title: Spectrum of early lung cancer presentation in low-dose screening CT: a pictorial review.
abstract: The typical presentation of early stage lung cancers on low-dose CT screening are non-calcified pulmonary nodules. However, there is a wide spectrum of unusual focal abnormalities that can be early presentations of lung cancer. These abnormalities include, for example, cancers associated with 'cystic airspaces' or scar-like cancers. The detection of lung cancer with low-dose CT can be affected by the absence of intravenous contrast medium. As a consequence, endobronchial and central lesions can be difficult to recognize, raising the potential for missed cancers. Focal lesions arising within pre-existing lung disease, such as lung fibrosis or apical scars, can also be early lung cancer manifestations and deserve particular consideration as recognition of these lesions may be hindered by the underlying disease. Furthermore, the unpredictable growth rate of lung cancer, which ranges from indolent to aggressive cancers, necessitates attention to the wide spectrum of progression in lung cancer appearance on serial low-dose CT scans. In this pictorial review we discuss the spectrum of early lung cancer presentation in low-dose CT screening, highlighting typical as well as unusual radiological features and the varied growth rates of early lung cancer. Teaching Points • There is a wide spectrum of early presentations of lung cancer on LDCT. • Low radiation dose and the absence of contrast medium injection can affect lung cancer detection. • Lung cancer growth shows various behaviours, ranging from indolent to aggressive cancers. • Familiarity with LDCT technique can improve CT screening effectiveness and avoid missed diagnosis.
authors.affiliation: Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy. cristiano.rampinelli@ieo.it.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Rampinelli
authors.affiliation: School of Medicine, University of Milan, Milan, Italy.
authors.forename: Sonia Francesca
authors.initials: SF
authors.lastname: Calloni
authors.affiliation: School of Medicine, University of Milan, Milan, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Minotti
authors.affiliation: Department of Medical Imaging and Radiation Sciences, European Institute of Oncology, Via Ripamonti, 435, 20141, Milan, Italy.|School of Medicine, University of Milan, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
keywords: Low-dose CT; Lung cancer; Pulmonary nodule; Screening