Modified Lung-RADS Improves Performance of Screening LDCT in a Population with High Prevalence of Non-smoking-related Lung Cancer

Hui-Ting Hsu; En-Kuei Tang; Ming-Ting Wu; Carol C Wu; Chia-Hao Liang; Chi-Shen Chen; Guang-Yuan Mar; Ruay-Sheng Lai; Jo-Ching Wang; Chuan-Ling Wu; Yi-Luan Huang; Fu-Zong Wu

doi:10.1016/j.acra.2018.01.012

Modified Lung-RADS Improves Performance of Screening LDCT in a Population with High Prevalence of Non-smoking-related Lung Cancer

Acad Radiol. 2018 Oct;25(10):1240-1251. doi: 10.1016/j.acra.2018.01.012. Epub 2018 Mar 9.

Authors

Affiliations

¹ Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung, 81362, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.
³ Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung, 81362, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan.
⁴ Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas.
⁵ Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan.
⁶ Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
⁷ Department of Radiology, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung, 81362, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: cmvwu1029@gmail.com.

PMID: 29530488
DOI: 10.1016/j.acra.2018.01.012

Abstract

Objectives: We proposed a modification of the ACR Lung Imaging Reporting and Data System (Lung-RADS) to clarify the characteristics of subsolid nodules with categories 1-11, and to compare the diagnostic accuracy with Lung-RADS and National Lung Screening Trial criteria in an Asian population with high prevalence of adenocarcinoma.

Methods: We analyzed a retrospective cohort of 1978 consecutive healthy subjects (72.8% nonsmoker) who underwent low-dose computed tomography from August 2013 to October 2014 (1084 men, 894 women). Lung-RADS categories 2 and 3 were modified to include subcategories of 2A/2B/2C and 3A/3B/3C, respectively. Clinical information and nodule characteristics were recorded. Receiver operating characteristic curves were used to compare diagnostic accuracy at different cutoffs.

Results: Thirty-two subjects (30 nonsmokers) had pathology-proven adenocarcinoma spectrum lesions in the follow-up period (1.6 ± 0.5 years). Modified Lung-RADS, using modified Lung-RADS category 2C as cutoff, had an area under the curve (AUC) of 0.973 in predicting adenocarcinoma spectrum lesions (sensitivity of 100%, specificity of 89.3%), which was significantly higher than that of Lung-RADS (AUC = 0.815, P < .001) and National Lung Screening Trial (AUC = 0.906, P < .001). Furthermore, modified Lung-RADS showed an AUC of 0.992 in predicting invasive adenocarcinoma (sensitivity of 95%, specificity of 97.8%) when category 3B was used as cutoff.

Conclusions: Modified Lung-RADS may substantially improve sensitivity while maintaining specificity for detection of adenocarcinoma spectrum lesions in an Asian population. Compared to Lung-RADS, it has enhanced ability to differentiate invasive from indolent adenocarcinoma by more refined subclassification of subsolid nodules using two cutoff values of category 2C and 3B. The effect of using modified Lung-RADS in clinical practice must be carefully studied in prospective large cohort studies.

Keywords: Screening; diagnosis; low-dose CT (LDCT); lung adenocarcinoma; sensitivity and specificity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma / diagnostic imaging*
Adenocarcinoma / epidemiology
Adenocarcinoma / pathology
Adult
Aged
Aged, 80 and over
Asian People*
Cohort Studies
Data Systems
Early Detection of Cancer
Female
Humans
Lung Neoplasms / diagnostic imaging*
Lung Neoplasms / epidemiology
Lung Neoplasms / pathology
Male
Middle Aged
Prevalence
Radiology Information Systems*
Retrospective Studies
Sensitivity and Specificity
Taiwan
Tomography, X-Ray Computed*