National Lung Cancer Screening in Korea: Introduction and Imaging Quality Control

Hyae Young Kim

doi:10.3348/jksr.2019.80.5.826

Journal List > J Korean Soc Radiol > v.80(5) > 1134377

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim: National Lung Cancer Screening in Korea: Introduction and Imaging Quality Control

Review Article

J Korean Soc Radiol 2019;80(5):826-836.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.5.826

National Lung Cancer Screening in Korea: Introduction and Imaging Quality Control

Hyae Young Kim, MD^∗

Department of Diagnostic Radiology, National Cancer Center, Goyang, Korea

^∗Corresponding author Hyae Young Kim, MD Department of Diagnostic Radiology, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea. Tel 82-31-920-2638 Fax 82-31-920-2643 E-mail radhykim@ncc.re.kr

Received 3 May 2019 Revised 6 July 2019 Accepted 9 July 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Before the implementation of lung cancer screening as a national cancer screening program, the Korean Lung Cancer Screening Project was performed to evaluate its effectiveness and feasibility. A national lung cancer screening program with low-dose CT (LDCT) will begin from the second half of 2019. LDCT should be performed in high-risk subjects, aged 54–74 years, with a smoking history of 30 pack years or more. The use of multi-detector CT with a minimum of 16 channels is recommended, and LDCT scanning should be performed with the maximum CTDIvol radiation dose of 3 mGy in standard-sized subjects. The results of LDCT should be reported using the Lung CT Screening Reporting and Data System by diagnostic radiologists educated in specified programs. Radiologists play an important role in lung cancer screening. Quality control and reporting of LDCT is mandatory, and continued education is necessary. Cessation of smoking is the most important in lung cancer screening.

References

1. Jung KW, Won YJ, Kong HJ, Lee ES. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2016. Cancer Res Treat. 2019; 51:417–430.

2. National Lung Screening Trial Research Team. Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med. 2011; 365:395–409.

3. Moyer VA. U.S. Preventive Services Task Force. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014; 160:330–338.

4. Centers for Medicare & Medicaid Services. Decision memo for screening for lung cancer with low dose computed tomography (LDCT) (CAG-00439N). Available at.https://www.cms.gov/newsroom/press-releases/national-coverage-determination-ncd-screening-lung-cancer-low-dose-computed-tomography-ldct. Published 2015. Accessed Apr 18,. 2019.

5. Oudkerk M, Devaraj A, Vliegenthart R, Henzler T, Prosch H, Heussel CP, et al. European position statement on lung cancer screening.Lancet Oncol. 2017; 18:e754–e766.

6. Pinsky PF. Lung cancer screening with low-dose CT: a world-wide view. Transl Lung Cancer Res. 2018; 7:234–242.

7. Jang SH, Sheen SS, Kim HY, Yim HW, Park BY, Kim JW, et al. The Korean guideline for lung cancer screening. ^J Korean Med Assoc. 2015; 58:291–301.

8. Lee J, Lim J, Kim Y, Kim HY, Goo JM, Lee CT, et al. Development of protocol for Korean lung cancer screening project (K-LUCAS) to evaluate effectiveness and feasibility to implement national cancer screening program. Cancer Res Treat 2019 Feb 19 [Epub]. Available at.https://doi.org/10.4143/crt.2018.464.

9. Lee JW, Kim HY, Goo JM, Kim EY, Lee SJ, Kim TJ, et al. Radiological report of pilot study for the Korean lung cancer screening (K-LUCAS) project: feasibility of implementing lung imaging reporting and data system. Korean J Rad/iiol. 2018; 19:803–808.

10. Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: a systematic review.JAMA. 2012; 307:2418–2429.

11. Usman Ali M, Miller J, Peirson L, Fitzpatrick-Lewis D, Kenny M, Sherifali D, et al. Screening for lung cancer: a systematic review and metaanalysis. Prev Med. 2016; 89:301–314.

12. National Lung Screening Trial Research Team. Church TR, Black WC, Aberle DR, Berg CD, Clingan KL, et al. Results of initial low-dose computed tomographic screening for lung cancer.N Engl J Med. 2013; 368:1980–1991.

13. Silva M, Pastorino U, Sverzellati N. Lung cancer screening with low-dose CT in Europe: strength and weakness of diverse independent screening trials.Clin Radiol. 2017; 72:389–400.

14. Saghir Z, Dirksen A, Ashraf H, Bach KS, Brodersen J, Clementsen PF, et al. CT screening for lung cancer brings forward early disease. The randomised Danish Lung Cancer Screening Trial: status after five annual screening rounds with low-dose CT. Thorax. 2012; 67:296–301.

15. Becker N, Motsch E, Gross ML, Eigentopf A, Heussel CP, Dienemann H, et al. Randomized study on early detection of lung cancer with MSCT in Germany: study design and results of the first screening round.J Cancer Res Clin Oncol. 2012; 138:1475–1486.

16. Pinsky PF, Gierada DS, Black W, Munden R, Nath H, Aberle D, et al. Performance of lung-RADS in the national lung screening trial: a retrospective assessment.Ann Intern Med. 2015; 162:485–491.

17. Infante M, Cavuto S, Lutman FR, Passera E, Chiarenza M, Chiesa G, et al. Long-term follow-up results of the DANTE trial, a randomized study of lung cancer screening with spiral computed tomography.Am J Respir Crit Care Med. 2015; 191:1166–1175.

18. Horeweg N, Scholten ET, De Jong PA, Van der Aalst CM, Weenink C, Lammers JW, et al. Detection of lung cancer through low-dose CT screening (NELSON): a prespecified analysis of screening test performance and interval cancers.Lancet Oncol. 2014; 15:1342–1350.

19. Sone S, Nakayama T, Honda T, Tsushima K, Li F, Haniuda M, et al. Long-term follow-up study of a population-based 1996–1998 mass screening programme for lung cancer using mobile low-dose spiral computed tomography.Lung Cancer. 2007; 58:329–341.

20. Duffy SW, Field JK, Allgood PC, Seigneurin A. Translation of research results to simple estimates of the likely effect of a lung cancer screening programme in the United Kingdom. Br J Cancer. 2014; 110:1834–1840.

21. Patz EF Jr, Pinsky P, Gatsonis C, Sicks JD, Kramer BS, Tammemägi MC, et al. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med. 2014; 174:269–274.

22. Veronesi G, Maisonneuve P, Bellomi M, Rampinelli C, Durli I, Bertolotti R, et al. Estimating overdiagnosis in low-dose computed tomography screening for lung cancer: a cohort study. Ann Intern Med. 2012; 157:776–784.

23. Brenner DJ. Radiation risks potentially associated with low-dose CT screening of adult smokers for lung cancer.Radiology. 2004; 231:440–445.

24. McCunney RJ, Li J. Radiation risks in lung cancer screening programs.Chest. 2014; 145:618–624.

25. Mascalchi M, Sali L. Lung cancer screening with low dose CT and radiation harm-from prediction models to cancer incidence data.Ann Transl Med. 2017; 5:360.

26. American College of Radiology. Lung CT screening reporting & data system. Available at.https://www.acr.org/Clinical-Resources/Reporting-and-Data-systems/Lung-Rads. Published Apr 28, 2014. Accessed Apr 25,. 2019.

27. Han DH, Goo JM, Chong S, Ahn MI. Are lung imaging reporting and data system categories clear to radiologists? A survey of the Korean society of thoracic radiology members on ten difficult-to-classify scenarios. Korean J Radiol. 2017; 18:402–407.

28. Field JK, Marcus MW, Oudkerk M. Risk assessment in relation to the detection of small pulmonary nodules. Transl Lung Cancer Res. 2017; 6:35–41.

29. Ko JP, Azour L. Management of incidental lung nodules. Semin Ultrasound CT MR. 2018; 39:249–259.

30. American Association of Physicists in Medicine. Lung cancer screening protocols version 5.0. Available at.https://aapm.org/pubs/CTProtocols/documents/LungCancerScreeningCT.pdf. Accessed Sep 10,. 2019.

31. Godoy MCB, Odisio EGLC, Erasmus JJ, Chate RC, Dos Santos RS, Truong MT. Understanding lung-RADS 1.0: a case-based review.Semin Ultrasound CT MR. 2018; 39:260–272.

32. Ministry of Health and Welfare. Rules for the installation and operation of special medical equipment. Available at.http://www.law.go.kr/법령/특수의료장비의설치및운영에관한규칙. Published Jun 5, 2018. Accessed Sep 10,. 2019.

33. Tsai EB, Chiles C, Carter BW, Godoy MCB, Shroff GS, Munden RF, et al. Incidental findings on lung cancer screening: significant and management. Semin Ultrasound CT MR. 2018; 39:273–281.

34. Mazzone PJ, Silvestri GA, Patel S, Kanne JP, Kinsinger LS, Wiener RS, et al. Screening for lung cancer: CHEST guideline and expert panel report.Chest. 2018; 153:954–985.

35. Van de Wiel JC, Wang Y, Xu DM, Van der Zaag-Loonen HJ, Van der Jagt EJ, Van Klaveren RJ, et al. Neglectable benefit of searching for incidental findings in the Dutch-Belgian lung cancer screening trial (NELSON) using low-dose multidetector CT. Eur Radiol. 2007; 17:1474–1482.

36. Jacobs PC, Mali WP, Grobbee DE, Van der Graaf Y. Prevalence of incidental findings in computed tomographic screening of the chest: a systematic review. J Comput Assist Tomogr. 2008; 32:214–221.

37. Kucharczyk MJ, Menezes RJ, McGregor A, Paul NS, Roberts HC. Assessing the impact of incidental findings in a lung cancer screening study by using low-dose computed tomography. Can Assoc Radiol J. 2011; 62:141–145.

38. American College of Radiology. Lung Cancer Screening Registry (LCSR) 2016. Available at.http://www.acr.org/Quality-Safety/National-Radiology-Data-Registry/Lung-Cancer-Screening-Registry. Accessed Apr 25,. 2019.

39. American College of Radiology. Lung CT Screening Reporting & Data System 2019. Lung‐RADS® Version 1.1. Available at.https://www.acr.org/-/media/ACR/Files/RADS/Lung-RADS/LungRADSAssessmentCatego-riesv1–1.pdf?la=en. Accessed Jul 6,. 2019.

40. Minnix JA, Karam-Hage M, Blalock JA, Cinciripini PM. The importance of incorporating smoking cessation into lung cancer screening. Transl Lung Cancer Res. 2018; 7:272–280.

Table 1.

Selection of Participants in the Korean Lung Cancer Screening Project

Inclusion Criteria
Criteria 1
˙Age: 55–74 years
^˙Smoking history ≥ 30 PY, 1) Current smokers or 2) Ex-smokers quit within 15 years
Criteria 2^∗
˙Age: 50–74 years
^˙Ever-smokers who are over certain level of 5-year probability of lung cancer with (developing) risk prediction model
prediction model Exclusion Criteria
˙Past history of lung cancer
˙Past history of lung cancer^˙Unable to move without help (ECOG score ≥ 2)
^˙On treatment for TB, pneumonia or interstitial lung disease
^˙Diagnosis of any cancers within 5 years except thyroid or skin cancers
^˙Chest CT performed within 6 months

^∗ Applied since September 2017 in some part of participants. ECOG = Eastern Cooperative Oncology Group, PY = pack-years, TB = tuberculosis

Table 2.

Lung CT Screening Reporting and Data System Version 1.0 Classification by American College of Radiology with Modification by KSTR

Category	Attenuation and Imaging Findings	Baseline LDCT Nodule Size	Follow-up LDCT Nodule Size
1	Negative
2	Solid	< 6 mm	New < 4 mm
	Part-solid	< 6 mm in total diameter	NA
	GGN	< 20 mm	New < 20 mm
			≥ 20 mm & unchanged or slow growing Category 3 or 4 nodules unchanged for ≥ 3 months
2b^∗	Category 3 or 4 nodules with definite benign findings
3	Solid	≥ 6 mm to < 8 mm	New 4 mm to < 6 mm
	Part-solid	≥ 6 mm total diameter with a solid component < 6 mm	^New < 6 mm total diameter
	GGN	≥ 20 mm	New ≥ 20 mm
4A	Solid	≥ 8 mm to < 15 mm	Growing < 8 mm or new 6 mm to < 8 mm
	Part-solid	≥ 6 mm total diameter with a solid component ≥ 6 mm to < 8 mm	≥ 6 mm with a new or growing < 4 mm solid component
Endobronchial nodule
4B	Solid	≥ 15 mm	New or growing ≥ 8 mm
	Part-solid	Solid component ≥ 8 mm	New or growing ≥ 4 mm solid component
4X	Category 3 or 4 nodules with additional features^†
Imaging findings that increase suspicion of cancer^‡

Size is the average diameter rounded to the nearest whole number. Growth is a size increase > 1.5 mm. ∗2b suggested by KSTR.

^† Includes spiculation, GGN(s) that double in size in 1 year, enlarged regional lymph nodes.

^‡ Such as obstructive pneumonia, consolidation, lymph node enlargement, etc. GGN = ground-glass nodule, KSTR = Korean Society of Thoracic Radiology, LDCT = low-dose CT, NA = not applicable

Table 3.

Management of LDCT Findings Based on the Lung CT Screening Reporting and Data System Category

Screen Results	Lung-RADS Category	Description	Management
Screen Results Negative	Lung-RADS Category 0	Description Incomplete	Management Additional image
	1	Negative	LDCT at 12 months
	2	Benign appearance
Positive	3	Probably benign	LDCT at 6 months
	4A	Suspicious	LDCT at 3 months or PET-CT
	4B		CECT, PET-CT or Biopsy
	4B 4X		CECT, PET-CT or Biopsy

CECT = contrast enhanced CT, LDCT = low-dose CT, Lung-RADS = Lung Cancer Screening Reporting and Data System

TOOLS

Similar articles