LU‑RADS
The Lung Reporting and Data System
The LuRADS system was designed based on the authors' experience screening patients through the Pan Canadian Early Detection of Lung Cancer Study and the International Early Lung Cancer Action project (IELCAP). It was originally presented at RNSA in 2012, revised for the World Congress of Thoracic Imaging in 2013 and was published in the Canadian Association of Radiologists Journal in April 2014. The 6-level system initiated a move beyond simple negative/positive reporting schemes and identified suggested next steps. LU-RADS was designed to improve communication with patients and clinicians, provide a data collection framework, and assist with radiologist training and quality assurance.
Since the release of LuRADS many other result systems have been proposed, all recognizing that CT screening results are much more nuanced than binary positive or negative. The American College of Radiology Lung-RADS® system is the most widely used in North America.
Improving communication
LU-RADS is designed to improve communication with patients and clinicians, provide a data collection framework, and assist with radiologist training and quality assurance.
Issues |
Examples |
Comments |
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1 No nodule |
Return to regular screening. Risk of malignancy related to interval cancer, cancer not detectable by CT, and nodules present but not identified. |
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2 Benign nodule Safe to return to screening |
Nodule < 5mm Perifissural opacities Benign calcification Core biopsy benign |
Solid and stable for 2 yrs Subsolid stable for 5 yrs Round atelectasis definite Hamartoma definite |
Safe to return to annual screening. Risk of malignant diagnosis prior to next screen very low. No benefit for earlier follow up. |
3 Indeterminate Requires serial LDCT |
SMALL: 5-9 mm non-enlarging solid nodule with < 2 years stability. 5-9 mm subsolid nodule with < 5 years stability. |
Follow as per schedule (Fleischner or screening-specific guidelines. Note some suggest following new nodules more closely than baseline nodules) |
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LARGE: Baseline or new nodule > 10 mm with any possibility of transient inflammatory process. e.g., new or baseline subsolid nodules >10 mm e.g., Inflammatory clinical or CT features (rapid development, multifocal, satellite nodules, air bronchogram, OR ground glass border) |
Do short interval follow up (4 to 12 weeks) to allow transient inflammatory process an opportunity to improve or resolve. No improvement is worrisome (reclassify into category 4). |
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4 Suspicious |
4A Low risk of malignancy Solid nodule ( > 10mm) with benign features but CT not definitive for category 2. e.g., probable round atelectasis; well-defined roughly spherical nodule possibly hamartoma or granuloma. |
Review all possibly relevant prior imaging. Needs work up. At minimum follow at 3 months. REFER Other possibilities: Core biopsy, PET (negative PET reassuring in this category Value of + PET dependent on rate of granulomatous disease.) |
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4B Likely low grade adenocarcinoma Non-resolving subsolid opacity > 10 mm (with solid component < 5mm) |
Risk of pre-invasive or minimally invasive disease high. REFER. Surgical biopsy/resection vs. annual screen if stable. PET and biopsy not routinely recommended (high false negatives) Biopsy if non surgical treatment. |
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4C Likely malignant Worrisome persistence Non-resolving part solid nodule > 10 mm (solid portion > 5 mm) OR Worrisome change Malignant growth rate in solid nodule or portion OR Worrisome baseline Lobulated or spiculated entirely solid nodule > 10mm with no inflammatory CT or clinical features, no ground glass border. |
Risk of malignancy very high in high risk screening population. REFER. Benefit of PET is in staging not diagnosis. Negative PET, bronchoscopy or biopsy is discordant and should prompt multidisciplinary review. |
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5 Malignant by CT |
Invasion of chest wall or mediastinum. |
As per 4C |
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6 Tissue malignant |
E.g., positive FNA, core, bronch, or surgical resection |
False positive results possible but very rare with FNA. Assuming patient remains a treatment candidate and no regular CT for disease surveillance, continued screening recommended. |
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© Copyright Daria Manos 2014