The PanCan nodule management protocol may be superior at triaging lung cancer screening participants compared with the LungRADSv1.1 approach, according to new findings presented by McWilliams et al at the International Association for the Study of Lung Cancer (IASLC) 2024 World Conference on Lung Cancer (Abstract PL02.14).
Background
Effective management of pulmonary nodules detected through low-dose computed tomography (CT) screening is often crucial for early lung cancer detection and treatment. Traditionally, management strategies have relied on baseline measurements and follow-up imaging.
The PanCan nodule management protocol utilizes a risk-based approach for triaging participants at the point of screening entry. The model potentially simplifies management by reducing the need for frequent low-dose CT scans when prior imaging is unavailable and is unique in its use for biennial screening triage. LungRADSv1.1 is a quality assurance tool designed to standardize lung cancer screening CT reporting and management recommendations as well as reduce confusion in lung cancer screening CT interpretations and facilities outcome monitoring.
Study Methods and Results
In the study, investigators evaluated 4,494 participants from the International Lung Screen Trial who had baseline low-dose CT scans between August 2016 and July 2021 and who either completed at least 2 years of follow-up or had a confirmed lung cancer diagnosis. The participants were managed according to the PanCan nodule management protocol, and their outcomes were compared with the LungRADSv1.1 approach. Lung cancer diagnoses were tracked until May 30, 2024. The investigators then compared the risk categories for both protocols and assessed cancer detection rates and stage distribution at 12 and 24 months.
Among the study participants, lung cancer was detected in 184 patients over a mean follow-up period of 57.9 months, with 109 cases identified within the first 2 years. Compared with the LungRADSv1.1 approach, the PanCan protocol was associated with fewer referrals for diagnostic workup at screening entry (2.8% vs 7.4%) and demonstrated a greater positive predictive value for malignancy in high-risk categories (48.0% vs 18.1%, P < .00001).
Further, compared with the PanCan protocol, the LungRADSv1.1 approach required 2.63 times as many positive scans to find the same number of lung cancer cases. The proportion of stage I disease at 12 and 24 months was similar between the two approaches. Notably, the PanCan protocol enabled triage for 75% of the participants with a lower risk of lung cancer to biennial screening, resulting in 3,381 fewer low-risk CT scans without compromising the lung cancer stage distribution. The protocol also reduced the number of participants who required specialist referral for diagnostic workup of suspicious lesions.
Conclusions
The investigators emphasized that the PanCan protocol showed improved risk stratification and reduced the number of low-dose CT scans necessary.
“This approach shows improved identification of low- and high-risk [patients], and our findings suggest that adopting the PanCan protocol could streamline lung cancer screening and management processes,” concluded lead study author Annette McWilliams, MBBS, FRACP, PhD, of the Fiona Stanley Hospital in Australia.
Disclosure: For full disclosures of the study authors, visit cattendee.abstractsonline.com.
