Frequency of Incidental Findings and Subsequent Evaluation in Low-Dose Computed Tomographic Scans for Lung Cancer Screening

Morgan, L.; Choi, Humberto; Reid, Michal; Khawaja, Ali; Mazzone, Peter J.

doi:10.1513/annalsats.201612-1023oc

Cited by 94 publications

(90 citation statements)

References 25 publications

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“…Second, guideline-based interventional pulmonology review effectively reduced false positives and unnecessary invasive testing. Prior screening and incidental nodule studies have reported false positive rates as high as 96% [9,24]. In our program, guideline-based interventional pulmonology review in Year 1 eliminated 1,127 of the original 1,792 CT scans identified by the radiology search to yield 665 nodules requiring intervention or radiologic follow-up.…”

Section: Discussionmentioning

confidence: 99%

Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

LeMense

Waller²,

Campbell³

et al. 2020

Preprint

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Background: Appropriate management of lung nodules detected incidentally or through lung cancer screening can increase the rate of early-stage diagnoses and potentially improve treatment outcomes. However, the implementation and management of comprehensive lung nodule programs is challenging. Methods: This single-center, retrospective report describes the development and outcomes of a comprehensive lung nodule program at a community practice in Tennessee. Computed tomography (CT) scans potentially revealing incidental lung nodules were identified by a computerized search. Incidental or screening-identified lung nodules that were enlarging or not seen in prior scans were entered into a nodule database and guideline-based review determined whether to conduct a diagnostic intervention or radiologic follow-up. Referral rates, diagnosis methods, stage distribution, treatment modalities, and days to treatment are reported. Results: The number of patients with lung nodules referred to the program increased over 2 years, from 665 patients in Year 1 to 745 patients in Year 2. Most nodules were incidental (62%-65%). Nodules identified with symptoms (15.2% in Year 1) or through screening (12.6% in Year 1) were less common. In Year 1, 27% (182/665) of nodules required a diagnostic intervention and 18% (121/665) were malignant. Most diagnostic interventions were image-guided bronchoscopy (88%) or percutaneous biopsy (9%). The proportion of Stage I-II cancer diagnoses increased from 23% prior to program implementation to 36% in Year 1 and 38% in Year 2. In screening cases, 71% of patients completed follow-up scans within 18 months. Only 2% of Year 1 patients under watchful waiting required a diagnostic intervention, of which 1% received a cancer diagnosis. Conclusions: The current study reports outcomes over the first two years of a lung cancer screening and incidental nodule program. The results show that the program was successful, given the appropriate level of data management and oversight. Comprehensive lung nodule programs have the potential to benefit the patient, physician, and hospital system.

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Section: Discussionmentioning

confidence: 99%

Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

LeMense

Waller²,

Campbell³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The cohort eligible for LDCT screening, based on smoking history and age, has been shown to frequently have comorbidities (eg, hypertension in about 60%, hyperlipidemia in approximately 50%, COPD in about 30%, coronary artery disease in 15%, diabetes mellitus in 15%). 141 As such, it is not surprising that many LDCT screening scans reveal incidental findings (other than pulmonary nodules). 50,74,75,[141][142][143] The value of what amounts to screening for other findings is undefined; the balance of benefits and harms of lung cancer screening is affected if a significant portion of those screened undergo investigation of incidental findings.…”

Section: Structured Radiology Reportingmentioning

confidence: 99%

“…141 As such, it is not surprising that many LDCT screening scans reveal incidental findings (other than pulmonary nodules). 50,74,75,[141][142][143] The value of what amounts to screening for other findings is undefined; the balance of benefits and harms of lung cancer screening is affected if a significant portion of those screened undergo investigation of incidental findings. Therefore, management of incidental findings is an important part of implementation of a screening program.…”

Section: Structured Radiology Reportingmentioning

confidence: 99%

Screening for Lung Cancer

Mazzone

Silvestri

Patel

et al. 2018

Chest

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285

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“…In addition to identifying nodular lesions suspected of being LC, CT offers the benefit of incidental findings of other diseases, such as benign lung diseases (COPD, interstitial diseases, and bronchiectasis) and cardiovascular diseases (based on the degree of coronary artery calcification), at earlier stages; such findings are present in 24% to 64% of cases. (27) However, LC screening is not yet available in Brazil via the Brazilian Unified Health Care System. Brazilian National Ministry of Health Directive no.…”

Section: Discussionmentioning

confidence: 99%

Tumor-node-metastasis staging and treatment patterns of 73,167 patients with lung cancer in Brazil

Mello

Bergmann

Ferreira³

et al. 2020

J. bras. pneumol.

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Objective: To characterize the clinical and histological profile, as well as treatment patterns, of patients with early-stage, locally advanced (LA), or advanced/metastatic (AM) lung cancer, diagnosed between 2000 and 2014, in Brazil. Methods: This was an analytical cross-sectional epidemiological study employing data obtained for the 2000-2014 period from the hospital cancer registries of two institutions in Brazil: the José Alencar Gomes da Silva National Cancer Institute, in the city of Rio de Janeiro; and the São Paulo Cancer Center Foundation, in the city of São Paulo. Results: We reviewed the data related to 73,167 patients with lung cancer. The proportions of patients with early-stage, LA, and AM lung cancer were 13.3%, 33.2%, and 53.4%, respectively. The patients with early-stage lung cancer were older and were most likely to receive a histological diagnosis of adenocarcinoma; the proportion of patients with early-stage lung cancer remained stable throughout the study period. In those with LA lung cancer, squamous cell carcinoma predominated, and the proportion of patients with LA lung cancer decreased significantly over the period analyzed. Those with AM lung cancer were younger and were most likely to have adenocarcinoma; the proportion of patients with AM lung cancer increased significantly during the study period. Small cell carcinoma accounted for 9.2% of all cases. In our patient sample, the main treatment modality was chemotherapy. Conclusions: It is noteworthy that the frequency of AM lung cancer increased significantly during the study period, whereas that of LA lung cancer decreased significantly and that of early-stage lung cancer remained stable. Cancer treatment patterns, by stage, were in accordance with international guidelines.

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Frequency of Incidental Findings and Subsequent Evaluation in Low-Dose Computed Tomographic Scans for Lung Cancer Screening

Cited by 94 publications

References 25 publications

Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

Screening for Lung Cancer

Tumor-node-metastasis staging and treatment patterns of 73,167 patients with lung cancer in Brazil

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