Overestimation of screening-related complications in the National Lung Screening Trial.
complications
invasive procedures
lung cancer
pulmonary nodules
screening
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
15
06
2022
revised:
09
10
2022
accepted:
28
10
2022
medline:
17
7
2023
pubmed:
13
12
2022
entrez:
12
12
2022
Statut:
ppublish
Résumé
Lung cancer screening-associated complications are often quoted as one of the major barriers for wider screening adoption. A detailed analysis of the National Lung Screening Trial dataset was performed to extrapolate the safety of lung cancer screening. Lung cancer screening-associated invasive procedures and their related complications were analyzed using the National Lung Screening Trial dataset. Factors associated with 90-day postprocedure complications per patient were analyzed with logistic-regression multivariable analysis. Major complications rate in patients undergoing low-dose computed tomography screening who were diagnosed with lung cancer was 10.2% compared with only 0.04% for patients without lung cancer. Low-dose computed tomography screening, compared with chest radiography, led to major complications in an excess of only 3.5 per 10,000 patients without lung cancer. Among 25,633 patients without lung cancer who underwent low-dose computed tomography screening, 45 developed 90-day postprocedure complications (71 total complications). The most common were pneumothorax (n = 29; 41%), postprocedure hospitalization (n = 6; 8.5%), and infection/fever requiring antibiotics (n = 5; 7%). Cardiac/respiratory arrest occurred in less than 1 in 10,000 low-dose computed tomography-screened patients without lung cancer. On multivariable analysis, pulmonary comorbidity (confidence interval, 1.00-3.37) and procedure type (thoracoscopy [confidence interval, 2.04-10.64] or thoracotomy [confidence interval, 2.38-8.93]) were associated with postprocedure complications in patients without lung cancer. Randomization arm (low-dose computed tomography vs chest x-ray) was not a significant factor (confidence interval, 0.89-1.37). It is more informative to report procedural complications in patients not found to have cancer as the true screening-associated risk. Only 4 in 10,000 of patients undergoing low-dose computed tomography screening but not found to have lung cancer will have major complications. Permanent or debilitating complications are exceedingly rare.
Sections du résumé
BACKGROUND
BACKGROUND
Lung cancer screening-associated complications are often quoted as one of the major barriers for wider screening adoption. A detailed analysis of the National Lung Screening Trial dataset was performed to extrapolate the safety of lung cancer screening.
METHODS
METHODS
Lung cancer screening-associated invasive procedures and their related complications were analyzed using the National Lung Screening Trial dataset. Factors associated with 90-day postprocedure complications per patient were analyzed with logistic-regression multivariable analysis.
RESULTS
RESULTS
Major complications rate in patients undergoing low-dose computed tomography screening who were diagnosed with lung cancer was 10.2% compared with only 0.04% for patients without lung cancer. Low-dose computed tomography screening, compared with chest radiography, led to major complications in an excess of only 3.5 per 10,000 patients without lung cancer. Among 25,633 patients without lung cancer who underwent low-dose computed tomography screening, 45 developed 90-day postprocedure complications (71 total complications). The most common were pneumothorax (n = 29; 41%), postprocedure hospitalization (n = 6; 8.5%), and infection/fever requiring antibiotics (n = 5; 7%). Cardiac/respiratory arrest occurred in less than 1 in 10,000 low-dose computed tomography-screened patients without lung cancer. On multivariable analysis, pulmonary comorbidity (confidence interval, 1.00-3.37) and procedure type (thoracoscopy [confidence interval, 2.04-10.64] or thoracotomy [confidence interval, 2.38-8.93]) were associated with postprocedure complications in patients without lung cancer. Randomization arm (low-dose computed tomography vs chest x-ray) was not a significant factor (confidence interval, 0.89-1.37).
CONCLUSIONS
CONCLUSIONS
It is more informative to report procedural complications in patients not found to have cancer as the true screening-associated risk. Only 4 in 10,000 of patients undergoing low-dose computed tomography screening but not found to have lung cancer will have major complications. Permanent or debilitating complications are exceedingly rare.
Identifiants
pubmed: 36503729
pii: S0022-5223(22)01239-9
doi: 10.1016/j.jtcvs.2022.10.051
pii:
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
336-344.e2Informations de copyright
Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.