Improving lung cancer screening diagnostic efficiency

We discuss opportunities to improve lung cancer screening (LCS) diagnostic efficiency, which necessitates simultaneous focus on both diagnosis of early-stage lung cancer and reduction of diagnostic errors during diagnostic evaluation.

Recent efforts have focused on three distinct targets for improving LCS diagnostic efficiency: Eligibility and uptake, Adherence to annual screening, and Diagnostic evaluation of concerning findings. There has been ongoing debate regarding who should be screened and how to consider lung cancer risk factors, even as LCS uptake remains suboptimal. LCS annual adherence has emerged as an important quality metric, as it is associated with increased early-stage lung cancer detection. Finally, optimization of the diagnostic pathway once concerning findings are identified via LCS is necessary to minimize exposing those without cancer to the harms of invasive diagnostic testing. Efforts to improve pulmonary nodule risk assessment, the nonmalignant resection rate, and lung cancer overdiagnosis will be crucial.

Improving LCS diagnostic efficiency requires a careful balance between prioritizing lung cancer sensitivity (i.e., ability to diagnose early-stage lung cancers) and avoiding both false negatives (i.e., failure to diagnose an early-stage lung cancer) and false positives (i.e., unnecessary performance of invasive testing for benign lesions).