Growing small solid nodules in lung cancer screening: safety and efficacy of a 200 mm 3 minimum size threshold for multidisciplinary team referral.

Autor:	Creamer AW; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK., Horst C; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK., Dickson JL; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK., Tisi S; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK., Hall H; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK., Verghese P; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK., Prendecki R; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK., Bhamani A; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK., McCabe J; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK., Gyertson K; University College London Hospitals NHS Foundation Trust, London, UK., Mullin AM; Cancer Research UK and UCL Cancer Trials Centre, London, UK., Teague J; Cancer Research UK and UCL Cancer Trials Centre, London, UK., Farrelly L; Cancer Research UK and UCL Cancer Trials Centre, London, UK., Hackshaw A; Cancer Research UK and UCL Cancer Trials Centre, London, UK., Nair A; University College London Hospitals NHS Foundation Trust, London, UK., Devaraj A; Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.; National Heart and Lung Institute, Imperial College London, London, UK., Janes SM; Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK s.janes@ucl.ac.uk.
Jazyk:	angličtina
Zdroj:	Thorax [Thorax] 2023 Feb; Vol. 78 (2), pp. 202-206. Date of Electronic Publication: 2022 Nov 25.
DOI:	10.1136/thorax-2022-219403
Abstrakt:	The optimal management of small but growing nodules remains unclear. The SUMMIT study nodule management algorithm uses a specific threshold volume of 200 mm 3 before referral of growing solid nodules to the multidisciplinary team for further investigation is advised, with growing nodules below this threshold kept under observation within the screening programme. Malignancy risk of growing solid nodules of size >200 mm 3 at initial 3-month interval scan was 58.3% at a per-nodule level, compared with 13.3% in growing nodules of size ≤200 mm 3 (relative risk 4.4, 95% CI 2.17 to 8.83). The positive predictive value of a combination of nodule growth (defined as percentage volume change of ≥25%), and size >200 mm 3 was 65.9% (29/44) at a cancer-per-nodule basis, or 60.5% (23/38) on a cancer-per-participant basis. False negative rate of the protocol was 1.9% (95% CI 0.33% to 9.94%). These findings support the use of a 200 mm 3 minimum volume threshold for referral as effective at reducing unnecessary multidisciplinary team referrals for small growing nodules, while maintaining early-stage lung cancer diagnosis. Competing Interests: Competing interests: AWC, CH, JLD, ST, HH, PV, RP and AB are all funded or part-funded through GRAIL as part of the SUMMIT Study. SUMMIT is sponsored and conducted by University College London and funded by GRAIL LLC through a research grant awarded to SMJ as principal investigator. SMJ’s full disclosures are as a Paid Advisory Board member Astra-Zeneca, Bard1 Bioscience, Achilles Therapeutics, Jansen. Assistance for travel to meetings from Astra Zeneca, Takeda, and grant income from GRAIL Inc, Owlstone and share options from Optellum; BARD1 Lifescience. AN is part-funded through the UCLH Biomedical Research Centre. AD’s disclosures are personal fees from Boehringer Ingelheim, Roche, Galacto Biotech, Galapagos, Brainomix and Vicore. AH’s disclosures are consulting fees to Evidera and assistance for travel to meetings from GRAIL. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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