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Interpretation |
Management |
| Aberle 2011 |
Positive scan: findings suspicious of lung cancer, such as non‐calcified nodule ≥ 4 mm, lung consolidation, or obstructive atelectasis, nodule enlargement, and nodules with suspicious changes in attenuation |
No trial‐wide algorithm |
| Becker 2020 |
Positive scan: any nodule ≥ 5 mm |
No abnormality or nodule < 5 mm: routine screening Nodules 5 mm to 7 mm: early recall (6 months) Nodules 8 mm to 10 mm: earlier recall (3 months) Nodules > 10 mm: immediate recall
On recall scans
> 600 VDT: back to routine scans 400 VDT to 600 VDT: 6 months early recall < 7.5 mm: early recall 6 months ≥ 7.5 mm to 10 mm: early recall at 3 months ≤ 400 VDT or > 10 mm diameter: immediate recall
|
| Blanchon 2007 |
Positive scan: non‐calcified nodule > 5 mm |
If no change: repeat scan at 6 months, 12 months and 24 months from baseline. If growth at any time: histological diagnosis.
|
| De Koning 2020 |
Classification of non‐calcified nodules:
NODCAT 1: benign nodule (fat/benign calcifications) or other benign characteristics NODCAT 2: any nodule, smaller than NODCAT 3 and no characteristics of NODCAT 1 NODCAT 3: solid (500 mm3 to 500 mm3), solid/pleural based (5 mm dmin to 10 mm dmin), partial solid/non‐solid component (≥ 8 mm dmean), partial solid/solid component (50 mm3 to 500 mm3), non‐solid (≥ 8 mm dmean) NODCAT 4: solid (> 500 mm3), solid/pleural based (> 10 mm dmin), partial solid/solid component (> 500 mm3)
Classification of nodules based on growth:
GROWCAT A: VDT > 600 days GROWCAT BL: VDT 400 days to 600 days GROWCAT C: VDT< 400 days or a new solid component in a non‐solid lesion
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Management of non‐calcified nodules based on baseline screening
NODCAT 1: negative test, annual CT NODCAT 2: negative test, annual CT NODCAT 3: indeterminate test, 3‐month follow‐up CT NODCAT 4: positive test, refer to pulmonologist for work up and diagnosis GROWCAT: positive test, histological diagnosis
Management protocol for non‐calcified nodules at incidence screening
NODCAT 1: negative test, CT in year 4 NODCAT 2: indeterminate test, CT in year 3 NODCAT 3: indeterminate test, CT after 6‐8 weeks NODCAT 4: positive test, work up for work up and diagnosis GROWCAT C‐ positive test, histological diagnosis required
At year 4
NODCAT 1: negative test, CT in year 6 NODCAT 2: indeterminate test, CT after 1 year NODCAT 3: indeterminate test, CT after 6‐8 weeks NODCAT 4: positive test, refer to pulmonologist GROWCAT A: negative test, CT in year 6 GROWCAT B: indeterminate test, repeat CT after 1 year GROWCAT C: positive test, refer to pulmonologist
At year 6
NODCAT 1: negative test, end of screening NODCAT 2: indeterminate test, end of screening NODCAT 3: indeterminate test, CT after 6‐8 weeks NODCAT 4: positive test, refer to pulmonologist for work up and diagnosis GROWCAT A: negative test, end of screening GROWCAT B: indeterminate screening, CT after 1 year GROWCAT C: positive test, refer to pulmonologist
Preoperative biopsy was not routine.
Suspicious nodules were removed by VATS or thoracotomy with wedge resection+frozen section.
Lobectomies were performed only for central nodules that could not be approached by wedge resection.
If cancer was diagnosed by VATS, the procedure was converted to an open thoracotomy with sampling of lobar, interlobar, hilar and mediastinal lymph nodes as VATS resection in lung cancer was not fully implemented at the time of trial in the Netherlands. Mediastinoscopy was performed before proceeding to VATS or thoracotomy in subjects with mediastinal lymph nodes > 10 mm in short axis and/or positive nodes. |
| Field 2021 |
Classification of nodules:
Cat 1: nodules containing fat or with a benign pattern of calcification are considered benign. Solid nodules < 15 mm3 or if pleural or juxta pleural < 3 mm3. Cat 2: solid intraparenchymal nodules with a volume of 15 mm3 to 49 mm3. Pleural or juxta pleural nodules with a maximal diameter of 3.1 mm to 4.9mm. Part solid nodules with a maximal non‐solid component of < 5 mm diameter or where the solid component volume is < 15 mm3. Cat 3: solid intraparenchymal nodules with a volume of 50 mm3 to 500 mm3. Pleural or juxtapleural nodules with a maximal diameter of 5 mm to 9.9 mm. Non‐solid nodules with a maximal diameter of > 5 mm or part solid nodules where solid component volume is 15 mm3 to 500 mm3. Cat 4: solid intraparenchymal nodules with a volume > 500 mm3, pleural or juxtapleural nodules with a maximal diameter of ≥ 10 mm. Part solid nodules with a solid component with a volume > 500 mm3.
|
Cat 1: nil further scans Cat 2: follow‐up CT in 1 year and assessed for VDT or new solid component in non‐solid nodule If no growth, stop follow‐up If growth, for MDT Cat 3: follow‐up CT in 3 months and assessed for VDT or new solid component in non‐solid nodule. If no growth then CT in 9 months If VDT > 400 days, stop follow‐up If VDT ≤ 400 days then MDT assessment If growth then MDT assessment 4. Cat 4: MDT assessment |
| Gohagan 2005 |
Other abnormalities could also be considered suspicious for lung cancer at the discretion of the radiologist. |
No trial‐wide algorithm for management
Telephone call to patient with positive test and urged to seek medical follow‐up with additional follow‐up calls at 4 weeks +/‐ 8 weeks if follow‐up had not begun at the 4‐week phone call Referrals to specialists for follow‐up of positive screening; results were provided if requested by the participant
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| Infante 2015 |
Positive scan: non‐calcified pulmonary nodules ≥ 10 mm in diameter or smaller but showing spiculated margins, or non‐nodular lesions such as a hilar mass, focal ground glass opacities, major atelectasis, endobronchial lesions, mediastinal adenopathy, pleural effusion or pleural masses
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No set trial‐wide algorithm for management
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If lesion smooth and < 10 mm in size: LDCT at 3, 6, and 12 months
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Non‐smooth lesion ≥ 6 mm but ≤ 10 mm: oral antibiotics and new HRCT after 6 to 8 weeks
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Lesion ≥ 10 mm but ≤ 20 mm: oral antibiotics and new HRCT after 6 to 8 weeks
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Lesion ≥ 20 mm: discretional oral antibiotics and new HRCT or standard CT + PET
Focal ground glass opacities: oral antibiotics and new HRCT after 6 to 8 weeks. Evaluation on case‐by‐case basis as to opportunity to follow lesion or obtain tissue diagnosis based on the size, number of lesions, location and ratio of any solid versus non‐solid component
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| LaRocca 2002 |
|
Abnormal mass > 10 mm in diameter or 5 mm to 10 mm in diameter and highly suspicious for malignancy: CXR and tissue diagnosis is obtained If the abnormal mass ≤ 10 mm in diameter: thin section high resolution image of the mass is obtained If this image is normal or benign, annual spiral CT scanning is continued. If the image is indeterminate, a repeat high‐resolution scan is performed in 3 months. If the image is unchanged at 3 months, annual spiral CT scanning is continued. If the mass is larger at 3 months: CXR and tissue diagnosis is performed. |
| Paci 2017 |
|
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Solid non‐calcified nodule ≥ 8mm and non‐solid non‐calcified nodule > 10 mm: PET
If PET positive: FNA recommended (if FNA negative or indeterminate: 3 month follow‐up scan) If PET negative: 3 month follow‐up scan All cases with no nodule growth at follow‐up exam were invited to annual repeat CT scan
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Solid or part‐solid non‐calcified nodules with diameter between 5 mm to 7 mm: follow‐up dose LDCT after 3 months
If significant growth (increase ≥ 1 mm in mean diameter in a solid nodule or increase of solid component in a part solid nodule): considered potentially malignant If considered potentially malignant and peripheral nodule, FDG PET or CT‐guided FNA arranged If considered potentially malignant and deep nodule, FDG PET or bronchoscopy arranged. Bronchoscopy also performed for airway abnormalities
If screening test revealed focal abnormalities consistent with inflammatory disease: antibiotic therapy and 1 month follow‐up CT recommended In case of complete resolution, the subject was sent to annual repeat screening In case of partial or lack of resolution, further 2‐month follow‐up CT performed All subjects with FNA evidence of malignancy underwent a staging CT (CT chest/abdominal/head and neck exam with IV contrast).
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| Pastorino 2012 |
Negative nodule: non‐calcified nodule < 60 mm3 or nodules with fat or benign pattern of calcification Indeterminate: non‐calcified nodules 60 mm3 to 250 mm3 Positive result: non‐calcified nodules > 250 mm3 Positive result was also based on findings such as non‐calcified hilar or mediastinal lymphadenopathy, atelectasis, consolidation, pleural findings |
Solid lesions < 60 mm3 in volume (diameter ≥ 4.8 mm) considered: repeat LDCT for 1 or 2 years Nodules with a volume of 60 mm3 to 250 mm3 (5 mm to 8 mm in diameter): underwent repeat CT exam after 3 months Nodules with a volume > 250 mm3: additional work‐up including PET or lung biopsy -
Volumetric growth was used on serial imaging with significant growth considered ≥ 25% after 3‐month interval
Ground glass opacities were conservatively managed. |
| Wille 2016 |
Category 1: nodules ≤ 15 mm in maximal diameter with benign characteristics or ≤ 20 mm for calcified nodules Category 2: nodules < 5 mm Category 3: nodules 5 mm to 15 mm not classified as benign Category 4: nodules > 15 mm or suspicious morphology Category 5: growing nodules (increase in volume ≥ 25%) |
Category 1 and 2: nil further action Category 3: indeterminate: repeat scan in 3 months Category 4 and 5: diagnostic investigation |
