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Snowsill T, Yang H, Griffin E, et al. Low-dose computed tomography for lung cancer screening in high-risk populations: a systematic review and economic evaluation. Southampton (UK): NIHR Journals Library; 2018 Nov. (Health Technology Assessment, No. 22.69.)

Cover of Low-dose computed tomography for lung cancer screening in high-risk populations: a systematic review and economic evaluation

Low-dose computed tomography for lung cancer screening in high-risk populations: a systematic review and economic evaluation.

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Appendix 5Network meta-analysis

Characteristics of study populations

TABLE 45

Characteristics of study populations (CXR vs. usual care)

Study identifierArmCountry; number of centresNumber of patients approachedNumber of patients randomisedNumber of patients screened at baselineCharacteristics of patients at baseline
Age (years)Male, n/N (%)Current smokers, n/N (%)Former smokers, n/N (%)Family history of LC, n/N (%)
Czech105CXRCzech Republic; six districts636463463172

40–44: n = 487

45–49: n = 716

50–54: n = 923

55–59: n = 582

60–64: n = 464

3172/3172 (100)3172/3172 (100)NRNR
Control3174

40–44: n = 499

45–49: n = 710

50–54: n = 926

55–59: n = 584

60–64: n = 455

3174/3174 (100)3174/3174 (100)NRNR
Mayo106CXRUSA; NRNR10,933 screened; 9211 randomised4618

< 50: n = 1159

50 to < 55: n = 1102

55 to < 60: n = 1042

60 to < 65: n = 811

65 to < 70: n = 483

≥ 70: n = 21

4618/4618 (100)NR/NR (90)NR/NR (10)NR
Control4593

< 50: n = 1154

50 to < 55: n = 1135

55 to < 60: n = 1019

60 to < 65: n = 784

65 to < 70: n = 469

≥ 70: n = 32

4593/4593 (100)NR
PLCO (for sensitivity analysis only)107CXRUSA; 10 centres154,90177,44515,183NR9252/15,183 (60.9)6146 (40.5)NRNR
Control77,45615,138NR9110/15,138 (60.2)6069/15,138 (40.1)aNRNR

LC, lung cancer; NR, not reported.

a

Calculated from raw data, differs from PLCO107 for which % is reported as 40.3%.

Characteristics of recruitment and adherence

TABLE 46

Characteristics of recruitment and adherence: CXRs

Study identifierMethod of recruitmentDefinition of high-risk individuals at baselineExclusion criteriaInitial adherence to screening
Czech105Via general health examination of middle-aged males onlyAged 40–64 years; current smokers (approximate lifetime consumption > 150,000 cigarettes)History of pulmonary disease. Likely inability to participate over 3 years due to serious disease or other reasonsAdherence to screening over 3 years in screening arm 92.5% vs. control arm 94.7%
Mayo106

Via ‘smoking survey’ completed by outpatients at a general medical examinations by the Mayo Clinic

If questionnaire categorised as ‘high-risk’ males only were referred to the study

Aged > 45 years; current or former smokers (at least one pack per day at time of recruitment or within previous year)History of known or suspected cancer of the respiratory tract (except roentgenographically occult cancer); < 5 years’ life expectancy; unable to tolerate pulmonary resection; failure to complete general medical examination; insufficient mental capacity for study cooperationAdherence to testing schedule over 6 years of screening averaged 75%
PLCO (for sensitivity analysis only)107Via mass mailing of general population. A subset of entire PLCO population in line with population characteristics of NLST were used for this analysis. Males and females recruitedAged 55–74 years; current or former smokers (≥ 30 pack-years; quit < 15 years before recruitment)History of prostate, lung, colorectal or ovarian cancer, or current cancer treatment or removal of one lung

Adherence to baseline screening, screening arm 85.9% (13,035/15,183)

Overall adherence to expected screens, screening arm 81.4% (48,330/15,183)

Characteristics of screening programmes

TABLE 47

Characteristics of screening programmes: CXRs

Study identifier(country)Screening programme comparisonDefinition of a positive scan for lung cancerImaging evaluation and interpretation strategyDiagnostic follow-up for suspicious abnormality finding
Kubík et al. (Czech Republic)105

CXR

(at baseline, 6-monthly during years 1–3, and then at years 3, 4 and 5 and 6, screening also included sputum cytology testing)

vs.

No screening

(+ CXR at baseline, years 3, 4, 5 and 6, included sputum cytology testing at same times as CXR)

CXR

Positive if abnormality identified (reader decision whether or not further investigation was required)

Other

Also sent for further investigation if one or more of the following was evident: patient approached with symptoms, cancer or atypical cells from sputum testing, bloody sputum

CXR

Chest photofluorogram, posteroanterior view

Double-reading by chest physician and chest radiologist. Decision based on consensus (third experienced physician arbitrated disagreements)

CXR

Follow-up protocol

Positive CXR – referral to specialist diagnostic hospital ward (if sputum signs – recommendation for inpatient stay), fibre-optic animation, additional CXR, (including whole-lung CXR), otorhinolaryngological examination (for exclusion purposes)

Mayo (USA)106

CXR

(4-monthly, screening also included sputum cytology testing, medical history review)

vs.

Usual care

(annual CXR and sputum cytology testing)

CXR

Not clear

CXR

Stereo chest roentgenograms, standard size

Double-reading by chest physician and radiologist. Decision based on consensus (another chest physician arbitrated disagreements)

CXR

Follow-up protocol

Positive CXR, suggesting lung cancer – review of clinical data

Positive CXR, new or growing abnormality – work-up could include additional CXR and sputum testing, bronchoscopy (with or without fluoroscopic guidance)

PLCO (USA)107

CXR

(at baseline, annually up to 4 years)

vs.

No screening

CXR

Positive if the readers felt that one of the following was evident and suspicious: any nodule, mass, infiltrate or other abnormality

CXR

Posteroanterior CXR

CXR

No study follow-up protocol, positive CXR follow-up was decided by patients and their health-care providers

Copyright © Queen’s Printer and Controller of HMSO 2018. This work was produced by Snowsill et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.
Bookshelf ID: NBK534561
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