In a commercially insured population of patients, rates of subsequent testing, including imaging and diagnostic procedures, following lung cancer screening with the use of low-dose computed tomography (LDCT) are low, according to study results published in the journal CHEST.
A retrospective analysis was conducted using the Clinformatics Data Mart database — one of the nation’s largest commercial health insurance databases, with >18,000,000 enrollees — from July 1, 2014, through December 31, 2017.
Investigators sought to describe rates of follow-up imaging and diagnostic procedures following the use of screening with LDCT in the community setting. The cohort of patients evaluated in this analysis included beneficiaries between 55 and 80 years of age who underwent LDCT lung cancer screening between January 1, 2016, and December 31, 2016, and had complete insurance enrollment in the year prior to receipt of the initial LDCT screening.
The researchers evaluated rates of diagnostic chest CT, magnetic resonance imaging, and positron emission tomography, as well as follow-up procedures, including bronchoscopy, percutaneous biopsy, thoracotomy, mediastinoscopy, and thoracoscopy, in the 12 months after LDCT for lung cancer screening. The same rates were also evaluated by matching individuals who did not undergo LDCT according to age, sex, and number of comorbidities to estimate whether the rates were unrelated to the LDCT screening. The researchers then reported the adjusted rate of follow-up testing, which was defined as the observed rate in the screening LDCT population minus the rate in the non-LDCT population.
Among a total of 11,520 enrollees who underwent LDCT in 2016, adjusted rates of follow-up at 12 months after LDCT examinations were low (17.7% for imaging and 3.1% for procedures). Among the procedures that were evaluated, the adjusted rates were 2.0% for bronchoscopy, 1.3% for percutaneous biopsy, 0.9% for thoracoscopy, 0.2% for mediastinoscopy, and 0.4% for thoracotomy. Overall, the adjusted rates of follow-up procedures were higher among enrollees who underwent an initial screening with LDCT (3.3%) than among those following a second screening examination (2.2%).
The investigators concluded that rates of subsequent testing following LDCT in the community are low. Without additional detailed clinical information, however, the appropriateness of the follow-up testing in community practice and the downstream outcomes of evaluation cannot be established. Future studies that explore larger populations of patients are warranted to validate these findings.
Nishi SPE, Zhou J, Okereke I, Kuo Y-F, Goodwin J. Use of imaging and diagnostic procedures after low dose computed tomography screening for lung cancer [published online September 12, 2019]. CHEST. doi:10.1016/j.chest.2019.08.2187