Lung Cancer Screening With Low-dose Computed Tomography And Chest Radiography In A Smoking Or Asbestos-exposed Population: A Systematic Review And Meta-analysis

Background:Low-dose computed tomography (LDCT) is capable to detect early stage lung cancers in asymptomatic individuals, particularly in a high-risk population. To compare the diagnostic accuracy of low-dose computed tomography (LDCT) and chest radiography (CXR) for lung cancer screening in a smoking or asbestos- exposed population, a systematic review and meta-analysis is necessary.Methods:Computerized search of MEDLINE/PubMed, Elsevier ScienceDirect and Cochrane Library databases and reference lists of retrieved studies. We identified studies that involved both LDCT and CXR for lung cancer screening in a high-risk population and provided enough data for analysis. Five studies included 7739 asymptomatic participants met inclusion criteria. We performed a systematic review and meta-analysis of the baseline results of the five studies by the Review Manager 5. Analysis was used to determine whether data was for or against the screening of lung cancers using LDCT.Results:Compared with CXR, LDCT got significantly higher rate of non-calcified nodules (NCN) (24.3% vs 5.50%, RR=5.28,95% confidence interval (CI):2.58-10.77, P< 0.00001), thus of more total lung cancers (1.56% vs 0.38%, RR=4.06,95% CI:2.53-6.54, P<0.00001) and stageâ… lung cancers (1.08% vs 0.273%, RR=3.93,95% CI:2.64-6.91, P< 0.00001), and adenocarcinoma constitutes 0.72 of the total detected lung cancers (95% CI: 0.52-1.00) in LDCT arm. Although screening with LDCT also resulted in a higher false-positive rate than CXR (23.1% vs 5.15%, RR=5.43,95% CI:2.54-11.60, P< 0.0001), only a small proportion of benign lesions underwent unnecessary biopsies in LDCT arms (RR=0.34,95% CI:0.24-0.47, P<0.00001)Conclusions:LDCT was superior to CXR in screening and detection of lung cancers in high-risk individuals. LDCT is potential to reduce lung cancer mortality by detecting more early and resectable lung cancers. Although false-positive results are common, they can be managed with little use of invasive diagnostic procedures. Background:Low-dose computed tomography (LDCT) is capable to detect early stage lung cancers in asymptomatic individuals, particularly in a high-risk population. To compare the diagnostic accuracy of low-dose computed tomography (LDCT) and chest radiography (CXR) for lung cancer screening in a smoking or asbestos-exposed population, a systematic review and meta-analysis is necessary.Methods:Computerized search of MEDLINE/PubMed, Elsevier ScienceDirect, OvidSP and Cochrane Library databases and reference lists of retrieved studies. We identified studies that involved both LDCT and chest radiography (CXR) for lung cancer screening in a high-risk population and provided enough data for analysis. Five studies included 7739 asymptomatic participants met inclusion criteria. We performed a systematic review and meta-analysis of the baseline results of the five studies to determine whether data was for or against the screening of lung cancers using LDCT.Results:Compared with CXR, LDCT got significantly higher rate of total lung cancers (1.56% vs 0.38%, RR=4.06,95% confidence interval (CI):2.53-6.54, P< 0.00001) and stage I lung cancers (1.08% vs 0.273%, RR=3.93,95% CI:2.64-6.91, P< 0.00001), and adenocarcinoma constitutes 0.72 of total detected lung cancers (95% CI:0.52-1.00) in LDCT arm. Although screening with LDCT also resulted in a higher false-positive rate than CXR (23.1% vs 5.15%, RR=5.43,95% CI:2.54-11.60, P< 0.0001), only a small proportion of benign lesions underwent unnecessary biopsies in LDCT arms (RR=0.34,95% CI: 0.24-0.47, P< 0.00001).Conclusions:LDCT was superior to CXR in screening and detection of lung cancers in high-risk individuals. LDCT reduced lung cancer mortality by detecting more early and resectable lung cancers. Although false-positive results are common, they can be managed with little use of invasive diagnostic procedures.