) patients were not surgical candidates. Adenocarcinoma accounted for 49/67 (73%) patients who underwent surgery for non-small-cell lung cancer (NSCLC); 56/67 (84%) patients had stage I NSCLC, and 26/67 (38%) underwent video-assisted thoracoscopic surgery lobectomy.
  
  
  CONCLUSIONS
  Futile diagnostic work-ups and operations must be reduced before LDCT screening can be broadly used. Stage I adenocarcinoma dominated in the NSCLC patients who underwent surgery.
authors.affiliation: Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland.
authors.forename: Witold
authors.initials: W
authors.lastname: Rzyman
authors.forename: Malgorzata
authors.initials: M
authors.lastname: Jelitto-Gorska
authors.forename: Robert
authors.initials: R
authors.lastname: Dziedzic
authors.forename: Iwona
authors.initials: I
authors.lastname: Biadacz
authors.forename: Janina
authors.initials: J
authors.lastname: Ksiazek
authors.forename: Piotr
authors.initials: P
authors.lastname: Chwirot
authors.forename: Tomasz
authors.initials: T
authors.lastname: Marjanski
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D000077192:Adenocarcinoma of Lung; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011044:Poland / Q000453:epidemiology; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D019616:Thoracic Surgical Procedures / Q000379:methods; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures
keywords: Early detection; Low-dose computed tomography; Lung cancer; Screening; Surgery