Why radiologists should consider earlier follow-up imaging for many Lung-RADS cases
Scheduling follow-up exams for probably benign lung nodules one month earlier than current guidelines recommend leads to better health outcomes, according to data published Thursday, Aug. 19.
The American College of Radiology’s Lung CT Screening and Reporting Data System was developed primarily to reduce false positives and standardize radiologists’ reporting. While successful, there has been little research into Lung-RADS follow-up guidance, experts explained in JACR.
New evidence out of Stanford suggests providers may want to consider ordering follow-up CTs for probably benign nodules earlier than is currently suggested. Doing so reduced mortality rates and prevented more deaths, among other health benefits, Sylvia K. Plevritis, PhD, of Stanford University’s Department of Radiology, and colleagues found.
“By evaluating different intervals for diagnostic follow-ups of indeterminate cases through microsimulation analysis, we found that three months remains the optimal interval for Lung-RADS category 4A, aligning with existing guidelines; however, we also found that five-month intervals for category 3 (compared with current six-month intervals) yields improved health outcomes, thereby diverging from current guidelines,” the authors added.
For their study, Plevritis et al. utilized the Lung Cancer Outcome Simulator to assess population-level outcomes of alternative follow-up times for Lung-RADS nodules. The microanalysis is based on U.S. Preventative Services Task Force lung screening guidelines for men and women born in 1960.
Utilizing five month follow-up for Lung-RADS 3 reduced mortality by 0.08% in men and 0.05% among women. Earlier care also averted deaths (36 male vs. 27 female), yielded more screen-detected cases (13 vs. 7, respectively) and lowered the number of combined low-dose CTs per 1 million people.
The authors reported similar results after testing their approach using National Lung Screening Trial and Centers for Medicare & Medicaid Services screening strategies.
One big question remains: Will the health benefits of early screening justify potential cost increases related to earlier diagnoses? More research will be needed to figure this out, the group noted.
“Further comparative cost-effectiveness analysis using trial data or simulated population are required to evaluate the impact of alternative diagnostic follow-up on cost-effectiveness analysis,” Plevritis and co-authors concluded.
Read the full study here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.