Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial.

Aged Belgium / epidemiology Cone-Beam Computed Tomography Early Detection of Cancer / methods False Positive Reactions Female Humans Incidence Lung Neoplasms / diagnostic imaging Male Medical Overuse Middle Aged Netherlands / epidemiology Registries Sex Factors Smoking / epidemiology

Journal

The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562

Informations de publication

Date de publication:
06 02 2020
Historique:
pubmed: 30 1 2020
medline: 19 2 2020
entrez: 30 1 2020
Statut: ppublish

Résumé

There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers. A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants. Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 (95% confidence interval [CI], 0.61 to 0.94; P = 0.01) in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 (95% CI, 0.38 to 1.14) at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9. In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580.).

Sections du résumé

BACKGROUND
There are limited data from randomized trials regarding whether volume-based, low-dose computed tomographic (CT) screening can reduce lung-cancer mortality among male former and current smokers.
METHODS
A total of 13,195 men (primary analysis) and 2594 women (subgroup analyses) between the ages of 50 and 74 were randomly assigned to undergo CT screening at T0 (baseline), year 1, year 3, and year 5.5 or no screening. We obtained data on cancer diagnosis and the date and cause of death through linkages with national registries in the Netherlands and Belgium, and a review committee confirmed lung cancer as the cause of death when possible. A minimum follow-up of 10 years until December 31, 2015, was completed for all participants.
RESULTS
Among men, the average adherence to CT screening was 90.0%. On average, 9.2% of the screened participants underwent at least one additional CT scan (initially indeterminate). The overall referral rate for suspicious nodules was 2.1%. At 10 years of follow-up, the incidence of lung cancer was 5.58 cases per 1000 person-years in the screening group and 4.91 cases per 1000 person-years in the control group; lung-cancer mortality was 2.50 deaths per 1000 person-years and 3.30 deaths per 1000 person-years, respectively. The cumulative rate ratio for death from lung cancer at 10 years was 0.76 (95% confidence interval [CI], 0.61 to 0.94; P = 0.01) in the screening group as compared with the control group, similar to the values at years 8 and 9. Among women, the rate ratio was 0.67 (95% CI, 0.38 to 1.14) at 10 years of follow-up, with values of 0.41 to 0.52 in years 7 through 9.
CONCLUSIONS
In this trial involving high-risk persons, lung-cancer mortality was significantly lower among those who underwent volume CT screening than among those who underwent no screening. There were low rates of follow-up procedures for results suggestive of lung cancer. (Funded by the Netherlands Organization of Health Research and Development and others; NELSON Netherlands Trial Register number, NL580.).

Identifiants

DOI: 10.1056/NEJMoa1911793 PMID: 31995683
pubmed: 31995683
doi: 10.1056/NEJMoa1911793
doi:

Banques de données

NTR
['NL580']

Types de publication

Journal Article Multicenter Study Randomized Controlled Trial

Langues

eng

Sous-ensembles de citation

IM

Pagination

503-513

Commentaires et corrections

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Informations de copyright

Copyright © 2020 Massachusetts Medical Society.

Auteurs

Harry J de Koning (HJ)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Carlijn M van der Aalst (CM)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Pim A de Jong (PA)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Ernst T Scholten (ET)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Kristiaan Nackaerts (K)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Marjolein A Heuvelmans (MA)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Jan-Willem J Lammers (JJ)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Carla Weenink (C)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Uraujh Yousaf-Khan (U)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Nanda Horeweg (N)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Susan van 't Westeinde (S)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Mathias Prokop (M)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Willem P Mali (WP)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Firdaus A A Mohamed Hoesein (FAA)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Peter M A van Ooijen (PMA)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Joachim G J V Aerts (JGJV)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Michael A den Bakker (MA)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Erik Thunnissen (E)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Johny Verschakelen (J)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Rozemarijn Vliegenthart (R)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Joan E Walter (JE)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Kevin Ten Haaf (K)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Harry J M Groen (HJM)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

Matthijs Oudkerk (M)

From the Departments of Public Health (H.J.K., C.M.A., U.Y.-K., K.H.) and Pulmonology (J.G.J.V.A.), Erasmus MC-University Medical Center Rotterdam, and the Departments of Pulmonology (S.W.) and Pathology (M.A.B.), Maasstad Hospital, Rotterdam, the Departments of Radiology (P.A.J., W.P.M., F.A.A.M.H.) and Pulmonology (J.-W.J.L.), University Medical Center Utrecht, Utrecht, the Departments of Radiology (E.T.S.) and Pulmonology (C.W.), Spaarne Gasthuis, Haarlem, the Department of Radiation Oncology, Leiden University Medical Center, Leiden (N.H.), the Faculty of Medical Sciences (M.A.H., J.E.W., M.O.), the Data Science Center in Health (P.M.A.O.), and the Departments of Radiology (R.V.) and Pulmonology (H.J.M.G), University of Groningen-University Medical Center Groningen, and the Institute for DiagNostic Accuracy (J.E.W., M.O.), Groningen, the Department of Radiology, Radboud University Medical Center, Nijmegen (M.P.), and the Department of Pathology, University Medical Center Amsterdam, Amsterdam (E.T.) - all in the Netherlands; and the Departments of Pulmonology (K.N.) and Radiology (J.V.), KU Leuven, University Hospital, Leuven, Belgium.

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