Experiences of Assiut University Hospitals in using low-dose computed tomography in screening for early detection of lung cancer in healthy smokers: a pilot study

Background
Globally, lung cancer continues to be the most common cause of cancer-related deaths, and poor survival outcomes are greatly exacerbated by delayed diagnosis. Low-dose computed tomography (LDCT) screening for early detection has demonstrated promise in detecting cancers at a stage that can be treated, especially in high-risk groups like smokers.


Objectives
To assess the efficacy of LDCT in identifying lung cancer early in smokers who appear to be in good health, focusing on its sensitivity, specificity, and the rate of false-positive findings.


Patients and methods
A cross-sectional study was conducted involving 200 asymptomatic smokers who underwent LDCT screening. Detected nodules were categorized by size, and further evaluation with positron emission tomography scans and histopathology was performed as indicated. Diagnostic performance metrics, including sensitivity, specificity, false-positive and false-negative rates, and outcomes of invasive procedures, were analyzed.


Results
LDCT detected lung nodules in 13.5% of participants. Among these, 11 participants had nodules more than or equal to 8 mm, of whom eight had positive positron emission tomography scan results. Biopsy confirmed five cases of early-stage lung cancer (four small cell lung cancer and one nonsmall cell lung cancer). The sensitivity of LDCT was 100%, the specificity was 88.7%, the false-positive rate was 13.5%, and the rate of unnecessary invasive procedures was 13.6%. No false negatives or metastases were detected. Incidental findings included emphysema (7.5%), bronchiectasis (1%), and interstitial lung diseases (2%).


Conclusions
LDCT is a highly sensitive tool for early detection of lung cancer in healthy smokers, with acceptable specificity and manageable rates of false positives. These findings support the implementation of LDCT screening in high-risk populations as part of a comprehensive lung cancer prevention strategy.
Clinical trial.gov: NCT06070922 (Registration Date in the manuscript for Clinical Trial Number 10|5|2023).