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Analysis of the Predictive Positive Value of Invasive Diagnostic Testing when Performed in a Lung Cancer Screening Program
Jiatian Qu, Stephanie L. Scarlett, Brian R. Lace, Danielle J. Smith, Nicole M. Larson, Allen M. Rakers, Richard F. Kucera, Ankur Puri, Chuanxing Qu, Michael F. Szwerc.
Excela Health, Greensburg, PA, USA.

OBJECTIVE: Lung cancer screening with low-dose computed tomography (LDCT) has been shown to reduce mortality rates from lung cancer in eligible patients. Previous studies have shown that LDCT screening can have a low Predictive Positive Value (PPV). We sought to determine the LDCT PPV and other related outcome data in this analysis.
METHODS: Retrospective analysis was conducted with LDCT-eligible patients from May 2016 through December 2020. All scans were interpreted using Lung-RADS and DynaCAD analysis. All invasive diagnostic procedures were analyzed for outcome, complications, and efficacy.
RESULTS: A total of 4043 patients were screened for lung cancer using LDCT. Of the 9591 scans completed (4043 new and 5548 follow-up), 196 diagnostic procedures were performed as part of the lung screening program. 140 of those procedures resulted in confirmed cancer diagnoses, with a PPV of 71.4% (95% CI, 65.1% to 77.8%).
CONCLUSIONS: This study demonstrates the ability of regional lung centers to use LDCT programs to accurately and safely diagnose cancer. The PPV of this study is greater than those of previous literature. High PPVs mean a reduction in the number of unnecessary invasive procedures. Future studies explore ways to maximize the utility of invasive diagnostic studies in LDCT-eligible patients.


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