Lung Cancer Screening in a Rural Academic Health System Reveals Low False-Positive Rates.

Area of Science:

• Radiology
• Pulmonology
• Oncology

Background:

• Lung cancer screening (LCS) uptake is limited by concerns about high false-positive rates.
• Accurate quantification of false-positive findings in LCS is crucial for patient and clinician confidence.

Purpose of the Study:

• To assess lung cancer screening results and quantify false-positive rates.
• To address misconceptions regarding the reliability of LCS findings.

Main Methods:

• Retrospective review of 1708 patients undergoing LCS from January 2017 to March 2022.
• Analysis of Lung Reporting and Data Systems (Lung-RADS) scores and follow-up data.
• Calculation of false-positive rates using Lung-RADS 3+ and separately using Lung-RADS 4B/4X criteria.

Main Results:

• 89.9% of scans were Lung-RADS 1 or 2, indicating no or minimal findings.
• False-positive rates were 9.4% (Lung-RADS 3+) and significantly lower at 1.6% (Lung-RADS 4B/4X).
• A substantial proportion of initially positive scans (Lung-RADS 3 or 4A) were downgraded on follow-up, allowing return to annual screening.

Conclusions:

• Lung-RADS score distribution aligns with national data.
• The false-positive risk of LCS is comparable to mammography.
• Findings support increased utilization of LCS as a life-saving screening modality.