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Iaccarino JM, Silvestri GA, Wiener RS. Patient-level trajectories and outcomes after low-dose CT screening in the National Lung Screening Trial. Chest. 2019 Jul 5.
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Abstract: BACKGROUND: Shared decision-making is an essential element of low-dose computed tomography (LDCT) screening for lung cancer. Understanding patient-level outcomes from the National Lung Screening Trial (NLST) is critical to effectively communicate risks and benefits of screening to patients. METHODS: We performed a secondary analysis of data collected in the NLST. We determined outcomes of each individual LDCT performed in the NLST (downstream evaluation, complications, lung cancer diagnoses), and compared outcomes at the test-level to outcomes calculated at the patient-level for those randomized to LDCT screening. To assess impact of COPD on patient outcomes, we compared outcomes among patients with and without COPD. RESULTS: Of 75,138 LDCT scans, 14.2% led to a diagnostic study and 1.5% an invasive procedure, with 0.3% of LDCT scans resulting in procedure-related complication and 0.1% a serious complication. Among 24,453 patients who underwent LDCT screening, 30.5% underwent a diagnostic study and 4.2% an invasive procedure, with 0.9% of screened patients experiencing a procedure-related complication and 0.3% a serious complication. Patients with COPD (defined by self-report) were more likely to need a diagnostic study (aOR 1.29, p<0.01) and invasive procedure (aOR 1.41, p<0.01) and more likely to experience a complication (adjusted OR 1.83, p<0.01) and serious complication (aOR 1.78, p=0.01). Patients with COPD also were more likely to be diagnosed with lung cancer (aOR 1.43, p<0.01). CONCLUSIONS: We provide important patient-level data from the NLST that can be used to guide shared decision-making. The risk-benefit ratio of screening may vary significantly in some patients, such as those with COPD, in whom both risks and benefits of screening may be increased.