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Missed and Interval Lung Cancers in an Academic Lung Cancer Screening Program
Ariadne K DeSimone1, Silvia Arora, Kathryn A Schulz
1Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Journal of Thoracic Imaging
|July 25, 2025
Summary
Lung cancer screening (LCS) has 95% sensitivity, but missed and interval cancers still occur. Endobronchial lesions are a key area for radiologists to improve LCS accuracy.
Area of Science:
- Pulmonary Medicine
- Radiology
- Oncology
Background:
- Lung cancer screening (LCS) programs aim to detect lung cancer early.
- Identifying missed and interval lung cancers is crucial for improving screening efficacy.
- Understanding the characteristics of false-negative screening CT scans is essential.
Purpose of the Study:
- To analyze the imaging features and pathology of missed and interval lung cancers within an academic LCS program.
- To compare cancer stage and pathology between false-negative and true-positive cases in LCS.
- To identify specific locations and types of lung cancers that are frequently missed during screening.
Main Methods:
- Retrospective analysis of patients diagnosed with lung cancer within one year of LCS CT scans (January 2015 - June 2023).
- Classification of prior LCS CT scans as "false negative" (Lung-RADS 1-2) or "true positive" (Lung-RADS 3-4).
- Retrospective review of false-negative cases, including assessment of cancer histology, stage, and location.
Main Results:
- 456 lung cancers diagnosed; 95% were true positive, 5% false negative (24 cases).
- Of false-negative cases, 33.3% were missed cancers, 12.5% interval cancers, and 54.2% slow-growing nodules (Lung-RADS 2).
- Missed cancers were frequently located paramediastinally (37.5%), perihilar (12.5%), and endobronchially (50%). No significant difference in histology or stage between false-negative and true-positive groups.
Conclusions:
- Despite high sensitivity (95%), LCS programs can still miss lung cancers, including interval cancers.
- Endobronchial lesions represent a significant source of missed lung cancers, offering a potential target for radiologist improvement.
- Findings offer insights into improving lung cancer detection rates within screening programs.
