Diagnostic Follow-up of Positive Results on Low-Dose Computed Tomography Screening in the Medicare Population.

Abstract

Diagnostic evaluation of positive screening results for lung cancer is critically important for optimal outcomes. Data on such follow-up are limited. To assess the use of diagnostic tests after positive results on lung cancer screening in clinical practice. Retrospective cohort study. U.S. institutions performing diagnostic follow-up of lung cancer screening, 2015 to 2022. Persons with a first positive screening result at age 65 years or older who had Medicare fee-for-service coverage. Rates of diagnostic test use (imaging or invasive procedures) within 1 year of an index positive screening result and rates of receiving guideline-concordant follow-up care and of receiving less or more intensive (than guideline-concordant) care. Multiple logistic regression was used to assess factors associated with less or more intensive care. The cohort consisted of 64 555 persons. The rate of guideline-concordant care was 59.7% overall and increased with increasing Lung-RADS score: 49.2% for a score of 3, 68.6% for 4A, 74.1% for 4B, and 79.5% for 4X. Care was less intensive than recommended in 32.3% of participants, generally decreasing with Lung-RADS score: 39.3% for a score of 3, 24.7% for 4A, 25.9% for 4B, and 20.5% for 4X. Rates of more intensive care, applicable only for scores of 3 and 4A, were 11.5% and 6.7%, respectively. Among participants with Lung-RADS scores of 3 and 4A, non-Hispanic Black persons, those who currently smoked, and those undergoing baseline screening had significantly higher rates of less intensive care. Of all participants, 12.4% had a lung cancer diagnosis within 1 year. Invasive procedures were done in 16.2% of all participants and in 7.3% of those without eventual lung cancer. The cohort was limited to those in fee-for-service Medicare plans. Information on institutional and patient socioeconomic factors was limited. About 60% of participants had guideline-concordant care, and about one third had less intensive care. Invasive procedure rates in those without cancer were low. None.