Community-based Lung Cancer Screening Results in Relation to Patient and Radiologist Characteristics: the PROSPR Consortium

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Ann Am Thorac Soc


RATIONALE: Lung-RADS classification was developed to standardize reporting and management of lung cancer screening using low-dose computed tomography (LDCT). While variation in Lung-RADS distribution between healthcare systems has been reported, it is unclear if this is explained by patient characteristics, radiologist experience with lung cancer screening, or other factors.

OBJECTIVE: Our objective was to determine if patient or radiologist factors are associated with Lung-RADS score.

METHODS: In the Population-based Research to Optimize the Screening Process (PROSPR) Lung consortium, we conducted a study of patients who received their first screening LDCT at one of the five healthcare systems in the PROSPR Lung Research Center from 5/1/2014 through 12/31/2017. Data on LDCTs, patient factors, and radiologist characteristics were obtained via electronic health records. LDCT findings were categorized using Lung-RADS [negative (1), benign (2), probably benign (3), or suspicious (4)]. We used generalized estimating equations with a multinomial distribution to compare the odds of Lung-RADS 3, and separately Lung-RADS 4, vs. Lung-RADS 1 or 2 and estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between Lung-RADS assignment and patient and radiologist characteristics.

RESULTS: Analyses included 8,556 patients; 24% were assigned Lung-RADS 1, 60% Lung-RADS 2,10% Lung-RADS 3, and 5% Lung-RADS 4. Age was positively associated with Lung-RADS 3 (OR=1.02; CI: 1.01-1.03) and 4 (OR=1.03; CI: 1.01-1.05); chronic obstructive pulmonary disease (COPD) was positively associated with Lung-RADS 4 (OR=1.78; 95% CI: 1.45-2.20); obesity was inversely associated with Lung-RADS 3 (OR=0.70; CI: 0.58-0.84) and 4 (OR=0.58; 95% CI: 0.45-0.75). There was no association between sex, race, ethnicity, education, or smoking status and Lung-RADS assignment. Radiologist volume of interpreting screening LDCTs, years in practice, and thoracic specialty were also not associated with Lung-RADS assignment.

CONCLUSIONS: Healthcare systems that are comprised of patients with an older age distribution or higher levels of COPD will have a greater proportion of screening LDCTs with Lung-RADS 3 or 4 findings and should plan for additional resources to support appropriate and timely management of noted positive findings.

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ePub ahead of print