Positive Screens are More Likely in a National Lung Cancer Screening Registry than the National Lung Screening Trial

Tina D. Tailor; Roee Gutman; Na An; Richard M. Hoffman; Caroline Chiles; Ruth C. Carlos; JoRean Sicks; Ilana F. Gareen

doi:10.1016/j.jacr.2025.02.012

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Positive Screens are More Likely in a National Lung Cancer Screening Registry than the National Lung Screening Trial

Journal article

Peer reviewed

Positive Screens are More Likely in a National Lung Cancer Screening Registry than the National Lung Screening Trial

Tina D. Tailor, Roee Gutman, Na An, Richard M. Hoffman, Caroline Chiles, Ruth C. Carlos, JoRean Sicks and Ilana F. Gareen

Journal of the American College of Radiology, Vol.22(6), pp.644-652

06/2025

DOI: 10.1016/j.jacr.2025.02.012

PMCID: PMC12133422

PMID: 40023436

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Abstract

While lung cancer screening (LCS) with low dose chest CT (LDCT) is recommended for high-risk populations, little is known about how clinical screening compares with research trials. We compared Lung-RADS scores between a nationally screened population from the American College of Radiology’s (ACR) LCS Registry (LCSR) and the National Lung Screening Trial (NLST). This retrospective study included baseline LDCT exams from the LCSR and NLST. Patient characteristics (age, gender, smoking status, pack-years, and body mass index (BMI)) were obtained. NLST LDCT results were recoded to Lung-RADS version 1.1. A multivariable multinomial logistic model was used to examine variations in Lung-RADS scores by screening group (LCSR versus NLST) and patient characteristics. 686,011 and 26,432 participants from the LCSR and NLST, respectively, were included. Compared to the NLST, the LCSR population was older (mean age (SD): 64.0 (5.4) versus 61.4 (5.0) years), p<0.001), included more females (47.9% versus 40.9%, p<0.001), and more likely to be currently smoking (61.5% versus 48.1%, p<0.001). After adjusting for age, gender, smoking history, and BMI, the LCSR population was more likely to have higher Lung-RADS scores than the NLST (adjusted odds ratio (aOR) and 95%CI >1 for Lung-RADS scores 2, 3, 4A, 4B, 4X relative to Lung-RADS 1). Lung-RADS scores in clinical LCS are higher than in the NLST, even after adjusting for known confounders such as age and smoking. This would imply higher rates of follow-up testing after LCS and potentially higher cancer rates in the clinically screened population than the NLST.

Lung Cancer

Low dose chest CT

Lung cancer screening

Pulmonary nodule

Thoracic oncology

Details

Title: Subtitle: Positive Screens are More Likely in a National Lung Cancer Screening Registry than the National Lung Screening Trial
Creators: Tina D. Tailor - Duke University Health System
Roee Gutman - Brown University
Na An - Brown University
Richard M. Hoffman - University of Iowa
Caroline Chiles - Atrium Health Wake Forest Baptist
Ruth C. Carlos - University of Michigan
JoRean Sicks - Brown University
Ilana F. Gareen - Brown University
Resource Type: Journal article
Publication Details: Journal of the American College of Radiology, Vol.22(6), pp.644-652
DOI: 10.1016/j.jacr.2025.02.012
PMID: 40023436
PMCID: PMC12133422
NLM abbreviation: J Am Coll Radiol
ISSN: 1546-1440
eISSN: 1558-349X
Publisher: Elsevier Inc
Grant note: NIH NCI: 1R01CA215240
ACKNOWLEDGMENTS This work was funded by NIH NCI: 1R01CA215240 (principal investigator: I.F.G.) .
Language: English
Electronic publication date: 02/27/2025
Date published: 06/2025
Academic Unit: General Internal Medicine; Internal Medicine
Record Identifier: 9984798227202771

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