Incidental findings evident in 70% of lung screening exams, but few reported
Incidental findings on low dose CT lung cancer screenings may be significantly more prevalent than previously thought.
The results of a new prospective study that included data from nearly 4,500 patients who underwent lung cancer screening suggest incidental findings have become increasingly common. Despite this, consensus is lacking on whether radiologists should be required to report on findings that are not relevant to the cancer screening itself.
In the United States, there is no official mandate for readers to report incidental findings in patients’ radiology reports, though the American College of Radiology highly recommends it. Australia, however, will soon require rads to report several incidentals—pleural effusions, abdominal lesions, coronary artery calcifications and reduced bone density—under the country's new National Lung Cancer Screening Program set to begin in less than two months.
Under the mandate, radiologists will follow a structured template designed for LDCT exams, which will include a section where readers can notate the presence of the aforementioned findings. A driving factor behind the new reporting requirement is the mounting evidence supporting the use of cancer screenings as opportunistic exams for identifying adverse health conditions.
“Incidental findings are a major consideration for lung cancer screening using LDCT. Unlike other cancer screening techniques, it can detect tissue changes other than lung cancer and pulmonary nodules,” Asha Bonney, with Royal Melbourne Hospital, and colleagues explained. “Some incidental findings could facilitate earlier detection of clinically significant changes, such as coronary artery calcification and cardiovascular disease, and vertebral fractures and osteoporosis.”
The authors pointed to previous work from the United States that suggested up to 38% of LDCT participants have incidental findings on their screening exams. However, this most recent work indicates that figure may be much higher.
For their work, researchers analyzed LDCT data from nearly 4,500 participants living in Australia and Canada. Of those, 72.8% had at least one incidental finding visible on their scan, of which 10.3% required clinical follow-up. Coronary artery calcification was the most prevalent finding observed, at 70%, while emphysema was seen in 54%. The majority of patients did not report the presence of any symptoms related to these findings, the group noted.
They observed “marked” differences in communication related to incidental findings between providers, which further validates the need for standardized reporting.
“Our study was conducted under real world conditions, and our findings illustrate the potential for variation in recommendations and care when there is no clear and consistent guidance about reporting,” the authors wrote. “It is important for lung cancer screening programs that radiologists uniformly characterize and describe incidental findings, and that they provide consistent recommendations regarding the need for further assessment in a structured format.”
The authors acknowledged that not all incidental findings warrant reporting or further investigation. However, the need for global consensus remains.
Learn more about the findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.