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Background: In lung cancer screening, a nodule management protocol describes nodule assessment and thresholds for nodule size and growth rate to identify patients who require immediate diagnostic evaluation or additional imaging exams. The Netherlands-Leuvens Screening Trial and the National Lung Screening Trial used different selection criteria and nodule management protocols. Several modelling studies have reported variations in screening outcomes and cost-effectiveness across selection criteria and screening intervals; however, the effect of variations in the nodule management protocol remains uncertain. This study evaluated the effects of the eligibility criteria and nodule management protocols on the benefits, harms and cost-effectiveness of lung screening scenarios in a population-based setting in Germany.Methods: We developed a modular microsimulation model: a biological module simulated individual histories of lung cancer development from carcinogenesis onset to death; a screening module simulated patient selection, screening-detection, nodule management protocols, diagnostic evaluation and screening outcomes. Benefits included mortality reduction, life years gained and averted lung cancer deaths. Harms were costs, false positives and overdiagnosis. The comparator was no screening. The evaluated 76 screening scenarios included variations in selection criteria and thresholds for nodule size and growth rate.Results: Five years of annual screening resulted in a 9.7-12.8% lung cancer mortality reduction in the screened population. The efficient scenarios included volumetric assessment of nodule size, a threshold for a volume of 300 mm3 and a threshold for a volume doubling time of 400 days. Assessment of volume doubling time is essential for reducing overdiagnosis and false positives. Incremental cost-effectiveness ratios of the efficient scenarios were 16,754-23,847 euro per life year gained and 155,287-285,630 euro per averted lung cancer death.Conclusions: Lung cancer screening can be cost-effective in Germany. Along with the eligibility criteria, the nodule management protocol influences screening performance and cost-effectiveness. Definition of the thresholds for nodule size and nodule growth in the nodule management protocol should be considered in detail when defining optimal screening strategies. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the association between computed tomography (CT) quantitative pulmonary vessel morphology and lung function, disease severity, and mortality risk in patients with chronic obstructive pulmonary disease (COPD)., Patients and Methods: Participants of the prospective nationwide COSYCONET cohort study with paired inspiratory-expiratory CT were included. Fully automatic software, developed in-house, segmented arterial and venous pulmonary vessels and quantified volume and tortuosity on inspiratory and expiratory scans. The association between vessel volume normalised to lung volume and tortuosity versus lung function (forced expiratory volume in 1 sec [FEV 1 ]), air trapping (residual volume to total lung capacity ratio [RV/TLC]), transfer factor for carbon monoxide (TLCO), disease severity in terms of Global Initiative for Chronic Obstructive Lung Disease (GOLD) group D, and mortality were analysed by linear, logistic or Cox proportional hazard regression., Results: Complete data were available from 138 patients (39% female, mean age 65 years). FEV 1 , RV/TLC and TLCO, all as % predicted, were significantly (p < 0.05 each) associated with expiratory vessel characteristics, predominantly venous volume and arterial tortuosity. Associations with inspiratory vessel characteristics were absent or negligible. The patterns were similar for relationships between GOLD D and mortality with vessel characteristics. Expiratory venous volume was an independent predictor of mortality, in addition to FEV 1 ., Conclusion: By using automated software in patients with COPD, clinically relevant information on pulmonary vasculature can be extracted from expiratory CT scans (although not inspiratory scans); in particular, expiratory pulmonary venous volume predicted mortality., Trial Registration: NCT01245933., Competing Interests: Dr Gabor Kovacs reports grants, personal fees and/or non-financial support from Janssen, Astra Zeneca, Boehringer Ingelheim, Bayer, GSK, MSD, Chiesi, Vitalaire, Ferrer, and AOP, outside the submitted work. Dr Horst Olschewski reports personal fees from Iqvia, MSD, Janssen, Pfizer, Astra Zeneca, GSK, Boehringer; department director for Ludwig Boltzmann Institute for Lung Vascular Research, outside the submitted work. Dr Hans-Ulrich Kauczor reports non-financial support from Bayer and Siemens; grants from BMBF, during the conduct of the study; grants and/or personal fees from Siemens, Philips, Boehringer Ingelheim, Sanofi, Median, outside the submitted work. Dr Mark Wielpütz reports grants from Vertex and Boehringer, outside the submitted work. Professor Tobias Welte reports grants from German Ministry of Research and Education, during the conduct of the study; personal fees from GSK, AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, and Chiesi, outside the submitted work. Professor Jürgen Behr reports personal fees from Astra-Zeneca, Boehringer-Ingelheim, BMS, Ferrer, Novartis, Roche, Sanofi-Genzyme, Janssen, and Johnson&Johnson, outside the submitted work. Dr Robert Bals reports grants from German Ministery of Education and Science (BMBF), during the conduct of the study; grants from DFG, Schwiete Stiftung, Krebshilfe, personal fees from Boehringer Ingelheim, CSL Behring, outside the submitted work. Professor Claus Vogelmeier reports grants and/or personal fees from Aerogen, AstraZeneca, Boehringer Ingelheim, CSL Behring, Chiesi, GlaxoSmithKline, Grifols, Insmed, Menarini, Novartis, Nuvaira, Roche, and Sanofi, outside the submitted work. The authors declare that they have no other known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Stoleriu et al.)