New data presented today reveals that the PanCan nodule management protocol demonstrates superior performance in triaging lung cancer screening participants compared to the LungRADSv1.1 approach. Specifically, PanCan showed improved risk stratification and reduced the number of low-dose computed tomography(CT) scans required.
The research was reported by Dr. Annette McWilliams, Fiona Stanley Hospital, Australia at the International Association for the Study of Lung Cancer 2024 World Conference on Lung Cancer.
The PanCan nodule protocol utilises a risk-based approach for triaging participants at the point of screening entry. This model potentially simplifies management by reducing the need for frequent LDCT scans when prior imaging is unavailable. Lung-RADS is a quality assurance tool designed to standardized lung cancer screening CT reporting and management recommendations, reduce confusion in lung cancer screening CT interpretations and facilities outcome monitoring.
Effective management of pulmonary nodules detected through low-dose computed tomography screening is crucial for early lung cancer detection and treatment. Traditionally, management strategies have relied on baseline measurements and follow-up imaging. The PanCan approach, unique in its use for biennial screening triage, was compared to the LungRADSv1.1 approach in this study.
This study evaluated participants from the International Lung Screen Trial who had baseline LDCT scans between August 2016 and July 2021, and who either completed at least two years of follow-up or had a confirmed lung cancer diagnosis. Participants were managed according to the PanCan protocol, and their outcomes were compared to the LungRADSv1.1 approach. The analysis included a total of 4,494 participants, with cancer diagnoses tracked until May 30, 2024. The study compared the risk categories for both protocols and assessed cancer detection rates and stage distribution at 12 and 24 months.
Out of 4,494 participants, lung cancer was detected in 184 individuals over a mean follow-up period of 57.9 months, with 109 cases identified within the first two years. The PanCan protocol was associated with fewer referrals for diagnostic workup at screening entry (2.8% vs. 7.4% for LungRADSv1.1) and demonstrated a significantly better positive predictive value (PPV) for malignancy in high-risk categories (48.0% vs. 18.1%, P<0.00001). Compared to PanCan, the LungRADSv1.1 approach required 2.63 times as many positive scans to find the same number of lung cancers. The proportion of Stage I disease at 12 and 24 months was similar between the two approaches. Notably, the PanCan protocol enabled triage of 75% of participants with lower risk of lung cancer to biennial screening, resulting in 3,381 fewer LDCT scans without compromising the lung cancer stage distribution. The protocol also reduces the number of participants who require specialist referral for diagnostic workup of suspicious lesions.
"This approach shows improved identification of low and high-risk individuals and our findings suggest that adopting the PanCan protocol could streamline lung cancer screening and management processes," said Dr. McWilliams.
About the IASLC:
The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer and other thoracic malignancies. Founded in 1974, the association's membership includes more than 10,000 lung cancer specialists across all disciplines in over 100 countries, forming a global network working together to conquer lung and thoracic cancers worldwide. The association also publishes the Journal of Thoracic Oncology, the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis, and treatment of all thoracic malignancies. Visit www.iaslc.org
