title: Surgical Outcomes in a Large, Clinical, Low-Dose Computed Tomographic Lung Cancer Screening Program.
abstract: BACKGROUND
  Lung cancer screening with low-dose computed tomography is proven to reduce lung cancer mortality among high-risk patients. However, critics raise concern over the potential for unnecessary surgical procedures performed for benign disease as a result of screening. We reviewed our outcomes in a large clinical lung cancer screening program to assess the number of surgical procedures done for benign disease, as we believe this is an important quality metric.
  
  
  METHODS
  We retrospectively reviewed our surgical outcomes of consecutive patients who underwent low-dose computed tomography lung cancer screening from January 2012 through June 2014 using a prospectively collected database. All patients met the National Comprehensive Cancer Network lung cancer screening guidelines high-risk criteria.
  
  
  RESULTS
  There were 1,654 screened patients during the study interval with clinical follow-up at Lahey Hospital & Medical Center. Twenty-five of the 1,654 (1.5%) had surgery. Five of 25 had non-lung cancer diagnoses: 2 hamartomas, 2 necrotizing granulomas, and 1 breast cancer metastasis. The incidence of surgery for non-lung cancer diagnosis was 0.30% (5 of 1,654), and the incidence of surgery for benign disease was 0.24% (4 of 1,654). Twenty of 25 had lung cancer, 18 early stage and 2 late stage. There were no surgery-related deaths, and there was 1 major surgical complication (4%) at 30 days.
  
  
  CONCLUSIONS
  The incidence of surgical intervention for non-lung cancer diagnosis was low (0.30%) and is comparable to the rate reported in the National Lung Screening Trial (0.62%). Surgical intervention for benign disease was rare (0.24%) in our experience.
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Bryan L
authors.initials: BL
authors.lastname: Walker
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts. Electronic address: christina.williamson@lahey.org.
authors.forename: Christina
authors.initials: C
authors.lastname: Williamson
authors.affiliation: Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Regis
authors.affiliation: Department of Radiation Oncology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: McKee
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Richard S
authors.initials: RS
authors.lastname: D'Agostino
authors.affiliation: Department of Hematology and Oncology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hesketh
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Carla R
authors.initials: CR
authors.lastname: Lamb
authors.affiliation: Department of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Flacke
authors.affiliation: Department of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Christoph
authors.initials: C
authors.lastname: Wald
authors.affiliation: Department of Radiology, Lahey Hospital & Medical Center, Burlington, Massachusetts.
authors.forename: Brady J
authors.initials: BJ
authors.lastname: McKee
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D006099:Granuloma / Q000000981:diagnostic imaging; D006222:Hamartoma / Q000000981:diagnostic imaging; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D008403:Mass Screening; D008481:Mediastinoscopy; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed / Q000379:methods*