Author of

• 13707

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  P1.06 - Poster Session/ Screening and Early Detection (ID 218)

  • Event: WCLC 2015
  • Type: Poster
  • Track: Screening and Early Detection
  • Presentations: 1
  • Moderators:
  • Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)

  • 13728

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    P1.06-021 - Is Safe to Follow High-Risk Patients with Suspicious Lung Nodules without Invasive Tests? (ID 3182)

    09:30 - 09:30  |  Author(s): R. Saad Junior
    • Abstract

    Background:
    Low dose computed tomography (LDCT) screening for lung cancer (LC) provides reduction in mortality rates among individuals at high risk. Pre-Test Probability of Malignancy (PTPM) is a common tool used during the decision process: when the probability of malignancy is moderate or high, patients should be referred for further testing or tissue sampling. However, in some cases, these statistic models may give an overestimated value, especially in countries with a high incidence of granulomatous diseases. We have calculated the PTPM in our LDCT screening program and this work explores its main results.
    
    Methods:
    Prospective cohort of current or former smokers, with a heavy smoking history. Data of the first LDCT were analyzed to calculate the PTPM. The inclusion criteria were similar to NLST. LDCT scans with indeterminate pulmonary nodules above 4mm in size were considered positive and were evaluated by a multidisciplinary team. The PTPM model used in this study was designed by Swensen et al and included patient’s age, smoking history, diameter of the nodule, spiculation and upper lobe location. A PTPM > 60% was considered high and between 6 and 60% was considered moderate.
    
    Results:
    From January 2013 to July 2014, 790 were included in the protocol. We found 310 positive LDCT at baseline (39%), 34 (11%) with high PTPM. Among them, 16 were followed with LDCT in 3 (56.2%), 6 (37.5%) or 12 (6.3%) months and the remaining were investigated with PET-CT and/or lung biopsy. From the patients followed by LDCT, one case showed an increase in nodule size and was investigated with lung biopsy; all others were stable in one-year follow up. LC was diagnosed in 7 patients and benign diseases in 5 patients with high PTPM, including 1 case of tuberculosis. Other 4 cases of NSCLC were found in the moderate PTPM group (n=272). Therefore, malignancy rate was 20.6% for high PTPM and 1.5% for moderate PTPM nodules.
    
    Conclusion:
    The Swensen’s PTPM model overestimates the prevalence of LC in both groups of moderate and high-calculated values of PTPM. The decision making process should include other variables discussed in a multidisciplinary board, been safe to follow patients with further image tests.