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Significant Incidental Findings in the National Lung Screening Trial.

Publication ,  Journal Article
Gareen, IF; Gutman, R; Sicks, J; Tailor, TD; Hoffman, RM; Trivedi, AN; Flores, E; Underwood, E; Cochancela, J; Chiles, C
Published in: JAMA Intern Med
July 1, 2023

IMPORTANCE: Low-dose computed tomography (LDCT) lung screening has been shown to reduce lung cancer mortality. Significant incidental findings (SIFs) have been widely reported in patients undergoing LDCT lung screening. However, the exact nature of these SIF findings has not been described. OBJECTIVE: To describe SIFs reported in the LDCT arm of the National Lung Screening Trial and classify SIFs as reportable or not reportable to the referring clinician (RC) using the American College of Radiology's white papers on incidental findings. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective case series study of 26 455 participants in the National Lung Screening Trial who underwent at least 1 screening examination with LDCT. The trial was conducted from 2002 to 2009, and data were collected at 33 US academic medical centers. MAIN OUTCOMES AND MEASURES: Significant incident findings were defined as a final diagnosis of a negative screen result with significant abnormalities that were not suspicious for lung cancer or a positive screen result with emphysema, significant cardiovascular abnormality, or significant abnormality above or below the diaphragm. RESULTS: Of 26 455 participants, 10 833 (41.0%) were women, the mean (SD) age was 61.4 (5.0) years, and there were 1179 (4.5%) Black, 470 (1.8%) Hispanic/Latino, and 24 123 (91.2%) White individuals. Participants were scheduled to undergo 3 screenings during the course of the trial; the present study included 75 126 LDCT screening examinations performed for 26 455 participants. A SIF was reported for 8954 (33.8%) of 26 455 participants who were screened with LDCT. Of screening tests with a SIF detected, 12 228 (89.1%) had a SIF considered reportable to the RC, with a higher proportion of reportable SIFs among those with a positive screen result for lung cancer (7632 [94.1%]) compared with those with a negative screen result (4596 [81.8%]). The most common SIFs reported included emphysema (8677 [43.0%] of 20 156 SIFs reported), coronary artery calcium (2432 [12.1%]), and masses or suspicious lesions (1493 [7.4%]). Masses included kidney (647 [3.2%]), liver (420 [2.1%]), adrenal (265 [1.3%]), and breast (161 [0.8%]) abnormalities. Classification was based on free-text comments; 2205 of 13 299 comments (16.6%) could not be classified. The hierarchical reporting of final diagnosis in NLST may have been associated with an overestimate of severe emphysema in participants with a positive screen result for lung cancer. CONCLUSIONS AND RELEVANCE: This case series study found that SIFs were commonly reported in the LDCT arm of the National Lung Screening Trial, and most of these SIFs were considered reportable to the RC and likely to require follow-up. Future screening trials should standardize SIF reporting.

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Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

July 1, 2023

Volume

183

Issue

7

Start / End Page

677 / 684

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Middle Aged
  • Mass Screening
  • Male
  • Lung Neoplasms
  • Lung
  • Incidental Findings
  • Humans
  • Female
  • Emphysema
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Gareen, I. F., Gutman, R., Sicks, J., Tailor, T. D., Hoffman, R. M., Trivedi, A. N., … Chiles, C. (2023). Significant Incidental Findings in the National Lung Screening Trial. JAMA Intern Med, 183(7), 677–684. https://doi.org/10.1001/jamainternmed.2023.1116
Gareen, Ilana F., Roee Gutman, JoRean Sicks, Tina D. Tailor, Richard M. Hoffman, Amal N. Trivedi, Efren Flores, Ellen Underwood, Jerson Cochancela, and Caroline Chiles. “Significant Incidental Findings in the National Lung Screening Trial.JAMA Intern Med 183, no. 7 (July 1, 2023): 677–84. https://doi.org/10.1001/jamainternmed.2023.1116.
Gareen IF, Gutman R, Sicks J, Tailor TD, Hoffman RM, Trivedi AN, et al. Significant Incidental Findings in the National Lung Screening Trial. JAMA Intern Med. 2023 Jul 1;183(7):677–84.
Gareen, Ilana F., et al. “Significant Incidental Findings in the National Lung Screening Trial.JAMA Intern Med, vol. 183, no. 7, July 2023, pp. 677–84. Pubmed, doi:10.1001/jamainternmed.2023.1116.
Gareen IF, Gutman R, Sicks J, Tailor TD, Hoffman RM, Trivedi AN, Flores E, Underwood E, Cochancela J, Chiles C. Significant Incidental Findings in the National Lung Screening Trial. JAMA Intern Med. 2023 Jul 1;183(7):677–684.

Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

July 1, 2023

Volume

183

Issue

7

Start / End Page

677 / 684

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Middle Aged
  • Mass Screening
  • Male
  • Lung Neoplasms
  • Lung
  • Incidental Findings
  • Humans
  • Female
  • Emphysema