title: Performance of ACR Lung-RADS in a Clinical CT Lung Screening Program.
abstract: OBJECTIVE
  The aim of this study was to assess the effect of applying ACR Lung-RADS in a clinical CT lung screening program on the frequency of positive and false-negative findings.
  
  
  METHODS
  Consecutive, clinical CT lung screening examinations performed from January 2012 through May 2014 were retroactively reclassified using the new ACR Lung-RADS structured reporting system. All examinations had initially been interpreted by radiologists credentialed in structured CT lung screening reporting following the National Comprehensive Cancer Network's Clinical Practice Guidelines in Oncology: Lung Cancer Screening (version 1.2012), which incorporated positive thresholds modeled after those in the National Lung Screening Trial. The positive rate, number of false-negative findings, and positive predictive value were recalculated using the ACR Lung-RADS-specific positive solid/part-solid nodule diameter threshold of 6 mm and nonsolid (ground-glass) threshold of 2 cm. False negatives were defined as cases reclassified as benign under ACR Lung-RADS that were diagnosed with malignancies within 12 months of the baseline examination.
  
  
  RESULTS
  A total of 2,180 high-risk patients underwent baseline CT lung screening during the study interval; no clinical follow-up was available in 577 patients (26%). ACR Lung-RADS reduced the overall positive rate from 27.6% to 10.6%. No false negatives were present in the 152 patients with >12-month follow-up reclassified as benign. Applying ACR Lung-RADS increased the positive predictive value for diagnosed malignancy in 1,603 patients with follow-up from 6.9% to 17.3%.
  
  
  CONCLUSIONS
  The application of ACR Lung-RADS increased the positive predictive value in our CT lung screening cohort by a factor of 2.5, to 17.3%, without increasing the number of examinations with false-negative results.
authors: Department of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts. Electronic address: brady.mckee@lahey.org.
authors: Brady J
authors: BJ
authors: McKee
authors: Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors: Shawn M
authors: SM
authors: Regis
authors: Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors: Andrea B
authors: AB
authors: McKee
authors: Department of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors: Sebastian
authors: S
authors: Flacke
authors: Department of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors: Christoph
authors: C
authors: Wald
keywords: CT lung screening; Lung-RADS