The Frequency of Incidental Findings and Subsequent Testing in Low-Dose CT Scans for Lung Cancer Screening

Abstract

SESSION TITLE: Imaging SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: To describe the frequency of incidental findings on low-dose CT scans (LDCT) for lung cancer screening and testing related to these findings. METHODS: We conducted a retrospective chart review of a random sample of patients who participated in the Cleveland Clinic Lung Cancer Screening Program from April 1, 2015 through March 4th, 2016. Reported findings other than pulmonary nodules from the structured report of the LDCT scans were categorized by organ system and type. The downstream investigations that occurred as a result of these incidental findings, including consultations, other diagnostic imaging and procedures were recorded. RESULTS: 245 LDCT screened patients records were reviewed. Virtually all scans had incidental findings reported. The most commonly reported findings were pulmonary(36.1%), cardiovascular(34.7%) and musculoskeletal(10.5%). Fourteen percent of the scans had a finding that resulted in further evaluation. The majority(70.6%) of further workup was done for cardiovascular findings such as coronary artery calcification or thoracic aortic ectasia, and less frequently for hepatic(8.6%), pulmonary (8.6%), adrenal(5.7%), thyroid (5.7%), renal (5.7%), esophageal (2.8%) or splenic (2.8%) findings. The most frequently ordered investigations were echocardiography (20.0%), CT angiography(17.1%) and stress test (14.3%). Invasive testing occurred in 4 patients, 2 underwent coronary catheterization and 2 were scheduled for robotic partial nephrectomy for radiographic findings consistent with renal cell carcinoma. CONCLUSIONS: Clinically significant incidental findings of LDCT scans for lung cancer screening are common. Additional testing related to these findings was required in approximately 1 out of every 7 patients. CLINICAL IMPLICATIONS: Given the frequency of incidental findings, their potential impact should be included in the shared decision making process before patients choose to undergo screening. Screening programs should develop a standard approach for the evaluation of these findings, and consider the financial impact of these findings when seeking infrastructure support for screening program implementation. DISCLOSURE: The following authors have nothing to disclose: Lillie Morgan, Michal Reid, Humberto Choi, Peter Mazzone No Product/Research Disclosure Information