title: 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.
authors.affiliation: University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands. j.c.m.van.de.wiel@rad.umcg.nl
authors.forename: J C M
authors.initials: JC
authors.lastname: van de Wiel
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.forename: D M
authors.initials: DM
authors.lastname: Xu
authors.forename: H J
authors.initials: HJ
authors.lastname: van der Zaag-Loonen
authors.forename: E J
authors.initials: EJ
authors.lastname: van der Jagt
authors.forename: R J
authors.initials: RJ
authors.lastname: van Klaveren
authors.forename: M
authors.initials: M
authors.lastname: Oudkerk
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009426:Netherlands; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography