The influence of different previous cancer histories on the diagnostic efficacy of Lung Imaging Reporting and Data System

BACKGROUND: For lung cancer screening in patients with previous malignant tumors, Lung Imaging Reporting and Data System (Lung-RADS) and other lung cancer screening tools are controversial in terms of requirements for the previous cancer history. This study investigated the effect of the length and type of malignancy history on the diagnostic efficacy of Lung Imaging Reporting and Data System (Lung-RADS) 2022 in pulmonary nodules (PNs). METHODS: Chest computed tomography and clinical data of PNs in patients with a history of cancer who underwent surgical resection in The First Affiliated Hospital of Chongqing Medical University from January 1, 2018, to November 30, 2021, were retrospectively collected and evaluated based on Lung-RADS. All PNs were divided into 2 groups: the prior lung cancer (PLC) and the prior extrapulmonary cancer (PEPC) groups. Each group was divided into the ≥5 years and <5 years groups based on the duration of cancer history. The diagnostic agreement of Lung-RADS was evaluated based on the pathological diagnosis of nodules after operation. The diagnostic agreement rate (AR) of Lung-RADS and the composition ratios of different types between different groups were calculated and compared. RESULTS: A total of 451 patients with 565 PNs were included in this study. These patients were divided into the PLC group (<5 years: 135 cases, 175 PNs; ≥5 years: 9 cases, 12 PNs) and the PEPC group (<5 years: 219 cases, 278 PNs; ≥5 years: 88 cases, 100 PNs). The diagnostic AR of partial solid nodules (93.0%; 95% CI: 88.7–97.2%) and solid nodules (88.1%; 95% CI: 84.1–92.1%) was close (P=0.13), while both were higher than that of the pure ground-glass nodules (24.0%; 95% CI: 17.5–30.4%; all P values <0.001). Within 5 years, the composition ratio of PNs and the diagnostic AR (PLC: 58.9%, 95% CI: 51.5–66.2%; PEPC: 76.6%, 95% CI: 71.6–81.6%) between the PLC and PEPC groups were all different (all P values <0.001), and the others [composition ratio of PNs & the diagnostic AR: PLC (≥5 years) vs. PEPC (≥5 years); PLC (<5 years) vs. PLC (≥5 years); PEPC (<5 years) vs. PEPC (≥5 years)] were similar (all P values >0.05; range: 0.10–0.93). CONCLUSIONS: The length of prior cancer history may affect the diagnostic agreement of Lung-RADS, especially for patients with prior lung cancer within 5 years.