Subsequent risk of lung cancer in patients with positive low-dose CT screens and initial negative lung biopsy.

Authors

LeeVan E, Pinsky P

Affiliations

• 9609 Medical Center Drive, Rockville, MD 20850, United States. Electronic address: elyse.leevan@nih.gov.
• 9609 Medical Center Drive, Rockville, MD 20850, United States.

Abstract

INTRODUCTION: Lung cancer screening with low-dose CT (LDCT) has been shown to reduce lung cancer mortality. There is a paucity of literature, however, describing the relationship between negative lung biopsy in individuals following a positive screen and ultimate lung cancer incidence. To assess this question, we analyzed data from the National Lung Screening Trial (NLST).

MATERIALS AND METHODS: LDCT arm NLST participants receiving a negative biopsy after a positive screen were included in the negative biopsy cohort (NBC). Lung cancer incidence was calculated within this group overall, and by biopsy type (resection vs. non-resection). In individuals ultimately receiving a lung cancer diagnosis, the biopsy site (lobe) was compared to the cancer diagnosis site. A control cohort without lung biopsy was also compared to the NBC for lung cancer incidence.

RESULTS: Of 10,160 LDCT arm participants with positive screens, 410 were included in the NBC, 152 with resection biopsy and 258 with non-resection biopsy. Within the NBC, lung cancer incidence rates were elevated in the non-resection versus resection biopsy group (RR = 3.5; 95% CI:1.8-6.6). The majority of biopsy sites in the non-resection group were concordant with the sites of eventual cancer diagnosis, 62.7% (p < 0.001). Individuals in the NBC had greater lung cancer incidence than controls (RR = 1.6, 95% CI:1.2-2.2) but this relationship was driven by the non-resection biopsy group (RR = 2.2, 95% CI:1.5-3.3).

DISCUSSION: Clinicians should maintain a high index of suspicion for lung cancer in individuals with positive LDCT screens and negative non-resection biopsies and counsel patients accordingly.