title: Interval lung cancer after a negative CT screening examination: CT findings and outcomes in National Lung Screening Trial participants.
abstract: OBJECTIVE
  This study retrospectively analyses the screening CT examinations and outcomes of the National Lung Screening Trial (NLST) participants who had interval lung cancer diagnosed within 1 year after a negative CT screen and before the next annual screen.
  
  
  METHODS
  The screening CTs of all 44 participants diagnosed with interval lung cancer (cases) were matched with negative CT screens of participants who did not develop lung cancer (controls). A majority consensus process was used to classify each CT screen as positive or negative according to the NLST criteria and to estimate the likelihood that any abnormalities detected retrospectively were due to lung cancer.
  
  
  RESULTS
  By retrospective review, 40/44 cases (91%) and 17/44 controls (39%) met the NLST criteria for a positive screen (P < 0.001). Cases had higher estimated likelihood of lung cancer (P < 0.001). Abnormalities included pulmonary nodules ≥4 mm (n = 16), mediastinal (n = 8) and hilar (n = 6) masses, and bronchial lesions (n = 6). Cancers were stage III or IV at diagnosis in 32/44 cases (73%); 37/44 patients (84%) died of lung cancer, compared to 225/649 (35%) for all screen-detected cancers (P < 0.0001).
  
  
  CONCLUSIONS
  Most cases met the NLST criteria for a positive screen. Awareness of missed abnormalities and interpretation errors may aid lung cancer identification in CT screening.
  
  
  CONCLUSIONS
  • Lung cancer within a year of a negative CT screen was rare. • Abnormalities likely due to lung cancer were identified retrospectively in most patients. • Awareness of error types may help identify lung cancer sooner.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, Box 8131, 510 S. Kingshighway Blvd., St. Louis, MO, 63110, USA. gieradad@wustl.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Gierada
authors.affiliation: National Cancer Institute, 9609 Medical Center Drive, Room 5E108, Bethesda, MD, 20892, USA.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Pinsky
authors.affiliation: Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, 02912, USA.
authors.forename: Fenghai
authors.initials: F
authors.lastname: Duan
authors.affiliation: University of Colorado School of Medicine, Mail Stop F726, Box 6510, Aurora, CO, 80045, USA.
authors.forename: Kavita
authors.initials: K
authors.lastname: Garg
authors.affiliation: Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. Saint Clair, Suite 800, Chicago, IL, 60611, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Hart
authors.affiliation: Department of Radiology, University of Michigan Health System, Cardiovascular Center, Room #5482, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA.
authors.forename: Ella A
authors.initials: EA
authors.lastname: Kazerooni
authors.affiliation: Department of Radiology-JTN370, University of Alabama at Birmingham School of Medicine, 619 19th Street South, Birmingham, AL, 35233, USA.
authors.forename: Hrudaya
authors.initials: H
authors.lastname: Nath
authors.affiliation: Department of Radiology-JTN370, University of Alabama at Birmingham School of Medicine, 619 19th Street South, Birmingham, AL, 35233, USA.
authors.forename: Jubal R
authors.initials: JR
authors.lastname: Watts
authors.affiliation: Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 420, Los Angeles, CA, 90024, USA.
authors.forename: Denise R
authors.initials: DR
authors.lastname: Aberle
mesh_terms: D000368:Aged; D003951:Diagnostic Errors / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
keywords: Computed tomography; Diagnostic errors; False-negative reactions; Lung cancer; Mass screening