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Computed tomographic characteristics of interval and post screen carcinomas in lung cancer screening

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Abstract

Objectives

To analyse computed tomography (CT) findings of interval and post-screen carcinomas in lung cancer screening.

Methods

Consecutive interval and post-screen carcinomas from the Dutch–Belgium lung cancer screening trial were included. The prior screening and the diagnostic chest CT were reviewed by two experienced radiologists in consensus with knowledge of the tumour location on the diagnostic CT.

Results

Sixty-one participants (53 men) were diagnosed with an interval or post-screen carcinoma. Twenty-two (36 %) were in retrospect visible on the prior screening CT. Detection error occurred in 20 cancers and interpretation error in two cancers. Errors involved intrabronchial tumour (n = 5), bulla with wall thickening (n = 5), lymphadenopathy (n = 3), pleural effusion (n = 1) and intraparenchymal solid nodules (n = 8). These were missed because of a broad pleural attachment (n = 4), extensive reticulation surrounding a nodule (n = 1) and extensive scarring (n = 1). No definite explanation other than human error was found in two cases. None of the interval or post-screen carcinomas involved a subsolid nodule.

Conclusions

Interval or post-screen carcinomas that were visible in retrospect were mostly due to detection errors of solid nodules, bulla wall thickening or endobronchial lesions. Interval or post-screen carcinomas without explanation other than human errors are rare.

Key points

• 22 % of missed carcinomas originally presented as bulla wall thickening on CT.

• 22 % of missed carcinomas originally presented as endobronchial lesions on CT.

• All malignant endobronchial lesions presented as interval carcinomas.

• In the NELSON trial subsolid nodules were not a source of missed carcinomas.

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Acknowledgements

The scientific guarantor of this publication is Prof. W.P.Th.M. Mali. The authors of this manuscript declare no relatinoships with any companies whose products or services may be releated to the subject matter of the article. The NELSON study has received funding from Zorf Onderzoek Nederland-Medische Wtenschappen (ZonMw), KWF Kankerbestrijding, Stichting Centraal Fonds Reserves van Voormalig Vrijwillige Ziekenfondsverzekeringen (RvvZ), G. Ph. Verhagen Foundation, Rotterdam Oncologic Thoracic Study Group (ROTS) and Erasmus Trust Fung, Stichting tegen Kanker, Vlaamse Liga tegen Kanker and LOGO Leuven and Hageland. One of the authors has significant statistical expertise; however no complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, observational, multicentre study.

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Authors and Affiliations

  1. Department of Radiology, University Medical Centre, Utrecht, The Netherlands

    Ernst Th. Scholten, Willem P. Th. M. Mali & Pim A. de Jong

  2. Department of Radiology, Kennemer Gasthuis, Haarlem, The Netherlands

    Ernst Th. Scholten

  3. Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Nanda Horeweg & Harry J. de Koning

  4. Department of Pulmonary Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands

    Nanda Horeweg

  5. Department of Radiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

    Rozemarijn Vliegenthart

  6. Center for Medical Imaging-North East Netherlands, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

    Rozemarijn Vliegenthart & Matthijs Oudkerk

Authors
  1. Ernst Th. Scholten
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  2. Nanda Horeweg
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  3. Harry J. de Koning
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  4. Rozemarijn Vliegenthart
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  5. Matthijs Oudkerk
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  6. Willem P. Th. M. Mali
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  7. Pim A. de Jong
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Corresponding author

Correspondence to Ernst Th. Scholten.

Additional information

Ernst Th Scholten and Nanda Horeweg have equal contribution.

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Scholten, E.T., Horeweg, N., de Koning, H.J. et al. Computed tomographic characteristics of interval and post screen carcinomas in lung cancer screening. Eur Radiol 25, 81–88 (2015). https://doi.org/10.1007/s00330-014-3394-4

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  • DOI: https://doi.org/10.1007/s00330-014-3394-4

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