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David S. Ettinger, MD, FACP, FCCP

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WCLC 2022: NELSON Trial Protocol Versus NLST Protocol in Lung Cancer Screening

By: JNCCN 360 Staff
Posted: Wednesday, August 10, 2022

The protocol used to screen and detect lung cancer in the NELSON trial appears to be more sensitive than the protocol used in the National Lung Cancer Screening Trial (NLST), particularly for early-stage cancers. This is the finding of research reported at the International Association for the Study of Lung Cancer (IASLC) World Conference on Lung Cancer (WCLC) 2022.

The Dutch-Belgian lung cancer screening trial (commonly known as the NELSON trial) demonstrated a reduction in lung cancer mortality of 24% for screening with low-dose computed tomography (CT) compared with the 20% found in the NLST. The researchers reported that nodule management protocols based on volumetry are likely to increase the benefits of lung cancer screening while reducing unnecessary follow-up procedures.

“We evaluated how the difference in nodule management protocols affected the CT sensitivity across stage and histology in the trials,” said PhD student Koen de Nijs, of Erasmus University Medical Center Rotterdam, the Netherlands.

Mr. de Nijs and colleagues from the NELSON consortium employed the MISCAN-Lung model, previously used to evaluate the results of the NLST, to evaluate the outcomes of the NELSON trial. The model was used to reproduce lung cancer incidence and mortality by method of detection (clinical or screen-detected), sex, histology, and stage. For both trials, the investigators considered a screening result a true positive when lung cancer was detected through the screening CT and related follow-up procedures.

The sensitivity in the NELSON trial was estimated to be higher across all stages compared with the NLST. CT sensitivity was considerably higher for early-stage adenocarcinoma (stage 1A: 73% in NELSON and more than 57% in the NLST; for stage 1B: 90% in NELSON vs. 64% in the NLST) and stage 2 squamous cell carcinoma (75% in NELSON and more than 39% in the NLST).


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