Invasive Procedures Associated With Lung Cancer Screening in Clinical Practice

Abstract

Background: The harm associated with imaging abnormalities related to lung cancer screening (LCS) is not well documented, especially outside the clinical trial and academic setting.

Research question: What is the frequency of invasive procedures and complications associated with a community based LCS program, including procedures for false-positive and benign, but clinically important, incidental findings?

Study design and methods: We performed a single-center retrospective study of an LCS program at a nonuniversity teaching hospital from 2016 through 2019 to identify invasive procedures prompted by LCS results, including their indication and complications.

Results: Among 2,003 LCS participants, 58 patients (2.9%) received a diagnosis of lung cancer and 71 patients (3.5%) received a diagnosis of any malignancy. Invasive procedures were performed 160 times in 103 participants (5.1%), including 1.7% of those without malignancy. Eight invasive procedures (0.4% of participants), including four surgeries (12% of diagnostic lung resections), were performed for false-positive lung nodules. Only 1% of Lung Imaging Reporting and Data System category 4A nodules that proved benign were subject to an invasive procedure. Among those without malignancy, an invasive procedure was performed in eight participants for extrapulmonary false-positive findings (0.4%) and in 19 participants (0.9%) to evaluate incidental findings considered benign but clinically important. Procedures for the latter indication resulted in treatment, change in management, or diagnosis in 79% of individuals. Invasive procedures in those without malignancy resulted in three complications (0.15%). Seventy nonsurgical procedures (6% complication rate) and 48 thoracic surgeries (4% major complication rate) were performed in those with malignancy.

Interpretation: The use of invasive procedures to resolve false-positive findings was uncommon in the clinical practice of a nonuniversity LCS program that adhered to a nodule management algorithm and used a multidisciplinary approach. Incidental findings considered benign but clinically important resulted in invasive procedure rates that were similar to those for false-positive findings and frequently had clinical value.

Keywords: Lung-RADS; chest CT scan; false-positive; incidental finding; invasive procedure; nodule.