Int J Med Sci 2021; 18(16):3861-3869. doi:10.7150/ijms.64648 This issue

Research Paper

The BUILT study: a single-center 5-year experience of Lung Cancer screening in Taiwan

Chih-Wei Wu1,2, Yen-Te Ku3, Chun-Yao Huang1, Po-Chun Hsieh4, Kun-Eng Lim5, I-Shiang Tzeng6, Chou-Chin Lan1✉, Yao-Kuang Wu1✉, Yi-Chiung Hsu2✉

1. Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
2. Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, Taiwan.
3. Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
4. Department of Chinese Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
5. Department of Radiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
6. Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.

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Citation:
Wu CW, Ku YT, Huang CY, Hsieh PC, Lim KE, Tzeng IS, Lan CC, Wu YK, Hsu YC. The BUILT study: a single-center 5-year experience of Lung Cancer screening in Taiwan. Int J Med Sci 2021; 18(16):3861-3869. doi:10.7150/ijms.64648. Available from https://www.medsci.org/v18p3861.htm

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Abstract

Graphic abstract

Background: There are no uniform guidelines on low-dose computed tomography (LDCT) follow-up in lung cancer screening. Few studies have analyzed the incidental abnormalities and role of tumor markers in lung cancer screening. The purpose of this study was to investigate the diagnostic performance of LDCT, optimal follow-up duration, incidental findings, and role of tumor markers in diagnosing lung cancer.

Methods: We retrospectively analyzed subjects who underwent their first LDCT in Taipei Tzu Chi Hospital between September 1, 2015, and August 31, 2016. All chest CT scans until August 31, 2020, were recorded. A non-calcified nodule with a diameter ≥2 mm on LDCT was defined as a positive result. We extracted the data, including possible risk factors of lung cancer and follow-up outcomes.

Results: A total of 1502 subjects were recruited. Of the 38 subjects who underwent biopsy, 31 had confirmed lung cancer. Lung cancer in all patients was diagnosed within 4 years. Univariate logistic regression analysis revealed that a family history of lung cancer in first-degree relatives and abnormal serum carcinoembryonic antigen (CEA) levels were the significant risk factors for lung cancer. A cumulative lung cancer incidence of 54.7 patients per 1000 person-years was determined solely via radiological follow-up. In total, 271 (18%) subjects exhibited incidental findings on baseline LDCT.

Conclusion: The overall lung cancer detection rate in this study was 2.1% in the 5-year study period. A family history of lung cancer and abnormal serum CEA levels are important risk factors for lung cancer. A minimum of 4-year follow-up is required to track suspicious nodules. A purely radiological follow-up detects a high incidence of lung cancer.

Keywords: low dose CT, lung cancer, screening, pulmonary nodule