New Research Supports Standardization of Reporting for Incidental Findings in Lung Cancer Screening

Ilana Gareen, PhD

Credit: Brown University

A recent study supported the importance of standardizing reporting for incidental findings in future lung cancer screening trials. Results showed that the standardized reporting was frequently reported in low-dose computed tomography (LDCT) lung screening, with the majority being considered reportable to the clinician and requiring follow-up.¹

In this study, Ilana Gareen, PhD, Department of Epidemiology, Brown University School of Public Health, and investigators, aimed to describe standardizing reporting for incidental findings reported in the LDCT arm of the National Lung Screening Trial (NLST) and classify standardizing reporting for incidental findings as reportable or not reportable to the referring clinician (RC) using the American College of Radiology's white papers on incidental findings.

The team stated that a standardized approach to standardized reporting incidental findings is crucial for proper patient management and improved outcomes.

The Standardizing Reporting for Incidental Findings in Lung Cancer Screening

The retrospective case series evaluation included 26,455 participants, with data showing 41.0% as women and the mean age as 61.4 years. There were 1179 (4.5%) Black, 470 (1.8%) Hispanic/Latino, and 24,123 (91.2%) white individuals. It was conducted from 2002 - 2009, and data were collected at 33 US academic medical centers.

Results reported the significant screening incidental finding was 33.8% of the participants who were screened with LDCT. Of the screening tests with standardized reporting for incidental findings detected, 89.1% considered the finding reportable to the radiology center.

Investigators observed the most common standardized reporting for incidental findings were emphysema (43.0%), coronary artery calcium (12.1%), and masses or suspicious lesions (7.4%).

Additionally, kidney (3.2%), liver (2.1%), adrenal (1.3%), and breast (0.8%) abnormalities were the most common masses reported, while 16.6% of the free-text comments could not be classified.

Lung cancer is the leading cause of cancer-related deaths worldwide, and early detection is crucial for improving survival rates. LDCT lung screening has been shown to reduce lung cancer mortality. However, significant incidental findings have been widely reported in patients undergoing LDCT lung screening.²

The standardizing reporting for incidental findings were classified as reportable or not reportable to the referring clinician using the American College of Radiology's white papers on incidental findings.¹

The team defined significant incident findings 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.

The analysis of standardized reporting for incidental findings found 12,228 (89.1%) had a standardizing reporting for incidental findings which was considered reportable to the referring clinician, with a higher proportion of reportable incidental findings among those with a positive screen result for lung cancer (7632 [94.1%]) compared with those with a negative screen result (4596 [81.8%]).

Investigators concluded that the findings highlight the need to standardize the reporting of findings in future screening trials, as they are are commonly reported in LDCT lung screening, and most are considered reportable to the referring clinician and likely to require follow-up.

The standardization of these this reporting will help in the proper management of patients with incidental findings and improve patient outcomes.

References:

1. Gareen IF, Gutman R, Sicks J, et al. Significant Incidental Findings in the National Lung Screening Trial. JAMA Intern Med. Published online May 08, 2023. doi:10.1001/jamainternmed.2023.1116
2. American Cancer Society. Lung Cancer Key Statistics. Accessed May 8, 2023. Available at: https://www.cancer.org/cancer/types/lung-cancer/about/key-statistics.html.