title: Computed tomographic characteristics of interval and post screen carcinomas in lung cancer screening.
abstract: OBJECTIVE
  To analyse computed tomography (CT) findings of interval and post-screen carcinomas in lung cancer screening.
  
  
  METHODS
  Consecutive interval and post-screen carcinomas from the Dutch-Belgium lung cancer screening trial were included. The prior screening and the diagnostic chest CT were reviewed by two experienced radiologists in consensus with knowledge of the tumour location on the diagnostic CT.
  
  
  RESULTS
  Sixty-one participants (53 men) were diagnosed with an interval or post-screen carcinoma. Twenty-two (36%) were in retrospect visible on the prior screening CT. Detection error occurred in 20 cancers and interpretation error in two cancers. Errors involved intrabronchial tumour (n = 5), bulla with wall thickening (n = 5), lymphadenopathy (n = 3), pleural effusion (n = 1) and intraparenchymal solid nodules (n = 8). These were missed because of a broad pleural attachment (n = 4), extensive reticulation surrounding a nodule (n = 1) and extensive scarring (n = 1). No definite explanation other than human error was found in two cases. None of the interval or post-screen carcinomas involved a subsolid nodule.
  
  
  CONCLUSIONS
  Interval or post-screen carcinomas that were visible in retrospect were mostly due to detection errors of solid nodules, bulla wall thickening or endobronchial lesions. Interval or post-screen carcinomas without explanation other than human errors are rare.
  
  
  CONCLUSIONS
  • 22% of missed carcinomas originally presented as bulla wall thickening on CT. • 22% of missed carcinomas originally presented as endobronchial lesions on CT. • All malignant endobronchial lesions presented as interval carcinomas. • In the NELSON trial subsolid nodules were not a source of missed carcinomas.
authors.affiliation: Department of Radiology, University Medical Centre, Utrecht, The Netherlands, ethscholten@quicknet.nl.
authors.forename: Ernst Th
authors.initials: ET
authors.lastname: Scholten
authors.forename: Nanda
authors.initials: N
authors.lastname: Horeweg
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: Pim A
authors.initials: PA
authors.lastname: de Jong
mesh_terms: D000368:Aged; D001530:Belgium; D001984:Bronchial Neoplasms / Q000000981:diagnostic imaging; D002277:Carcinoma / Q000000981:diagnostic imaging*; D057210:Delayed Diagnosis; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000592:standards; D009426:Netherlands; D015588:Observer Variation; D010996:Pleural Effusion / Q000209:etiology; D012189:Retrospective Studies