Lung Cancer Screening Program Research Articles

Evaluating the accuracy of lung-RADS score extraction from radiology reports: Manual entry versus natural language processing

IntroductionRadiology scoring systems are critical to the success of lung cancer screening (LCS) programs, impacting patient care, adherence to follow-up, data management and reporting, and program evaluation. LungCT ScreeningReporting and Data System (Lung-RADS) is a structured radiology scoring system that provides recommendations for LCS follow-up that are utilized (a) in clinical care and (b) by LCS programs monitoring rates of adherence to follow-up. Thus, accurate reporting and reliable collection of Lung-RADS scores are fundamental components of LCS program evaluation and improvement. Unfortunately, due to variability in radiology reports, extraction of Lung-RADS scores is non-trivial, and best practices do not exist. The purpose of this project is to compare mechanisms to extract Lung-RADS scores from free-text radiology reports. MethodsWe retrospectively analyzed reports of LCS low-dose computed tomography (LDCT) examinations performed at a multihospital integrated healthcare network in New York State between January 2016 and July 2023. We compared three methods of Lung-RADS score extraction: manual physician entry at time of report creation, manual LCS specialist entry after report creation, and an internally developed, rule-based natural language processing (NLP) algorithm. Accuracy, recall, precision, and completeness (i.e., the proportion of LCS exams to which a Lung-RADS score has been assigned) were compared between the three methods. ResultsThe dataset includes 24,060 LCS examinations on 14,243 unique patients. The mean patient age was 65 years, and most patients were male (54 %) and white (75 %). Completeness rate was 65 %, 68 %, and 99 % for radiologists’ manual entry, LCS specialists’ entry, and NLP algorithm, respectively. Accuracy, recall, and precision were high across all extraction methods (>94 %), though the NLP-based approach was consistently higher than both manual entries in all metrics. DiscussionAn NLP-based method of LCS score determination is an efficient and more accurate means of extracting Lung-RADS scores than manual review and data entry. NLP-based methods should be considered best practice for extracting structured Lung-RADS scores from free-text radiology reports.

Brief Report: Understanding Program-Level Impact of COVID-19 in Lung Cancer Screening Programs in the United States

IntroductionLung cancer screening (LCS) reduces lung cancer mortality, yet uptake pre– and post–coronavirus disease 2019 (COVID-19) remains low. The impact of COVID-19 on LCS programs across the United States is unknown. Ours is the first multi-institutional study to identify barriers to LCS experienced during the pandemic. Our work will hopefully inform the development of targeted resources to facilitate increased uptake of LCS. MethodsA nationwide survey of Centers of Excellence (SCOE) in LCS was conducted by GO2 for Lung Cancer Foundation. In 2021, survey items included questions regarding program structure, screening rates, and systemic barriers to LCS delivery experienced amid COVID-19. ResultsA total of 99 programs representing 1112 screening sites responded. A median of 868 patients were screened during the year of 2020. Patient recruitment, patient education, and in-person service access were negatively affected by COVID-19, whereas the use of telemedicine was positively affected. Coordination of care and timely reporting of results were largely unaffected by the pandemic. ConclusionsOur findings provide a real-world snapshot of how COVID-19 affected LCS from a program perspective. These findings highlight ongoing challenges with educating and engaging those at high risk for lung cancer in LCS. Program resources should be directed toward increasing adherence to LCS among eligible patients.

Shall We Screen Lung Cancer with Volume Computed Tomography in Austria? A Cost-Effectiveness Modelling Study.

This study assessed the cost-effectiveness of a lung cancer screening (LCS) program using low-dose computed tomography (LDCT) in Austria. An existing decision tree with an integrated Markov model was used to analyze the cost-effectiveness of LCS versus no screening from a healthcare payer perspective over a lifetime horizon. A simulation was conducted to model annual LCS for an asymptomatic high-risk population cohort aged 50-74 with a smoking history using the Dutch-Belgian Lung Cancer Screening Study (NEderlands-Leuvens Longkanker ScreeningsONderzoek, NELSON) screening outcomes. The principal measure utilized to assess cost-effectiveness was the incremental cost-effectiveness ratio (ICER). Sensitivity and scenario analyses were employed to determine uncertainties surrounding the key model inputs. At an uptake rate of 50%, 300,277 eligible individuals would participate in the LCS program, yielding 56,122 incremental quality-adjusted life years (QALYs) and 84,049 life years gained compared to no screening, with an ICER of EUR 24,627 per QALY gained or EUR 16,444 per life-year saved. Additionally, LCS led to the detection of 25,893 additional early-stage lung cancers and averted 11,906 premature lung cancer deaths. It was estimated that LCS would incur EUR 945 million additional screening costs and EUR 386 million additional treatment costs. These estimates were robust in sensitivity analyses. Implementation of annual LCS with LDCT for a high-risk population, using the NELSON screening outcomes, is cost-effective in Austria, at a threshold of EUR 50,000 per QALY.

Implementation of smoking cessation in the workflow of a lung cancer screening program in Germany - A Position Paper of the German Respiratory Society (DGP)

Both tobacco cessation and low-dose CT screening in at-risk individuals reduce lung cancer-specific and all-cause mortality. As part of a national screening program for the early detection of lung cancer, smoking cessation must be a mandatory part of the counseling given to participants. This increases the cost-benefit effectiveness of the screening program. As part of the initial consultation evidence-based measures for smoking cessation must be offered to smoking participants of the screening program in form of a minimal intervention. If participants do not want to participate in a quit smoking measure they must actively refuse (opt-out rule). The costs of quitting smoking, including the costs of withdrawal-inhibiting medication, have to be fully covered by statutory health insurance for participants in the lung cancer screening program.

Perioperative Challenges: Analysis of Surgical Complications in Screening Lung Carcinoma Patient.

Introduction In September 2020, the Institute for Pulmonary Diseases of Vojvodina (IPBV) started a lung cancer screening program using low-dose computed tomography (LDCT). Video-assisted thoracic surgery (VATS) lobectomy is the most effective treatment for early-stage lung cancer. However, the frequency of postoperative complications in VATS anatomical lung resections among patients enrolled in the screening program has not been adequately studied. This study aims to compare the frequency of surgical complications and length of hospital stay between patients enrolled in the screening program and a control group. Methods Retrospective, observational, monocentric, non-randomized study was conducted at the IPBV in Sremska Kamenica. The study included patients with a confirmed diagnosis of lung cancer who underwent anatomic pulmonary resection with mediastinal lymphadenectomy for therapeutic purposes. The patients were divided into two groups: the first group consisted of 34 patients who participated in the lung carcinoma screening program, while the second control group consisted of 102 patients. Over the past three years, all patients identified with nodules suspicious of malignancy during the screening program were sequentially enrolled in the screening group. For the control group, patients were selected based on a matching process to ensure valid statistical comparisons with the screening group. They were matched in a 3:1 ratio with patients from the screening group based on criteria including gender, disease stage, pathohistological type of cancer, tumor, node, and metastasis (TNM) stage of the disease, and degree of surgical resection. Patients were monitored for demographic parameters, smoking status, presence of comorbidities and prior oncological diseases, pulmonary function parameters, level of pre-operational risk, the number of lymph nodes removed by biopsies, spread through alveolar spaces (STAS), and the occurrence of complications after surgery (infection, bleeding, air leak, presence of adhesions), re-drainage, and length of hospital stay. Results The patients in the screening group had a higher incidence of infections, bleeding, prolonged air leak, and required re-drainage after surgery compared to the control group. Patients from the screening program with a high operative risk, prolonged air leak, and pleural adhesions had a statistically significant higher hospital stay longer than the control group. Conclusions This research emphasizes the importance of screening programs for detecting lung cancer in the early stages. However, it also highlights the need for further research to reduce surgical complications and improve therapeutic interventions for patients in the screening program.

Characteristics associated with early vs. late adoption of lung cancer screening

BackgroundAlthough lung cancer screening (LCS) reduces lung cancer mortality among high-risk individuals, uptake overall remains low. With all cancer screening modalities, a period of diffusion among medical providers and the public is expected, with screening uptake exhibiting a distribution among early vs. late adoption. We aimed to characterize individuals undergoing LCS based upon the timeframe of screening adoption. MethodsThis retrospective study examined patients who underwent LCS between January 2015 – December 2022 in a centralized LCS program. Based on United States Preventive Services Task Force (USPSTF) criteria for LCS, early and late adopters of LCS – defined by time from eligibility to screening completion – were compared. A multivariable regression model was constructed to identify factors associated with early adoption of LCS. ResultsAmong patients screened during the study period, 90.4% were eligible based on USPSTF 2013 criteria, and 9.6% were eligible based on USPSTF 2021 criteria. Of the USPSTF 2013 eligible persons, multivariable analysis demonstrated Black/African-American individuals and current smokers had significantly greater odds of early adoption (aOR 1.428 and 1.514, respectively). Those without a family history of lung cancer or without a personal history of cancer had significantly lower odds of early adoption of LCS. ConclusionsEarly adopters were more likely to report Black/African-American race or current smoking status after adjustment for covariates. Future research should examine how screening diffuses across the overall LCS-eligible population, as well as identify factors that drive and inhibit diffusion to create programs and policies with the ultimate goal of increasing timely LCS uptake.

Acceptability of adding a non-contrast abdominal CT scan to screen for kidney cancer and other abdominal pathology within a community-based CT screening programme for lung cancer: A qualitative study.

The Yorkshire Kidney Screening Trial (YKST) is a feasibility study of adding non-contrast abdominal CT scanning to screen for kidney cancer and other abdominal malignancies to community-based CT screening for lung cancer within the Yorkshire Lung Screening Trial (YLST). This study explored the acceptability of the combined screening approach to participants and healthcare professionals (HCPs) involved in the trial. We conducted semi-structured interviews with eight HCPs and 25 participants returning for the second round of scanning within YLST, 20 who had taken up the offer of the additional abdominal CT scan and five who had declined. Transcripts were analysed using thematic analysis, guided by the Theoretical Framework of Acceptability. Overall, combining the offer of a non-contrast abdominal CT scan alongside the low-dose thoracic CT was considered acceptable to participants, including those who had declined the abdominal scan. The offer of the additional scan made sense and fitted well within the process, and participants could see benefits in terms of efficiency, cost and convenience both for themselves as individuals and also more widely for the NHS. Almost all participants made an instant decision at the point of initial invitation based more on trust and emotions than the information provided. Despite this, there was a clear desire for more time to decide whether to accept the scan or not. HCPs also raised concerns about the burden on the study team and wider healthcare system arising from additional workload both within the screening process and downstream following findings on the abdominal CT scan. Adding a non-contrast abdominal CT scan to community-based CT screening for lung cancer is acceptable to both participants and healthcare professionals. Giving potential participants prior notice and having clear pathways for downstream management of findings will be important if it is to be offered more widely.

Yorkshire Lung Screening Trial (YLST) pathway navigation study: a protocol for a nested randomised controlled trial to evaluate the effect of a pathway navigation intervention on lung cancer screening uptake

IntroductionLung cancer is the most common cause of cancer death globally. In 2022 the UK National Screening Committee recommended the implementation of a national targeted lung cancer screening programme, aiming...

LUNG CANCER SCREENING WITH LOW-DOSE COMPUTED TOMOGRAPHY: A LITERATURE REVIEW

Relevance: Lung cancer (LC) is the leading cause of death among oncological diseases and occupies a leading position in the number of new cases worldwide. Early detection of symptoms, precise diagnosis, and effective treatment are crucial for increasing lung cancer survival rates. Low-dose computed tomography (LDCT) screening programs represent a promising method for early lung cancer detection, which can substantially decrease mortality rates and improve patient survival prospects. The study aimed to review foreign scientific publications on lung cancer screening using low-dose computed tomography. Methods: The study included the results of foreign randomized controlled trials (RCTs) of lung cancer screening using LDCT, based on articles, meta-analyses, systematic reviews, and reviews. Exclusion criteria included publications published before 2013; publications that were not publicly available. The search results yielded 369 articles, of which 39 literary sources were included in this review. The search covered a depth of 10 years (2013-2023). Results: An analysis of foreign studies was performed that confirmed the effectiveness of low-dose computed tomography in the detection of lung cancer. Data from randomized controlled trials, meta-analyses, systematic reviews and reviews are presented, confirming the potential of this method to improve early stage lung cancer detection, thus improving survival rates and reducing mortality. Conclusion: LDCT has been shown to be effective in reducing lung cancer mortality, as confirmed by the results of numerous studies. However, the strategy to implement the lung cancer screening program should be specific to each country in which it will be implemented, taking into account the specifics of the health system. To achieve optimal results, it is necessary to continue research related to the implementation of this screening method, including an analysis of its economic feasibility, as well as an assessment of long-term results and potential undesirable effects.

Problems and Alternatives for Korea National Lung Cancer Screening Program for Smoking Cessation: Analysis of a Survey Involving Experts

Problems and Alternatives for Korea National Lung Cancer Screening Program for Smoking Cessation: Analysis of a Survey Involving Experts

Comparative Analysis of Clinical Characteristics and Prognosis Between Primary Lung Cancers Identified as Screening Detected and Incidentally Detected Pulmonary Nodules.

Although the importance of low-dose computed tomography (LDCT) screening is increasingly emphasized and implemented, many lung cancers continue to be incidentally detected during routine medical practices, and data on incidentally detected lung cancer (IDLC) remain scarce. This study aimed to investigate the clinical characteristics and prognosis of IDLCs by comparing them with screening-detected lung cancers (SDLCs). In this retrospective study, subjects with cT1 (≤3 cm) pulmonary nodules detected on baseline computed tomography (CT), later pathologically confirmed as primary lung cancer in 2015, were included. Patients were categorized into IDLC and SDLC groups based on the setting of the first pulmonary nodule detection. Out of 457 subjects, 129 (28.2%) were IDLCs and 328 (71.8%) were SDLCs. The IDLC group, consisted of older individuals with a higher prevalence of smokers and underlying pulmonary disease, compared to the SDLC group. Adenocarcinomas were more frequently detected in SDLCs (87.5%) than in IDLCs (76.7%, p<0.001). The time to treatment initiation (TTI) and 5-year overall survival (OS) rates were similar. Multivariate analyses revealed underlying interstitial lung disease, DLCO, solidity of nodules and TNM stage as independent risk factors associated with mortality. Less than 30% of study participants would have been eligible for the current lung cancer screening program. The IDLC group was associated with older age, higher rate of smokers, underlying pulmonary disease, and non-adenocarcinoma histology. However, prognosis was similar to that of the SDLC group, attributable to the similarity in TNM stage, strict adherence to guidelines, and short TTI. Furthermore, less than 30% of the participants would have been suitable for the existing lung cancer screening program, indicating a potential need to reconsider the scope for screening candidates.

Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study.

Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment.

Lung cancer screening: where do we stand?

Lung cancer screening (LCS) programmes have emerged over recent years around the world. LCS programmes present differences in delivery, inclusion criteria and resource allocation. On a national scale, only a few LCS programmes have been fully established, but more are anticipated to follow. Evidence has shown that, in combination with a low-dose chest computed tomography scan, smoking cessation should be offered as part of a LCS programme for improved patient outcomes. Promising tools in LCS include further refined risk prediction models, the use of biomarkers, artificial intelligence and radiomics. However, these tools require further study and clinical validation is required prior to routine implementation.

LDCT lung cancer screening implementation in a Veterans Affairs hospital: A quality initiative.

e23238 Background: Lung cancer is the number one cause of cancer related deaths worldwide. United States Preventive Services Task Force (USPSTF) recommends annual Lung Cancer Screening (LCS) with Low Dose Computerized Tomography (LDCT) for adults who are current smokers aged 50 to 80 years with at least 20 pack year smoking history or have quit smoking within the past 15 years. Although LCS is a national initiative for Veteran Affairs (VA) Hospitals, there are several barriers in practice. Methods: The LCS program was established with a dedicated coordinator to provide better access to high-quality in-house screening, while reducing the dependance on expensive community care services and referrals. Smoking history in Tobacco Pack Years (TPY) is updated during a Primary Care Physician (PCP) visit, which triggers a clinical reminder in the electronic medical record for LCS. The LCS coordinator would then receive a consult. After shared decision-making with the patient, physician and coordinator, the patients are scheduled for LDCT. If the results are Lung-RADS 1 (negative), 2 or 3 (benign appearing nodules) the patients are notified of the findings and provided with subsequent follow ups. All Lung RADS 4 (suspicious findings) are discussed in the lung tumor board, which includes radiologist, oncologist, pulmonologist, pathologist, cardio-thoracic surgeon, and fellows in training. The committee determines the follow-up scan interval and/or additional investigations. Results: The performance of our LCS Program from June 2022 to January 2024 was reviewed. 5941 patients were assessed for TPY, of those 1127 patients were eligible for LCS scans and 1032 (93.3%) were enrolled into the LCS Program. 951 LDCT scans have been conducted thus far, this includes 598 annual initial screenings, the remaining are follow ups. 57 patients (6.81%) had Lung-RADS 3 findings and are undergoing nodule tracking. 16 patients (1.91%) required diagnostic work-up which includes a PET scan or biopsy. 14 patients (1.67%) have been diagnosed with cancer. Conclusions: Our LDCT Program showed a high acceptance rate of 93.3%, much of which can be attributed to the multiple layers of screening and shared decision-making processes. Patients received three phone calls and a letter as a reminder of their LDCT appointments. Our radiology department has four dedicated slots for LDCT screening each day which allows for further compliance. TPY documentation was identified as a limiting factor in this process. The LCS coordinator verified the TPY history with the patients which helped overcome this shortcoming. Overall a multidisciplinary team approach contributed to the success of our program.

Recruitment strategies in a lung cancer screening program for Asian women with no smoking history.

e22514 Background: The Female Asian Nonsmoker Screening Study (FANSS) is a pilot study for eligible Asian women with no smoking history to provide low-dose CT (LDCT) Chest scans for lung cancer screening annually for 3 years. To recruit for the study, we took into consideration several factors including potential language barriers, low awareness of lung cancer incidence in non-smoking populations, and participant (pt) availability. Here we describe the use of various recruitment strategies to support enrollment to the FANSS study. Methods: Multimodal recruitment strategies for enrollment into FANSS were used. A dedicated phone line answered by receptionists able to speak English and several Chinese dialects was created. Research staff are bilingual or utilized telephonic interpretation services in all pt interactions. Informational flyers available in both English and Chinese were mailed to primary care physicians serving primarily Asian communities and posted in pharmacies and storefronts in NYC Chinatown. A website was developed for interested individuals to submit their contact information for further information. Working with our institutional Epic EMR, a list of all pts with active MyChart accounts was created with criteria “Asian,” “female,” “OK to contact for Research recruitment,” “age 40-74,” and excluded anyone with a smoking history and “Cancer” in the past 5 years. From this list, pts then were sent an IRB-approved recruitment message through MyChart from 3/2023-6/2023. Interested pts who reached out through the above methods were contacted by research staff to determine eligibility. All eligible pts who agreed to participate were consented either in-person or virtually to allow for schedule flexibility to review the consent. Results: From 3/5/21 to 1/27/24, 1518 women inquired about FANSS through our website, dedicated phone line or MyChart messages and were directly contacted by our team. After determination of eligibility, 760 pts had an informed consent discussion either virtually or in-person. From 3/5/21 to 3/2023, 247 pts underwent the consent process and 229 pts had a baseline LDCT. Following the intervention of directed MyChart messaging in 3/2023, 568 pts responded to the MyChart message indicating interest, however 102 pts were not eligible due to inaccurate info in their Epic medical record (i.e. ethnicity or smoking history). Overall, from 3/2023 to 1/27/24, 513 pts underwent the consent process. Among these, 90 subjects (18%) were recruited via MyChart. Conclusions: Recruitment to a lung cancer screening program in non-smokers is feasible, and specific considerations tailored to engage minority populations can improve enrollment such as bilingual staff and translated materials. The use of directed messaging through the Epic EMR is an important tool to identify potential pts which may be applied to aid in recruitment to other clinical trials or lung cancer screening programs.

Improving LDCT screening rates within a large multidisciplinary community based practice using integrated ACR accredited imaging centers.

e13582 Background: Lung cancer remains the leading cause of cancer-related death in the US, accounting for about 22% of such deaths. Lung cancer detected by low-dose computed tomography (LDCT) screening is discovered at an early stage 64-85% of the time. The benefits of LDCT screening have been demonstrated in numerous trials, but there has been difficulty in establishing programs that screen a high percentage of eligible patients. We present data from the first 18 months of our lung cancer screening program that is designed to provide the highest quality screening, follow-up and access to prevention, diagnosis, and treatment including clinical trials within their local communities. Methods: New York Cancer and Blood Specialists (NYCBS) is a community practice with over 50 locations across NY. While most lung cancer screening programs are hospital-based, NYCBS has a series of American College of Radiology (ACR) accredited imaging centers that perform these screenings and are closely affiliated with oncology, primary care, Ob-Gyn, nephrology, urology and other specialty medical and surgical practices. These centers are strategically located in areas that have high rates of tobacco use as suggested by heat map data from the NY City Community Health Survey . Upon initial patient presentation, all NYCBS and affiliated sites screen patients with tablet-based questionnaires that prompt additional questions during follow-up appointments. Patients with positive findings are discussed during a monthly, system-wide multidisciplinary lung nodule review conference. Follow-up interventions include referrals to pulmonology, interventional radiology, or further imaging with PET/CT. Per ACR guidelines, patients not requiring acute intervention continue with follow-up CT. Results: In 2023, 29,501 patients were screened with an in-office questionnaire. Of those patients, 3,606 were eligible for screening, 225 declined, and 896 (29%) high risk patients proceeded to undergo LDCT screening. In screened patients, 128 underwent follow-up CT, 36 patients had findings requiring immediate intervention, and 6 were diagnosed with lung cancer. 5 of these patients were diagnosed with stage I and 1 patient was diagnosed with stage IV lung cancer. Conclusions: LDCT screening is a proven method to discover early stage lung cancer and improve the survival rate of diagnosed patients but has not been well adopted in practice. With access to a diverse array of multidisciplinary practices across NY and integrated accredited imaging centers, we have increased the accessibility of lung cancer screening and improved transitions to follow-up care. Nationally, only 4.5% of patients at high risk are screened, however, we found that with our approach to patient care, we have achieved among the highest reported screening rates in eligible individuals.

Interventional bronchoscopy in lung cancer treatment.

Interventional bronchoscopy has seen significant advancements in recent decades, particularly in the context of lung cancer. This method has expanded not only diagnostic capabilities but also therapeutic options. In this article, we will outline various therapeutic approaches employed through either a rigid or flexible bronchoscope in multimodal lung cancer treatment. A pivotal focus lies in addressing central airway obstruction resulting from cancer. We will delve into the treatment of initial malignant changes in central airways and explore the rapidly evolving domain of early peripheral malignant lesions, increasingly discovered incidentally or through lung cancer screening programmes. A successful interventional bronchoscopic procedure not only alleviates severe symptoms but also enhances the patient's functional status, paving the way for subsequent multimodal treatments and thereby extending the possibilities for survival. Interventional bronchoscopy proves effective in treating initial cancerous changes in patients unsuitable for surgical or other aggressive treatments due to accompanying diseases. The key advantage of interventional bronchoscopy lies in its minimal invasiveness, effectiveness and favourable safety profile.

Participant adherence in a lung cancer screening (LCS) program in a non-smoking population.

10556 Background: LCS guidelines in smoking populations includes an annual low-dose CT Chest (LDCT) scan. Historically, real-world adherence to repeat imaging following the baseline LDCT has been low at 22% (Silvestri et al. Chest 2023). Various reasons for non-adherence have been cited and can be amplified in populations where English is not the primary language, low health literacy, or logistical reasons that interfere with scheduling. We are conducting the Female Asian Nonsmoker Screening Study (FANSS), which is a pilot study for Asian women with no smoking history to provide LDCTs to this population. We describe the strategies utilized to address potential barriers to adherence and report the participant (pt) adherence observed to date for this population. Methods: FANSS is an IRB-approved trial that provides LDCTs annually for 3 years and has an interim follow-up phone call every 6 months. All aspects of the study other than the LDCT could be conducted virtually pending pt preference. All pt interactions were conducted in the pt’s requested language. LDCTs were interpreted according to Lung-RADS. Review of the LDCT results were available in-person or virtually by a nurse practitioner or the principal investigator. The timeline for the 2nd and 3rd LDCT after the baseline scan was determined as follows: pts with negative findings were recommended for a repeat LDCT in 1 year; pts with suspicious findings were reviewed at the NYU Multidisciplinary Nodule Board and recommended for a repeated LDCT in a 3 or 6 month interval. A bilingual (English and Chinese speaking) research coordinator and medical secretaries reached out to pts at their preferred contact (email, phone, or text) for scheduling the follow-up LDCT. Up to three attempts to reach pts to schedule their follow-up LDCT were made. Results: From 3/5/21 to 1/27/24, 634 subjects completed their baseline LDCTs. Language interpretation services were utilized in 30% of pts. As of 1/27/24, 215 pts were due for their 2nd LDCT: 195 (91%) completed (186) or scheduled (9) the LDCT, 5 pts withdrew their consent, and 15 did not complete the scan. The main reasons for not completing the scans were: living outside New York City, other health concerns, and lost to follow-up. As of 1/27/24, 95 pts were due for their 3rd LDCT: 87 (92%) completed (82) and scheduled (5) the LDCT, and 8 did not complete the scan due to being lost to follow-up. Conclusions: The FANSS population is a unique pt cohort comprised of all Asian women who do not qualify for current LCS guidelines. Interventions to address potential adherence issues were implemented. In our research-based setting, virtual conduct of most of the study procedures allowed pt flexibility. Pt outreach to ensure follow-up by contacting through various methods also ensured adherence of &gt;90%. These interventions can be considered for use in other LCS programs to improve adherence to LCS follow-up.

Telemedicine-Enhanced Lung Cancer Screening Using Mobile Computed Tomography Unit with Remote Artificial Intelligence Assistance in Underserved Communities: Initial Results of a Population Cohort Study in Western China.

Introduction: Lung cancer is a leading cause of cancer deaths globally. Despite favorable recommendations, low-dose computed tomography (LDCT) lung screening adoption remains low in China. Barriers such as limited infrastructure, costs, distance, and personnel shortages restrict screening access in disadvantaged regions. We initiated a telemedicine-enabled lung cancer screening (LCS) program in a medical consortium to serve people at risk in underserved communities. The objective of this study was to describe the implementation and initial results of the program. Methods: From 2020 to 2021, individuals aged 40-80 years were invited to take LCS by mobile computed tomography (CT) units in three underserved areas in Western China. Numerous CT scans were remotely reported by radiologists aided by artificial intelligence (AI) diagnostic systems. Abnormal cases were tracked through an integrated hospital network for follow-up. A retrospective cohort study documented participant demographics, health history, LDCT results, and outcomes. Descriptive analysis was conducted to report baseline characteristics and first-year follow-up results. Results: Of the 28,728 individuals registered in the program, 19,517 (67.94%) participated in the screening. The study identified 2.68% of participants with high-risk pulmonary nodules and diagnosed 0.55% with lung cancer after a 1-year follow-up. The majority of high-risk participants received timely treatment in hospitals. Conclusions: This study demonstrated mobile CT units with remote AI assistance improved access to LCS in underserved areas, with high participation and early detection rates. Our implementation supports the feasibility of deploying telemedicine-enabled LCS to increase access to a large scale of basic radiology and diagnostic services in resource-limited settings. Clinical Trial Registration Number: ChiCTR1900024623.

Budget impact model of LungFlag, a predictive risk model for lung cancer screening.

10534 Background: Lung cancer screening (LCS) programs using low-dose computed tomography (LDCT) for early detection reduce mortality and have been widely recommended. LungFlag is a machine-learning risk prediction model that uses patient-level data to identify individuals at high risk of developing non-small cell lung cancer (NSCLC), prompting their physician to recommend screening with LDCT. Methods: A budget impact model was developed to estimate the costs associated with adoption of LungFlag as an adjunct to existing US Preventive Services Task Force (USPSTF) screening guidelines for a hypothetical US commercial health plan population of 1 million beneficiaries. The model calculates the total expected annual costs of screening for NSCLC with LDCT in scenarios with and without LungFlag, including healthcare resource utilization for detecting NSCLC and treatment of patients diagnosed with NSCLC. Incremental costs were evaluated over a 5-year period. Results: Among 36,803 USPSTF-eligible persons, we assumed that 4600 (12.5%) had already initiated LCS, leaving 32,203 persons who were candidates for pre-screening with LungFlag. The model estimated that 17 additional NSCLC diagnoses per year would be detected by screening when using LungFlag, with most in stage 1. Over 5 years, LungFlag was estimated to result in 33 fewer patients with stage 3 or stage 4 NSCLC at diagnosis and 22 fewer NSCLC-related deaths. Use of LungFlag increased annual costs during the first 2 years and provided cost savings from Year 4 onwards (Table). Cost savings from LungFlag were attributable to reductions in the costs of advanced NSCLC treatment. Conclusions: In a population of 1 million commercial health plan beneficiaries, the adoption of LungFlag as an adjunct to existing screening guidelines for USPSTF-eligible patients was estimated to prevent 22 additional NSCLC-related deaths, with a cost savings of $2.87 million over 5 years from a US commercial payer perspective. [Table: see text]