Perspectives and limitations of Lung-RADS in different target populations: the power of systematic review and meta-analysis

Excerpt

With tobacco control policies remaining largely ineffective, lung cancer is still the leading cause of cancer and mortality, with almost 1 in 5 cancer deaths worldwide [1]. Lung cancer screening is a way to address this problem, with the findings of the National Lung Screening Trial (NLST) showing that screening with low-dose computed tomography (LDCT) can produce a 20% decline in deaths due to lung cancer [2]. Based on these findings, as well as the interval results of the European Nederlands-Leuvens Longkanker Screenings Onderzoek trial (NELSON) and the reports from the International Early Lung Cancer Action Program (I-ELCAP), in 2014, the American College of Radiology proposed the Lung Imaging Reporting and Data System (Lung-RADS) Version 1.0 to provide an effective standardized reporting format for LDCT, together with recommendations for their management [3]. Notably, the criteria of the NLST and Lung-RADS Version 1.0 differed in how a nodule identified through LDCT should be classed as positive, rising from 4 mm (greatest diameter) in NLST to 6 mm (average diameter) in Lung-RADS. This considerably reduced the false-positive rate while leaving the false-negative rate unaffected. …