Neglectable benefit of searching for incidental findings in the Dutch--Belgian lung cancer screening trial (NELSON) using low-dose multidetector CT
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The purpose of this study was to prospectively determine the frequency and spectrum of incidental findings (IFs) and their clinical implications in a high risk population for lung cancer undergoing low-dose multidetector computed tomography (MDCT) screening for lung cancer. Scans of 1,929 participants were evaluated for lung lesions and IFs by two radiologists. IFs were categorised as not clinically relevant or possibly clinically relevant. Findings were considered possibly clinically relevant if they could require further evaluation or could have substantial clinical implications. All possibly clinically relevant IFs were reviewed by a third radiologist, who determined its clinical relevance. Of all 1,929 participants, 1,410 (73%) had not clinically relevant IFs and 163 (8%) had possibly clinically relevant IFs of which 129 (79%) were indeed considered clinically relevant. Additional imaging was performed mainly by ultrasound (112 of 118, 96%). All but one lesion were concluded to be benign, mostly cysts (n = 115, 80%). Only 21 (1%) participants had findings with clinical implications. In one participant a malignancy was found, yet without any clinical benefit since no curative treatment was possible. Based on our results, we advise against systematically searching for and reporting of IFs in lung cancer screening studies using low-dose MDCT.
KeywordsLung cancer Screening Low-dose computed tomography Incidental findings
- NELSON: “Nederlands-Leuvens Longkanker Screenings Onderzoek”
Dutch--Belgian lung cancer screening trial; four participating hospitals of which three are located in The Netherlands (University Medical Centre Groningen, University Medical Centre Utrecht, Kennemer Gasthuis Haarlem) and one in Belgium (University Hospital Gasthuisberg Leuven)
We want to thank P.P. Taverne and H. ten Bhömer for their efforts concerning data collection and management. Furthermore we want to thank C. van Iersel and R. Faber for providing us the population data from the central NELSON databases.
The NELSON trial is financially supported by Zorg Onderzoek Nederland-Medische Wetenschappen (ZonMW), Dutch Cancer Society (NKB-KWF), Rotterdam Oncologic Thoracic Study Group (ROTS), Erasmus Trust Fund, G. Ph. Verhagen Foundation, Flemish Anti-Cancer Alliance (VLK), Stichting Centraal Fonds Reserves van Voormalig Vrijwillige Ziekenfondsverzekeringen (RvvZ), and Siemens Germany.
The authors certify that they have not entered into any agreement that could interfere with their access to the data on the research, nor upon their ability to analyse the data independently, to prepare manuscripts, and to publish them.