Abstract
The Pan-Canadian Early Detection of Lung Cancer (PanCan) risk model and the Lung CT Screening Reporting & Data System (Lung-RADS) estimate cancer probability for screening-detected nodules. The accuracy and agreement of these models require further study. What is the performance of the PanCan model and Lung-RADS to estimate the probability of cancer in screening-detected solid nodules? We analyzed data for newly identified, solid nodules detected on any screening round in the low-dose CT arm of the National Lung Screening Trial to assign a PanCan risk and Lung-RADS score. We compared PanCan risk with the corresponding Lung-RADS category according to the expected prevalence of cancer and examined accuracy using logistic regression and between-test agreement. We also analyzed baseline screen-detected nodules only, high (defined as≥ 5%probability of cancer) vslow-risk nodules, "risk-gap" nodules with a 3%to 5%PanCan probability and no equivalent Lung-RADS category, and procedure use by model. Participants with solid nodules (6,956) had a calculable PanCan risk and Lung-RADS score. PanCan accuracy by cancer probabilities< 1%, 1%to 2%, 5%to 15%, and > 15%was similar to corresponding Lung-RADS categories 2, 3, 4A, and 4B for any solid nodule (area under the curve, 0.84 vs0.84; P= .95) and for nodules identified at baseline (area under the curve, 0.85 vs0.84; P= .17). When dichotomized by high/low risk, PanCan and Lung-RADS were discordant (P< .001). Participants with risk-gap nodules (n= 543) were distributed across Lung-RADS categories 2 through 4; 41 (8%) had invasive procedures with 23 (4%) having unnecessary invasive procedure use for solid, benign nodules. PanCan and Lung-RADS had similar overall accuracy for assessing cancer in screening-detected, solid lung nodules with evidence of discordance by subgroup. The existence of Lung-RADS category 4 nodules with a≥ 3%to 5%PanCan risk may result in unnecessary procedures.
Published Version
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