Low Dose Computed Tomography for Lung Cancer Screening in Tuberculosis Endemic Countries: A Systematic Review and Meta-Analysis.

Introduction: Lung cancer screening (LCS) using low-dose computed tomography (LDCT) reduces mortality. Nevertheless, in high tuberculosis-burden countries (HTBC), there are concerns about high false-positive rates due to persistent lung lesions from prior tuberculosis (TB) infections. This study aims to evaluate the screen-positive rate (SPR) of LDCT screening in HTBC.

Methods: We conducted a systematic review and meta-analysis to identify studies utilizing LDCT for LCS in HTBC and reported SPR from inception to December 6, 2023. The primary outcome was the SPR, and the secondary outcome was the lung cancer detection rate (LCDR). The summary data was pooled using a random-effects model, and factors influencing the SPR were analyzed using multivariable meta-regression analysis.

Results: A total of 44 studies with 477,424 individuals (59.3% men) were included in the systematic review. Lung Imaging Reporting and Data System (Lung-RADS) (31%, 14 studies) and National Lung Screening Trial (NLST) criteria (non-calcified nodule ≥ 4 mm; 10 studies) were the most common criteria used for assessing SPR. The pooled SPR and LCDR were 18.36% (95% confidence interval [CI]: 14.6-22.1) and 0.94% (95% confidence interval: 0.75-1.15), respectively. Although SPR was significantly higher with NLST criteria than Lung-RADS criteria (25.6% versus 10.4%, p < 0.0001), the LCDR remained similar (0.91% versus 0.95%, p = 0.92). Studies using NLST criteria had a higher SPR in multivariable meta-regression analysis. Nevertheless, the analysis is limited by significant statistical heterogeneity and publication bias.

Conclusion: Lung cancer screening by LDCT in HTBC demonstrates comparable SPR and LCDR to regions with lower TB incidence rates. Lung-RADS criteria are preferable to NLST criteria for LCS in HTBC to mitigate false-positive rates.