The following is a summary of “Personalised follow-up and management schema for patients with screen-detected pulmonary nodules: A dynamic modelling study,” published in the April 2024 issue of Pulmonology by Wang et al.
Determining optimal follow-up intervals for lung cancer screening remains a complex challenge. This study aimed to develop and validate personalized, dynamic screening schemas for individuals with pulmonary nodules identified via low-dose computed tomography.
Methods involved creating and validating dynamic models using data from the National Lung Screening Trial, focusing on patients aged 55-74 years. Initially, patient-specific risk profiles were established at baseline (R0), with subsequent updates in repeated screening rounds (R1 and R2). Risk thresholds were utilized to enhance time-dependent sensitivity at an early decision point (3 months) and specificity at a later decision point (1 year).
Validation demonstrated robust predictive performance, with area under the receiver operating characteristic curve of 0.867 (95% CI: 0.827-0.894) at R0 and 0.807 (95% CI: 0.765-0.948) at R1-R2 for predicting lung cancer onset within 12 months. The personalized schema, when compared to National Comprehensive Cancer Network (NCCN) guidelines and Lung-RADS, showed reduced rates of delayed diagnoses (1.7% vs. 1.7% vs. 6.9% at R0) and over-testing (4.9% vs. 5.6% vs. 5.6% at R0), and even lower rates at R2. Notably, the personalized approach recommended earlier testing for patients with cancer more frequently than both NCCN (29.8% vs. 20.9%, p = 0.0065) and Lung-RADS (33.2% vs. 22.8%, p = 0.0025), particularly among women, those aged ≥65 years, and individuals with part-solid or non-solid nodules.
In conclusion, the personalized schema offers practical implementation and superior accuracy compared to conventional rule-based protocols. These findings underscore the value of personalized strategies in optimizing the management of pulmonary nodules, enhancing efficiency while minimizing unnecessary interventions and delays in diagnosis.
Source: sciencedirect.com/science/article/pii/S2531043724000400
The post Screen-Detected Pulmonary Nodules: Personalized Follow-Up and Management first appeared on Physician's Weekly.