Incidental findings on lung cancer screening: pictorial essay and systematic checklist

Abstract

Lung cancer screening (LCS) programs are increasing worldwide. Incidental findings (IFs) on LCS are defined as low-dose CT findings unrelated to the primary purpose of identifying lung cancer. Most IFs on LCS are benign and clinically insignificant but are being increasingly recognized, and some require urgent referral for further diagnostic workup. Other findings are expected and are known as smoking-related comorbidities, including COPD, cardiovascular disease, emphysema, and interstitial lung disease, and their diagnosis can have a significant impact on patient prognosis. The purpose of this pictorial essay is to illustrate the most common IFs on LCS, organized by organ. We will discuss the current literature on IFs on LCS, focusing on their prevalence, appropriate communication, and triggering of clinical pathway systems.

Lung Cancer Screening: Implementation Challenges and Health Equity Considerations For the Western Pacific Region

“…In cases where other cancers are detected, such as breast, adrenal, thyroid, and upper abdominal, referral for specialist clinical evaluation will be required. 64 The detection of actionable findings is an advantage of the LDCT scan and presents a positive opportunity to implement standardized reporting recommendations for incidental findings and to minimize unnecessary workup of low-risk nodules. Cancer care and treatment in WPR is challenged by limited infrastructure and workforce capacity (Table 2 ).…”

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging

“…Most IFs are clinically insignificant and do not need to be reported, others require referral to specialists and further evaluation, and some require immediate medical intervention. 88 , 89 …”

“… 10 Therefore, it is possible that there is an advantage to LDCT in that it can identify other diseases, such as cardiovascular diseases (coronary arteriosclerosis, aortic aneurysm, pericardial thickening, and calcifications), COPD (emphysema and thickening of bronchial walls), and other diseases related or unrelated to smoking (e.g., interstitial lung lesions, sarcopenia, osteopenia, diaphragmatic hernias, neck cancer, and tracheal neoplasia). 88 , 94 The main IFs are described in Table 2 . 91 , 92 , 94 …”

“… 74 , 75 , 127 , 128 IFs-The rate of IFs varies greatly, depending on the definition of what is considered an IF and on the mean age of the study participants. 74 , 75 , 129 Although the detection of some IFs can cause distress, it can improve the diagnosis and early management of potentially serious diseases. …”

ERS/ESTS/ESTRO/ESR/ESTI/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer

“…LDCT is known to frequently detect gall stones without complications, which would not be reported in the screening context, unless obvious complications or masses are observed [ 146 ].…”