The Lung Reporting and Data System (LU-RADS): A Proposal for Computed Tomography Screening
Abstract
Abstract
Despite the positive outcome of the recent randomized trial of computed tomography (CT) screening for lung cancer, substantial implementation challenges remain, including the clear reporting of relative risk and suggested workup of screen-detected nodules. Based on current literature, we propose a 6-level Lung-Reporting and Data System (LU-RADS) that classifies screening CTs by the nodule with the highest malignancy risk. As the LU-RADS level increases, the risk of malignancy increases. The LU-RADS level is linked directly to suggested follow-up pathways. Compared with current narrative reporting, this structure should improve communication with patients and clinicians, and provide a data collection framework to facilitate screening program evaluation and radiologist training. In overview, category 1 includes CTs with no nodules and returns the subject to routine screening. Category 2 scans harbor minimal risk, including <5 mm, perifissural, or long-term stable nodules that require no further workup before the next routine screening CT. Category 3 scans contain indeterminate nodules and require CT follow up with the interval dependent on nodule size (small [5-9 mm] or large [≥10 mm] and possibly transient). Category 4 scans are suspicious and are subdivided into 4A, low risk of malignancy; 4B, likely low-grade adenocarcinoma; and 4C, likely malignant. The 4B and 4C nodules have a high likelihood of neoplasm simply based on screening CT features, even if positron emission tomography, needle biopsy, and/or bronchoscopy are negative. Category 5 nodules demonstrate frankly malignant behavior on screening CT, and category 6 scans contain tissue-proven malignancies.
Résumé
En dépit des résultats positifs d'un récent essai clinique randomisé visant le dépistage du cancer du poumon par tomodensitométrie (TDM), l'instauration ou la diffusion des pratiques de dépistage continue de soulever des défis de taille, en ce qui concerne notamment la classification non équivoque du risque relatif et le bilan proposé pour évaluer les nodules décelés par dépistage. Après avoir analysé la documentation scientifique actuelle, nous avons formulé une proposition de système de données et de déclaration à six niveaux, appelée méthodologie LU-RADS (Lung-Reporting and Data System), qui permet de classifier les résultats des tomodensitométries de dépistage en fonction du nodule présentant le risque le plus élevé de cancer du poumon. Dans le cadre de la méthodologie LU-RADS, plus les résultats correspondent à un niveau élevé, plus le risque de malignité est élevé. Le niveau LU-RADS renvoie également directement à des recommandations concernant le cheminement de suivi. Ainsi, comparativement aux comptes rendus descriptifs actuels, cette méthodologie devrait améliorer la communication avec les patients et les cliniciens, et fournir un cadre de collecte de données qui facilitera l'évaluation du programme de dépistage et la formation des radiologistes. En résumé, dans le cadre de la méthodologie LU-RADS, la catégorie 1 correspond aux examens de tomodensitométrie qui ne révèlent aucun nodule et exigent simplement du patient qu'il poursuive le programme de dépistage périodique. Les résultats de catégorie 2 font état d'un risque minimal, notamment de nodules de moins de 5 mm, de nodules péri-scissuraux ou de nodules stables à long terme qui n'exigent aucune autre mesure avant la tenue de la prochaine tomodensitométrie de dépistage périodique. Les résultats de catégorie 3 révèlent des nodules de nature indéterminée. Une tomodensitométrie de suivi doit alors être réalisée, dans un intervalle qui varie selon la taille du nodule (selon qu'il s'agit d'un petit nodule de 5 à 9 mm ou d'un gros nodule de ≥ 10 mm et possiblement transitoire). Pour leur part, les résultats des examens tomodensitométriques de catégorie 4 présentent des caractéristiques suspectes et se subdivisent en trois catégories: 4A, faible risque de malignité; 4B, probabilité d'adénocarcinome de bas grade; et 4C, probabilité de malignité. Les nodules des catégories 4B et 4C sont associés à une forte probabilité de néoplasie simplement en raison des caractéristiques observées par tomodensitométrie de dépistage, et ce, même si une tomographie par émission de positons (TEP), une ponction-biopsie ou une bronchoscopie révèle des résultats négatifs. Enfin, les nodules de catégorie 5 révèlent une séméiologie maligne nettement observable par TDM de dépistage, alors que ceux de catégorie 6 contiennent des tissus dont la malignité a été prouvée.
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Article first published online: May 1, 2014
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