The Society of Thoracic Surgeons (2025) Expert Consensus Document on Interventions for Screen-Detected Lung Nodules

Computed tomographic (CT) lung cancer screening (LCS) reduces lung cancer-specific mortality and improves survival. We reviewed contemporary literature to develop consensus recommendations on perioperative quality standards for LCS programs to optimize outcomes.

The Society of Thoracic Surgeons (STS) Task Force on Lung Cancer Screening and STS Workforce on Evidence Based Surgery convened a multidisciplinary panel of thoracic surgeons, radiation oncologists, and interventional pulmonologists. A comprehensive literature review was conducted using the PICO (Population, Intervention, Comparisons, Outcome) framework. Consensus statements were developed through a modified Delphi process addressing: (1) preoperative biopsy and diagnostic surgical procedures, (2) acceptable rates of complications from diagnostic and therapeutic procedures, and (3) timing of intervention after a suspicious LCS finding, and the role of the multidisciplinary team in patient management. Consensus required ≥75% agreement.

The panel developed 23 consensus statements after 3 Delphi rounds; 20 achieved consensus in the first round. Surgery without tissue diagnosis was acceptable for carefully selected patients, favoring minimally invasive, parenchymal-sparing approaches. Pneumonectomy without diagnosis was unanimously rejected. Programs should track benign resection rates. Acceptable complication benchmarks included pneumothorax <5%, hemoptysis <2%, and mortality <1% for bronchoscopic biopsy; and surgical morbidity <10% and 30-day mortality <1%, per STS database standards. Definitive resection should occur within 12 weeks of the inciting imaging study. Multidisciplinary teams should include thoracic surgery, oncology, pulmonology, and radiology. Preoperative pulmonary rehabilitation and smoking cessation were emphasized.

This STS consensus defines perioperative quality standards for CT LCS programs, supporting shared decision-making, multidisciplinary care, and quality improvement.