Neglectable benefit of searching for incidental findings in the Dutch--Belgian lung cancer screening trial (NELSON) using low-dose multidetector CT

Abstract

The purpose of this study was to prospectively determine the frequency and spectrum of incidental findings (IFs) and their clinical implications in a high risk population for lung cancer undergoing low-dose multidetector computed tomography (MDCT) screening for lung cancer. Scans of 1,929 participants were evaluated for lung lesions and IFs by two radiologists. IFs were categorised as not clinically relevant or possibly clinically relevant. Findings were considered possibly clinically relevant if they could require further evaluation or could have substantial clinical implications. All possibly clinically relevant IFs were reviewed by a third radiologist, who determined its clinical relevance. Of all 1,929 participants, 1,410 (73%) had not clinically relevant IFs and 163 (8%) had possibly clinically relevant IFs of which 129 (79%) were indeed considered clinically relevant. Additional imaging was performed mainly by ultrasound (112 of 118, 96%). All but one lesion were concluded to be benign, mostly cysts (n = 115, 80%). Only 21 (1%) participants had findings with clinical implications. In one participant a malignancy was found, yet without any clinical benefit since no curative treatment was possible. Based on our results, we advise against systematically searching for and reporting of IFs in lung cancer screening studies using low-dose MDCT.

Interstitial lung diseases in a lung cancer screening trial

“…This prevalence is between that reported by other studies evaluating the incidental findings in lung cancer screening. In the DutchBelgian Randomised Controlled Lung Cancer Screening Trial (NELSON study) [7], signs of pulmonary fibrosis were reported in 117 (8%) out of 1,409 cases, whereas they were observed in six (1.3%) out of 449 cases recruited by the ProActive Lung Cancer Detection (PALCAD) study [8].…”

“…Although the thin-section CT features of these disorders have been increasingly described in the literature, few data have been reported on their significance in smokers participating in a lung cancer screening trial [7,8]. A comprehensive assessment of chest CT as a screening tool should include a thorough appreciation of the prevalence and nature of those findings that may have prognostic relevance and require therapeutic interventions.…”

Radiological profile of anemia on unenhanced MDCT of the thorax

“…Incidental findings on thoracic CT are common [1]. Despite their wide range of clinical relevance, identifying such incidental findings may impose considerable impact on patient management and outcome [2,3].…”

Early Detection of Lung Cancer: A Statement from an Expert Panel of the Swiss University Hospitals on Lung Cancer Screening

“…It is therefore possible that analysis of imaging features other than lung nodules may have an impact on survival or other clinical outcomes. The relevance of these additional findings has been investigated by several groups [71,72,73]. In all of these studies the number of significant incidental findings did not exceed 7%.…”