Journal of thoracic disease · 2026
Outcomes of lung cancer screening by low-dose computed tomography in the health screening program.
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Klinngam Niwan, Kittivanakul Seksan, Savigamin Chatuthanai, Panthongwiriyakul Nopparat, Poachanukoon Orapan, Bavonparadon Uaiporn, Bunyasartphan Duangduen, Saehu Voravarun, Raweearamwong Jarungrat, Phodjanawichaikul Phodjana, Jirisant Wasin, Laowakul Patthraporn, Sriprasart Thitiwat
Аннотация
BACKGROUND: Low-dose computed tomography (LDCT) screening reduces lung cancer mortality among high-risk smokers, but data from Southeast Asia remain limited. This study evaluated the detection yield and risk factors of lung cancer among adults undergoing LDCT health screening in Thailand.
METHODS: We retrospectively reviewed 4,478 adults aged 18-85 years who underwent LDCT between January 2019 and December 2023 at a tertiary private hospital in Bangkok. Scans were performed using a Philips IQon Spectral CT (256-slice, 120 kV, 30 mA, 1 mm slice thickness, radiation dose <1.5 mSv) and interpreted according to Lung Imaging Reporting and Data System (Lung-RADS) version 1.1. Lung-RADS 3-4X were confirmed histopathologically. Multivariable logistic regression identified predictors of lung cancer.
RESULTS: Among all participants, 1,980 (44.2%) were female and 84.0% were never-smokers, with a mean age of 56.9 years [standard deviation (SD) 12.5]. LDCT positivity was 55.8%, and 53 cancers (1.2%) were detected. Most were stage 0-IB (69.8%), with adenocarcinoma as the predominant histology (85%) and solid morphology (77.4%). Incidental findings occurred in 65.2%, most commonly coronary artery calcification (CAC) (39.8%). Independent predictors included age ≥55 years [adjusted odds ratio (OR) 4.82, 95% confidence interval (CI): 1.68-13.86], smoking history (P<0.001), CAC (adjusted OR 23.63, 95% CI: 2.09-266.98), and extrapulmonary malignancy (adjusted OR 173.54, 95% CI: 42.73-704.77).
CONCLUSIONS: LDCT health screening in an unselected Thai population detected a meaningful burden of early-stage lung cancer. The findings support age-based screening beginning at 55 years, highlighting the potential role of chronic inflammation and environmental injury, such as PM2.5 exposure and prior tuberculosis.
METHODS: We retrospectively reviewed 4,478 adults aged 18-85 years who underwent LDCT between January 2019 and December 2023 at a tertiary private hospital in Bangkok. Scans were performed using a Philips IQon Spectral CT (256-slice, 120 kV, 30 mA, 1 mm slice thickness, radiation dose <1.5 mSv) and interpreted according to Lung Imaging Reporting and Data System (Lung-RADS) version 1.1. Lung-RADS 3-4X were confirmed histopathologically. Multivariable logistic regression identified predictors of lung cancer.
RESULTS: Among all participants, 1,980 (44.2%) were female and 84.0% were never-smokers, with a mean age of 56.9 years [standard deviation (SD) 12.5]. LDCT positivity was 55.8%, and 53 cancers (1.2%) were detected. Most were stage 0-IB (69.8%), with adenocarcinoma as the predominant histology (85%) and solid morphology (77.4%). Incidental findings occurred in 65.2%, most commonly coronary artery calcification (CAC) (39.8%). Independent predictors included age ≥55 years [adjusted odds ratio (OR) 4.82, 95% confidence interval (CI): 1.68-13.86], smoking history (P<0.001), CAC (adjusted OR 23.63, 95% CI: 2.09-266.98), and extrapulmonary malignancy (adjusted OR 173.54, 95% CI: 42.73-704.77).
CONCLUSIONS: LDCT health screening in an unselected Thai population detected a meaningful burden of early-stage lung cancer. The findings support age-based screening beginning at 55 years, highlighting the potential role of chronic inflammation and environmental injury, such as PM2.5 exposure and prior tuberculosis.