Lung Cancer: Screening and Evaluation of Patients With Solitary Pulmonary Nodules

Abstract

Low-dose computed tomography (CT) scan is the only modality currently considered acceptable for lung cancer screening in high-risk populations. Screening recommendations vary. The US Preventive Services Task Force recommends annual low-dose CT scan to screen high-risk patients (ie, asymptomatic patients ages 55 to 80 years with a 30 pack-year smoking history and who currently smoke or have quit within the previous 15 years). The American Academy of Family Physicians recommends a shared decision-making discussion between the clinician and patient regarding the benefits and potential harms of screening. Medicare covers lung cancer screening to age 77 years as part of a shared decision-making visit and when offered in conjunction with smoking cessation. Approximately 320 high-risk patients who smoke need to be screened annually over 3 years to prevent 1 death from lung cancer. The false-positive rate is 96%. Solitary pulmonary nodules or masses identified on screening or incidentally on other imaging should be managed based on appearance and size and the clinical risk factors of the patient, in accordance with guidelines.