Baseline results from the Norwegian radiology-led lung cancer screening pilot

Abstract

BACKGROUND AND PURPOSE: Implementation of low-dose computed tomography (LDCT) screening for lung cancer is recommended. The Norwegian Lung Cancer Screening pilot (TIDL) has been conducted to explore recruitment strategy, detection rate and the value of a radiology-led screening program. This publication presents baseline results from the screened participants. Patient/material and methods: All 125,095 individuals aged 60-79 years in Akershus county, Norway were invited to participate. Ever-smokers completed a risk questionnaire based on the PLCOm2012NoRace model: those with ≥35 pack-years or a ≥2.6% 6-year lung cancer risk were eligible for inclusion. Of 2,499 eligible participants, 1,006 underwent baseline LDCT between August 2022 and May 2023, and up to two more rounds later. Nodules were categorized by Lung-RADS v2022. Follow-up and staging were managed by thoracic radiologists; High-suspicion cases were referred to pulmonologists. RESULTS: At baseline, lung cancer was diagnosed in 23 participants (2.3%), whereof 19 (83%) in stage I and 2 (9%) in stage II. Most underwent curative treatment, primarily robot-assisted surgery. Only 2.9% of the screened individuals were referred for further diagnostic evaluation. The false positive rate was 0.6% after pulmonologist referral and 1.7% after radiological staging. A total of 13.8% required 3- or 6-month imaging follow-up. Complication rates from diagnostic procedures were low. INTERPRETATION: LDCT screening using combined risk-based eligibility and a radiology-led model is feasible and effective in the Norwegian context. The high detection rate and low clinical burden support its potential for national implementation. These findings may guide the development of future lung cancer screening programs in the Nordic countries and beyond.

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