Results of the Two Incidence Screenings in the National Lung Screening Trial
T h e new engl and journa l o f medicine
n engl j med 369;10 nejm.org 920 september 5, 2013
The National Lung Screening Trial was conducted to determine whether three an- nual screenings (rounds T0, T1, and T2) with low-dose helical computed tomogra- phy (CT), as compared with chest radiography, could reduce mortality from lung cancer. We present detailed f indings from the f irst two incidence screenings (rounds T1 and T2).
We evaluated the rate of adherence of the participants to the screening protocol, the results of screening and downstream diagnostic tests, features of the lung-cancer cases, and f irst-line treatments, and we estimated the performance characteristics of both screening methods.
At the T1 and T2 rounds, positive screening results were observed in 27.9% and
16.8% of participants in the low-dose CT group and in 6.2% and 5.0% of partici- pants in the radiography group, respectively. In the low-dose CT group, the sensitiv- ity was 94.4%, the specif icity was 72.6%, the positive predictive value was 2.4%, and the negative predictive value was 99.9% at T1; at T2, the positive predictive value increased to 5.2%. In the radiography group, the sensitivity was 59.6%, the specif ic- ity was 94.1%, the positive predictive value was 4.4%, and the negative predictive value was 99.8% at T1; both the sensitivity and the positive predictive value in- creased at T2. Among lung cancers of known stage, 87 (47.5%) were stage IA and
57 (31.1%) were stage III or IV in the low-dose CT group at T1; in the radiography group, 31 (23.5%) were stage IA and 78 (59.1%) were stage III or IV at T1. These differences in stage distribution between groups persisted at T2.
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