Personalised Model Helps Determine Lung Nodule Follow-Up - EMJ

Personalised Model Helps Determine Lung Nodule Follow-Up

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A PERSONALISED model for lung cancer screening has proven helpful for clinicians when determining how to follow up patients with pulmonary nodules identified on low-dose CT. The model may be more effective than rule-based protocols, according to recent research conducted by Zixing Wang, Peking Union Medical College, Beijing, China, and colleagues. Up to half of the individuals screened for lung cancer have at least one pulmonary nodule, and determining the optimal time for follow-up testing of these nodules can be a challenge, meaning an improved follow-up process is required.  

In order to improve this process, the team developed and validated a modelling schema for predicting lung cancer using data from 1,809 patients in the National Lung Screening Trial (NLST) between the ages of 55–74 years with pulmonary nodules. In this group, 1,206 individuals were used for the development of the schema and 603 for its validation. Predictors used in the model included age, obesity, family history of lung cancer, smoking pack-years, and nodule information. Researchers assessed patients’ cancer risk profiles at baseline and at two follow-up screening rounds, one at 3 months after initial screening and another at 12 months. 

Overall, the team found that the personalised model showed an area under the receiver operating curve for predicting 12-month lung cancer onset of 0.87 at baseline screening, and 0.81 at 12-month follow-up. Rates of delayed diagnosis and over-testing were also significantly improved when using the personalised model.  

The team concluded that their personalised schema is easy to implement and is more accurate than rule-based protocols. “Benefits of early diagnosis and treatment of cancer largely depend on criteria and frequency of follow-up examinations. However, these benefits are often offset by high over-testing rates, resource waste, complications, and mental stress,” commented the authors, emphasising the importance of their findings. More research is needed to examine the model’s value in precision screening for lung cancer in diverse populations and settings.  



Wang Z et al. Personalised follow-up and management schema for patients with screen-detected pulmonary nodules: a dynamic modelling study. Pulmonology. 2024; DOI:10.1016/j.pulmoe.2024.02.010.  

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