Prevalence and clinical characteristics of non-malignant CT detected incidental findings in the SUMMIT lung cancer screening cohort

BackgroundPulmonary and extrapulmonary incidental findings are frequently identified on CT scans performed for lung cancer screening. Uncertainty regarding their clinical significance and how and when such findings should be reported back to clinicians and participants persists. We examined the prev...

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Published in:	BMJ open respiratory research Vol. 10; no. 1; p. e001664
Main Authors:	Tisi, Sophie, Creamer, Andrew W, Dickson, Jennifer, Horst, Carolyn, Hall, Helen, Verghese, Priyam, Gyertson, Kylie, Levermore, Claire, Hacker, Anne-Marie, Teague, Jonathon, Farrelly, Laura, Nair, Arjun, Devaraj, Anand, Hackshaw, Allan, Hurst, John R, Janes, Samuel, Janes, Sam M, Creamer, Andrew, Callender, Thomas, Prendecki, Ruth, Bhamani, Amyn, Ruparel, Mamta, Teague, Jon, Mullin, Anne-Marie, Chan, Kitty, Sarpong, Rachael, Suresh, Malavika, Quaife, Samantha L, Bowyer, Vicky, El-Emir, Ethaar, Cotton, Alice, Phua, Kaylene, Murali, Elodie, Mehta, Simranjit, Zylstra, Janine, Parry-Billings, Karen, Ife, Columbus, Neville, April, Robinson, Paul, Green, Laura, Hanif, Zahra, Kiconco, Helen, Arancon, Dominique, Beech, Nicholas, Ovayolu, Derya, Hosein, Christine, Enes, Sylvia Patricia, Neville, Qin April, Rowlands, Jane, Samson, Aashna, Patel, Urja, Hoque, Fahmida, Pervez, Hina, Nnorom, Sofia, Miah, Moksud, McKee, Julian, Clark, Mark, Eng, Jeannie, Bojang, Fanta, Patel, Anant, Lock, Sara, Banka, Rajesh, Bhowmik, Angshu, Ekeowa, Ugo, Mangera, Zaheer, Ricketts, William M, Navani, Neal, O'Shaughnessy, Terry, Taylor, Magali, Hare, Samanjit, Aziz, Tunku, Ellis, Stephen, Edey, Anthony, Robinson, Graham, Villanueva, Alberto, Robbie, Hasti, Stefan, Elena, Sayer, Charlie, Screaton, Nick, Nundlall, Navinah, Gallagher, Lyndsey, Crossingham, Andrew, Buchan, Thea, Limani, Tanita, Gowers, Kate, Davies, Kate, McCabe, John, Jacob, Joseph, Sennett, Karen, TaniaAnastasiadis, Andrew Perugia, Rusius, James
Format:	Journal Article
Language:	English
Published:	England British Thoracic Society 01-06-2023 BMJ Publishing Group LTD BMJ Publishing Group
Subjects:	Aortic aneurysms Calcification Coronary vessels Early Detection of Cancer Humans Imaging/CT MRI etc Incidental Findings Lung Cancer Lung Neoplasms - diagnostic imaging Lung Neoplasms - epidemiology Medical imaging Medical screening Mortality Prevalence Smoking cessation Spirometry Systematic review Tomography, X-Ray Computed - methods Vascular surgery Veins & arteries United Kingdom > UK Imaging/CT MRI etc Lung Cancer
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Summary:	BackgroundPulmonary and extrapulmonary incidental findings are frequently identified on CT scans performed for lung cancer screening. Uncertainty regarding their clinical significance and how and when such findings should be reported back to clinicians and participants persists. We examined the prevalence of non-malignant incidental findings within a lung cancer screening cohort and investigated the morbidity and relevant risk factors associated with incidental findings. We quantified the primary and secondary care referrals generated by our protocol.MethodsThe SUMMIT study (NCT03934866) is a prospective observational cohort study to examine the performance of delivering a low-dose CT (LDCT) screening service to a high-risk population. Spirometry, blood pressure, height/weight and respiratory history were assessed as part of a Lung Health Check. Individuals at high risk of lung cancer were offered an LDCT and returned for two further annual visits. This analysis is a prospective evaluation of the standardised reporting and management protocol for incidental findings developed for the study on the baseline LDCT.ResultsIn 11 115 participants included in this analysis, the most common incidental findings were coronary artery calcification (64.2%) and emphysema (33.4%). From our protocolised management approach, the number of participants requiring review for clinically relevant findings in primary care was 1 in 20, and the number potentially requiring review in secondary care was 1 in 25.ConclusionsIncidental findings are common in lung cancer screening and can be associated with reported symptoms and comorbidities. A standardised reporting protocol allows systematic assessment and standardises onward management.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3
ISSN:	2052-4439 2052-4439
DOI:	10.1136/bmjresp-2023-001664