Optimization of nodule management in CT lung cancer screening


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    Lung cancer is the leading cancer-related cause of death. Through computed tomography (CT) screening, cancer can be detected at the earliest stage, with a much greater probability of cure. After the positive outcome of the US National Lung Screening Trial (NLST), screening with low-dose CT in heavy (former) smokers is now being implemented in the US. An important disadvantage of this study, however, is the high number of false-positive screening results, about 27%, meaning that many individuals without lung cancer suffer from unnecessary follow-up scans, invasive investigations with complication risk, and fear of cancer.

    The Dutch-Belgian NELSON study used a screening protocol based on lung nodule volume, rather than diameter (NLST), and on growth rate expressed as volume-doubling time (VDT). This approach yields 10x fewer false-positive screening results and a better cancer detection rate. The aim of this thesis was to examine how the percentage of false-positive results can be reduced even further while maintaining reliable cancer detection.

    Management of screening-detected lung nodules can be optimized by semi-automatic volume measurements instead of manual diameter measurements: VDT can reliably quantify nodule growth, and optimized cut-off values for nodule volume and VDT can distinguish between negative, intermediate and positive screening results. For new nodules, more stringent guidelines are needed. Ultimately, the interpretation by the radiologist, who can deviate from the screening protocol, remains important to further improve the results. Mortality analysis of the NELSON trial is essential to decide whether lung cancer screening in Europe should be implemented (cite Editorial Lancet).
    Originele taal-2English
    KwalificatieDoctor of Philosophy
    Toekennende instantie
    • Rijksuniversiteit Groningen
    • Oudkerk, Matthijs, Supervisor
    • Groen, Harry, Supervisor
    • Vliegenthart, Rozemarijn, Supervisor
    Datum van toekenning21-dec.-2015
    Plaats van publicatie[Groningen]
    Gedrukte ISBN's978-90-367-8393-4
    Elektronische ISBN's978-90-367-8392-7
    StatusPublished - 2015

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