Lung Cancer Screening and Incidental Findings: A Research Agenda: An Official American Thoracic Society Research Statement

Abstract

Background: Lung cancer screening with low-dose computed tomography (LDCT) may uncover incidental findings (IFs) unrelated to lung cancer. There may be potential benefits from identifying clinically significant IFs that warrant intervention and potential harms related to identifying IFs that are not clinically significant but may result in additional evaluation, clinician effort, patient anxiety, complications, and excess cost. Objectives: To identify knowledge and research gaps and develop and prioritize research questions to address the approach to and management of IFs. Methods: We convened a multidisciplinary panel to review the available literature on IFs detected in lung cancer screening LDCT examinations, focusing on variability and standardizing reporting, management of IFs, and evaluation of the benefits and harms of IFs, particularly cardiovascular-related IFs. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in 1) reporting of IFs, 2) management of IFs, and 3) identifying and reporting coronary artery calcification found on lung cancer screening LDCT. Finally, we present the panel's initial 36 research questions and the final 20 prioritized questions. Conclusions: This statement provides a prioritized research agenda to further efforts focused on evaluating, managing, and increasing awareness of IFs in lung cancer screening.

Keywords: cardiovascular disease; incidental findings; lung cancer screening; net benefits.

Figure 1.

Incidental findings found on lung cancer screening.