Abstract discussant Anand Devaraj, MD, PhD, a thoracic radiologist at Royal Brompton and Harefield hospitals, and Professor of Thoracic Radiology at the National Heart and Lung Institute, Imperial College London, noted that both the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial and National Lung Screening Trial (NLST) demonstrated significant reductions in lung cancer mortality because of screening. Research conducted by de Nijs and colleagues, however, showed an improved and increased computed tomography (CT) sensitivity in the NELSON study, as compared to the NLST, which the authors attributed to differences in nodule management—specifically volumetry.

“There are several features that contribute to CT sensitivity in lung cancer screening; it’s not just a nodule management protocol,” said Dr. Devaraj. “But even within the nodule management protocol, volumetry offers the enhanced ability to categorize nodules as high, medium, or low risk by more accurately reflecting true nodule. Volumetry can also contribute to sensitivity in gross detection, but this is a far less frequent occurrence.”

Dr. Devaraj also highlighted the contribution of radiologists and/or computer-aided detection, noting that “CT sensitivity is not just about measurement and management—it’s also about detection.” Finally, Dr. Devaraj underscored the important role of decision-making—whether by the tumor board, the multidisciplinary team, or the pulmonologist—to perform PET [positron-emission tomography]/CT, biopsy, or resection.

“We have centralized, protocolized, quality-assured CT readings, but the subsequent downstream management is often performed by separate local centers, where a protocolized approach is less frequently used,” he concluded. 

DISCLOSURE: Dr. Devaraj disclosed financial relationships with Boehringer Ingelheim, Brainomix, Roche, Galecto Biotech, and Galapagos.