The PanCan nodule management protocol reduces the number of lung cancer screening participants needing referral for diagnostic workup following low-dose CT (LDCT) and requires 2.63 times fewer positive scans to find the same number of lung cancers compared to LungRADSv1.1. Using PanCan, 75% of lower-risk participants can be rescreened after 2 years rather than 1 year, significantly reducing resource utilization and overall cost.
This is according to data from a talk titled Triaging ILST Screening Participants at Program Entry: Comparative Performance of PanCan versus LungRADSv1.1 Protocol, which was presented during the first of two Presidential Symposia at the 2024 World Conference on Lung Cancer.
Multiple international trials have shown LDCT screening can significantly reduce lung cancer mortality, but how participants are managed after initial screening depends largely on baseline nodule measurement and longitudinal surveillance, explained Annette McWilliams, MBBS, FRACP, Clinical Associate Professor at the University of Western Australia in Perth, Australia, and a Consultant Respiratory Physician at Fiona Stanley Hospital.
The familiar LungRADSv1.1 model uses a uniform approach with repeat LDCT at 12 months for those at low risk and 3-6 months for those at moderate risk. Individuals at high risk on baseline LDCT are referred for immediate diagnostic workup.
“PanCan uses a risk-based screening approach to improve selection of both highest- and lowest-risk categories versus LungRADSv1.1,” Dr. McWilliams said. “I think PanCan is the way to go.”
The study evaluated 4,494 participants in the International Lung Screen Trial (ILST) who had a baseline LDCT between August 2016 and July 2021 and had completed at least 2 years of follow up or had a confirmed lung cancer diagnosis. All participants were managed based on the PanCan protocol.
PanCan calls for follow-up LDCT at 24 months for individuals at very low risk with no nodules detected or risk < 1.5%. Those at low risk (≥ 1.5% to < 6%) have a follow-up LDCT at 12 months. Individuals at moderate risk (≥ 6% to < 30%) undergo repeat LDCT at 3-6 months while those at high risk (≥ 30%) or those whose LDCTs demonstrate suspicious findings such as lesions, large masses, or airway nodules, are referred for immediate diagnostic workup.
The study showed significant differences in triage. Most participants (75%) were very low risk on PanCan with 24-month LDCT, a category and screening interval not used in LungRADS.
About 14% were low risk on PanCan versus 83% on LungRADS with 12-month LDCT.
The moderate risk group was similar at 8% for PanCan and 10% for LungRADS, with a 3-6 month LDCT. Only 3% of participants were at high risk on PanCan versus 7% on LungRADS.
The study detected lung cancer in 184 participants during a mean follow-up of 58 months; 109 of the 184 (59%) were detected within two years. PanCan triaged 75% of participants to biennial screening with low cancer rates of 0.3% and 3,381 fewer repeat LDCTs compared to LungRADS, Dr. McWilliams reported.
For individuals at high risk, PanCan had a positive predictive value of 48% compared to 18% for LungRADS (McNemar’s p < 0.0001).
“The PanCan protocol demonstrated improved selection of low- and high-risk categories whilst reducing LDCT burden and specialist referrals,” Dr. McWilliams said. “Our findings suggest that adopting the PanCan protocol could streamline lung cancer screening and management processes.”
