Surgical Outcomes in a Clinical CT Lung Screening Program
Bryan Walker1, Christina Williamson2, Shawn M. Regis2, Andrea B. McKee2, Brady J. McKee2, 1Tufts University School of Medicine, Boston, MA, 2Lahey Hospital and Medical Center, Burlington, MA
OBJECTIVE: To compare surgical outcomes in a clinical CT lung screening program to those reported in the National Lung Screening Trial (NLST).
METHODS: We retrospectively reviewed surgical outcomes of consecutive patients who underwent clinical CT lung screening exams from 1/2012 through 7/2014. All patients met the National Comprehensive Cancer Network (NCCN) Lung Cancer Screening Guidelines ® high-risk criteria. Exams were interpreted by lung screening credentialed radiologists following v1.2012 of the NCCN Guidelines ® which applied NLST positive thresholds. Rates and types of surgeries, histologies, and complications are presented and compared to those reported in the NLST.
RESULTS: 2290 patients underwent CT lung screening during the study interval; no follow-up was available in 636. 25 of 1654 (1.5%) with clinical follow-up at our institution underwent surgical intervention vs 2.8% in the NLST. Twenty-one underwent video-assisted thoracoscopic surgery: lobectomy (15), segmentectomy (1), wedge resection (5). Three underwent thoracotomy: lobectomy (2), wedge resection (1). Twelve underwent mediastinoscopy. Five of twenty-five (20%) resulted in non-lung cancer diagnoses: two harmatomas, two necrotizing granulomas, and one breast cancer metastasis, yielding a prescreening risk of non-lung cancer diagnosis following surgery of 0.30% (5/1654) vs 0.63% in the NLST. Twenty (80%) were found to have lung cancer for a malignancy rate of 1.2% (20/1654). Eighteen cancers were early stage (12=IA, 1=IB, 5=IIA); two were late stage (1=cIIIA, 1=IV). The 60-day major surgical complication rate was 4% (1/25) vs 11.9% in the NLST.
CONCLUSIONS: Surgical outcomes in our clinical CT lung screening program are similar to those reported in the NLST.