The decision to biopsy in a lung cancer screening program: Potential impact of risk calculators

Objective The National Lung Screening Trial demonstrated the benefits of lung cancer screening, but the potential high incidence of unnecessary invasive testing for ultimately benign radiologic findings causes concern. We aimed to review current biopsy patterns and outcomes in our community-based program, and retrospectively apply malignancy prediction models in a lung cancer screening population, to identify the potential impact these calculators could have on biopsy decisions. Methods Retrospective review of lung cancer-screening program participants from 2013 to 2016. Demographic, biopsy, and outcome data were collected. Malignancy risk calculators were retrospectively applied and results compared in patients with positive imaging findings. Results From 520 individuals enrolled in the screening program, pulmonary nodule(s) ≥6 mm were identified in 166, with biopsy in 30. Malignancy risk probabilities were significantly higher (Brock p