Screen-detected subsolid pulmonary nodules: long-term follow-up and application of the PanCan lung cancer risk prediction model

Zhao, Henry, Marshall, Henry M., Yang, Ian A., Bowman, Rayleen V., Ayres, John, Crossin, Jane, Lau, Melanie, Slaughter, Richard E., Redmond, Stanley, Passmore, Linda, McCaul, Elizabeth, Courtney, Deborah, Leong, Steven C., Windsor, Morgan, Zimmerman, Paul V. and Fong, Kwun M. (2016) Screen-detected subsolid pulmonary nodules: long-term follow-up and application of the PanCan lung cancer risk prediction model. British Journal of Radiology, 89 1060: . doi:10.1259/bjr.20160016


Author Zhao, Henry
Marshall, Henry M.
Yang, Ian A.
Bowman, Rayleen V.
Ayres, John
Crossin, Jane
Lau, Melanie
Slaughter, Richard E.
Redmond, Stanley
Passmore, Linda
McCaul, Elizabeth
Courtney, Deborah
Leong, Steven C.
Windsor, Morgan
Zimmerman, Paul V.
Fong, Kwun M.
Title Screen-detected subsolid pulmonary nodules: long-term follow-up and application of the PanCan lung cancer risk prediction model
Journal name British Journal of Radiology   Check publisher's open access policy
ISSN 0007-1285
1748-880X
Publication date 2016-03-04
Year available 2016
Sub-type Article (original research)
DOI 10.1259/bjr.20160016
Open Access Status Not Open Access
Volume 89
Issue 1060
Total pages 6
Place of publication London, United Kingdom
Publisher British Institute of Radiology
Collection year 2017
Language eng
Formatted abstract
Objective: To report the long-term follow-up of subsolid nodules (SSNs) detected in participants of a prospective low-dose CT lung cancer screening cohort, and to investigate the utility of the PanCan model in stratifying risk in baseline SSNs.

Methods: Participants underwent a baseline scan, two annual incidence scans and further follow-up scans for the detected nodules. All SSNs underwent a minimum of 2 years of follow-up (unless resolved or resected). Risk of malignancy was estimated using the PanCan model; discrimination [area under the receiver-operating characteristic curve (AUC)] and calibration (Hosmer-Lemeshow goodness-of-fit test) were assessed. The Mann-Whitney U-Wilcoxon test was used to compare estimated risk between groups.

Results: 70 SSNs were detected in 41 (16.0%) out of 256 total participants. Median follow-up period was 25.5 months range 2.0-74.0 months). 29 (41.4%) SSNs were transient. Five (7.1%) SSNs were resected, all found to be Stage I lung adenocarcinoma, including one SSN stable in size for 3.0 years before growth was detected. The PanCan model had good discrimination for the 52 baseline SSNs (AUC=0.89; 95% confidence interval 0.76-1); the Hosmer-Lemeshow goodness-of-fit test was non-significant (=0.27). Estimated risk was significantly higher in the baseline SSNs found to be cancer vs those not found to be cancer after 2-6 years of follow-up (<0.01).

Conclusion:
Our findings support a long-term follow-up approach for screen-detected SSNs for 3 years or longer. The PanCan model appeared discriminatory and well calibrated in this cohort.

Advances in knowledge:
The PanCan model may have utility in identifying low-risk SSNs which could be followed with less frequent CT scans
Keyword Subsolid pulmonary nodules
PanCan lung cancer risk prediction model
Risk prediction model
Subsolid nodules (SSNs)
Low-dose CT lung cancer screening
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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