Standardizing the Reporting of Incidental, Non-Lung Cancer (Category S) Findings Identified on Lung Cancer Screening Low-Dose CT Imaging

Tanoue, L.T.; Sather, Polly; Cortopassi, Isabel O.; Dicks, Demetrius; Curtis, Anne B.; Michaud, Gaetane; Bader, A.; Gange, Christopher A.; Detterbeck, Frank C.; Killam, Jonathan

doi:10.1016/j.chest.2021.12.662

Cited by 15 publications

(4 citation statements)

References 34 publications

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“…Unlike other screening programmes, lung cancer screening using LDCT encompasses multiple organ systems, making it more complex, but also more interesting, as it may identify multiple abnormalities. In nearly 70% of cases, thoracic and extrathoracic incidental findings unrelated to lung cancer have been reported [ 23 , 54 ]. Many may not have clinical significance and should not affect the screening process [ 55 , 56 ].…”

Section: Impact Of Lung Cancer Screening With Nonsuspicious Findings ...mentioning

confidence: 99%

How will lung cancer screening and lung nodule management change the diagnostic and surgical lung cancer landscape?

Hardavella,

Frille,

Chalela

et al. 2024

Eur Respir Rev

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Introduction: Implementation of lung cancer screening, with its subsequent findings, is anticipated to change the current diagnostic and surgical lung cancer landscape. This review aimed to identify and present the most updated expert opinion and discuss relevant evidence regarding the impact of lung cancer screening and lung nodule management on the diagnostic and surgical landscape of lung cancer, as well as summarise points for clinical practice. Methods: This article is based on relevant lectures and talks delivered during the European Society of Thoracic Surgeons–European Respiratory Society Collaborative Course on Thoracic Oncology (February 2023). Original lectures and talks and their relevant references were included. An additional literature search was conducted and peer-reviewed studies in English (December 2022 to June 2023) from the PubMed/Medline databases were evaluated with regards to immediate affinity of the published papers to the original talks presented at the course. An updated literature search was conducted (June 2023 to December 2023) to ensure that updated literature is included within this article. Results: Lung cancer screening suspicious findings are expected to increase the number of diagnostic investigations required therefore impacting on current capacity and resources. Healthcare systems already face a shortage of imaging and diagnostic slots and they are also challenged by the shortage of interventional radiologists. Thoracic surgery will be impacted by the wider lung cancer screening implementation with increased volume and earlier stages of lung cancer. Nonsuspicious findings reported at lung cancer screening will need attention and subsequent referrals where required to ensure participants are appropriately diagnosed and managed and that they are not lost within healthcare systems. Conclusions: Implementation of lung cancer screening requires appropriate mapping of existing resources and infrastructure to ensure a tailored restructuring strategy to ensure that healthcare systems can meet the new needs.

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Section: Impact Of Lung Cancer Screening With Nonsuspicious Findings ...mentioning

confidence: 99%

How will lung cancer screening and lung nodule management change the diagnostic and surgical lung cancer landscape?

Hardavella,

Frille,

Chalela

et al. 2024

Eur Respir Rev

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“…Although it is possible that SIFs detected in the NLST represented known conditions, NLST participants were healthier than most individuals undergoing lung screening in actual clinical settings . Individuals were excluded from NLST enrollment if they had been treated for, or told by a physician that they had, evidence of any cancer within the 5 years preceding study entry; thus, SIFs indicative of cancer were likely to be a novel finding …”

Section: Discussionmentioning

confidence: 99%

Significant Incidental Findings in the National Lung Screening Trial

et al. 2023

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ImportanceLow-dose computed tomography (LDCT) lung screening has been shown to reduce lung cancer mortality. Significant incidental findings (SIFs) have been widely reported in patients undergoing LDCT lung screening. However, the exact nature of these SIF findings has not been described.ObjectiveTo describe SIFs reported in the LDCT arm of the National Lung Screening Trial and classify SIFs as reportable or not reportable to the referring clinician (RC) using the American College of Radiology’s white papers on incidental findings.Design, Setting, and ParticipantsThis was a retrospective case series study of 26 455 participants in the National Lung Screening Trial who underwent at least 1 screening examination with LDCT. The trial was conducted from 2002 to 2009, and data were collected at 33 US academic medical centers.Main Outcomes and MeasuresSignificant incident findings were defined as a final diagnosis of a negative screen result with significant abnormalities that were not suspicious for lung cancer or a positive screen result with emphysema, significant cardiovascular abnormality, or significant abnormality above or below the diaphragm.ResultsOf 26 455 participants, 10 833 (41.0%) were women, the mean (SD) age was 61.4 (5.0) years, and there were 1179 (4.5%) Black, 470 (1.8%) Hispanic/Latino, and 24 123 (91.2%) White individuals. Participants were scheduled to undergo 3 screenings during the course of the trial; the present study included 75 126 LDCT screening examinations performed for 26 455 participants. A SIF was reported for 8954 (33.8%) of 26 455 participants who were screened with LDCT. Of screening tests with a SIF detected, 12 228 (89.1%) had a SIF considered reportable to the RC, with a higher proportion of reportable SIFs among those with a positive screen result for lung cancer (7632 [94.1%]) compared with those with a negative screen result (4596 [81.8%]). The most common SIFs reported included emphysema (8677 [43.0%] of 20 156 SIFs reported), coronary artery calcium (2432 [12.1%]), and masses or suspicious lesions (1493 [7.4%]). Masses included kidney (647 [3.2%]), liver (420 [2.1%]), adrenal (265 [1.3%]), and breast (161 [0.8%]) abnormalities. Classification was based on free-text comments; 2205 of 13 299 comments (16.6%) could not be classified. The hierarchical reporting of final diagnosis in NLST may have been associated with an overestimate of severe emphysema in participants with a positive screen result for lung cancer.Conclusions and RelevanceThis case series study found that SIFs were commonly reported in the LDCT arm of the National Lung Screening Trial, and most of these SIFs were considered reportable to the RC and likely to require follow-up. Future screening trials should standardize SIF reporting.

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“…Most IFs are clinically insignificant and do not need to be reported, others require referral to specialists and further evaluation, and some require immediate medical intervention. 88 , 89 …”

Section: Incidental Findings On Ldct and Their Implicationsmentioning

confidence: 99%

“…A maioria dos AIs são clinicamente insignificantes e não precisam ser relatados, outros necessitam de encaminhamento para especialistas e avaliação complementar, e alguns requerem intervenção médica imediata. (88,89) Os achados relevantes, quando conduzidos de modo adequado, podem aumentar os benefícios e a relação custo-efetividade do rastreamento. Por outro lado, os achados sem significância clínica identificados em programas de rastreamento podem induzir a investigações desnecessárias e custos adicionais.…”

Section: Achados Incidentais Na Tcbd E Suas Implicaçõesunclassified

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging

Ferreira Pereira1,

Sales dos Santos2,3,

Oliveira Bonomi4

et al. 2024

J Bras Pneumol.

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Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

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Standardizing the Reporting of Incidental, Non-Lung Cancer (Category S) Findings Identified on Lung Cancer Screening Low-Dose CT Imaging

Cited by 15 publications

References 34 publications

How will lung cancer screening and lung nodule management change the diagnostic and surgical lung cancer landscape?

How will lung cancer screening and lung nodule management change the diagnostic and surgical lung cancer landscape?

Significant Incidental Findings in the National Lung Screening Trial

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging

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