Abstract
Although professional societies agreed that CT screening inconsistent with recommendation leads to radiation-related cancer and unexpected cost, many patients still undergo unnecessary Chest CT before treatment. The goal of this study was to assess the overuse of Chest CT in different type of patients. Data on 1853 patients who underwent pulmonary resection from May 2019 to May 2020 were retrospectively analyzed. Data collected include age, sex, follow-up period, density and size of nodules and frequency of undergoing Chest CT. Pearson χ2test and logistic regression were conducted to compare the receipt of CT screening. Among 1853 patients in the study, 689 (37.2%) overused Chest CT during follow-up of the pulmonary nodules. This rate was 16.2% among patients with solid nodules, 57.5% among patients with pure ground glass opacity (pGGO), and 41.4% among patients with mixed ground glass opacity (mGGO) (P < 0.001). 50.7% in the "age ≤ 40" group, 39.8% in the "41 ≤ age ≤ 50" group, 38.7% in the "51 ≤ age ≤ 60" group, 32.3% in the "61 ≤ age ≤ 70" group, 27.8% in the " > 70" group underwent unnecessary CT (P < 0.001). Female got more unnecessary CT than male (40.6% vs 32.8%,P < 0.001). Factors associated with a greater likelihood of overusing Chest CT was the density of nodules [odds ratios (ORs) of 0.53 for mGGO; 0.15 for solid nodule, P < 0.0001, vs patients with pGGO]. Roughly 37% patients with pulmonary nodules received Chest CT too frequently despite national recommendations against the practice. Closer adherence to clinical guidelines is likely to result in more cost-effective care.
Highlights
Lung cancer is the leading cause of cancer death worldwide, with an estimated 1.6 million deaths annually. 1 Since a high range of lung cancer occurs and develops without any symptom until end-stage, screening becomes significant method of spotting lung cancer
As the US National Lung Screening Trial (NLST), Nederlands–Leuvens Longkanker Screenings Onderzoek (NELSON) and other trial revealed that Computed Tomography (CT) can produce more effect compared with X-ray, Chest CT becomes the first choice of lung cancer screening. 2-5
According to John Brodersen, 49% of detected cancers by Low-dose CT (LDCT) may be overdiagnosed, 6-7and researchers mentioned that risk of radiation-induced cancers can be a potentially harmful effect of Chest CT which is cumulative over a lifetime. 2,8-11
Summary
Lung cancer is the leading cause of cancer death worldwide, with an estimated 1.6 million deaths annually. 1 Since a high range of lung cancer occurs and develops without any symptom until end-stage, screening becomes significant method of spotting lung cancer. As the US National Lung Screening Trial (NLST), Nederlands–Leuvens Longkanker Screenings Onderzoek (NELSON) and other trial revealed that Computed Tomography (CT) can produce more effect compared with X-ray, Chest CT becomes the first choice of lung cancer screening. According to John Brodersen, 49% of detected cancers by Low-dose CT (LDCT) may be overdiagnosed, 6-7and researchers mentioned that risk of radiation-induced cancers can be a potentially harmful effect of Chest CT which is cumulative over a lifetime. The NLST results suggested that screening with low-dose CT cost $100,000 per QALY gained, but study of William C. Black showed that screening conducted outside the trial may be costlier if patients’ counseling and follow-up are properly accounted for the price. 2,12 The cost could become more considerable if the number of unnecessary CT scans increase, making a heavy burden for patients and economy of healthcare
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