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Significant Incidental Findings in the National Lung Screening Trial
Ilana F Gareen1,2, Roee Gutman2,3, JoRean Sicks2
1Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island.
JAMA Internal Medicine
|May 8, 2023
Summary
Low-dose computed tomography (LDCT) lung screening frequently reveals significant incidental findings (SIFs). Most SIFs detected during LDCT screening are reportable and may require follow-up, highlighting the need for standardized reporting in future trials.
Area of Science:
- Radiology and Imaging
- Oncology
- Public Health
Background:
- Low-dose computed tomography (LDCT) lung screening reduces lung cancer mortality.
- Significant incidental findings (SIFs) are common in LDCT lung screening but their nature is not well-described.
Purpose of the Study:
- To describe SIFs in the LDCT arm of the National Lung Screening Trial (NLST).
- To classify SIFs as reportable or not reportable to referring clinicians (RCs) based on ACR guidelines.
Main Methods:
- Retrospective case series of 26,455 participants in the NLST (2002-2009).
- Analysis of 75,126 LDCT screening examinations.
- Classification of SIFs using ACR white papers on incidental findings.
Main Results:
- SIFs were reported in 33.8% of participants.
- 89.1% of SIFs were deemed reportable to the RC.
- Common SIFs included emphysema (43.0%), coronary artery calcium (12.1%), and various masses (7.4%).
Conclusions:
- SIFs are common in LDCT lung screening and mostly reportable.
- Most SIFs likely require clinical follow-up.
- Standardized SIF reporting is recommended for future screening trials.
