European journal of cancer (Oxford, England : 1990) · 2026
Clinical urgency of incidental findings in the first year of the 4-IN-THE-LUNG-RUN lung cancer screening program.
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Walstra Anna N H, Heuvelmans Marjolein A, Han Daiwei, Hubert Juul, van den Bosch Isabelle, Schmitz Alexander M Th, Oudkerk Sytse F, van Leeuwen Maarten, Nair Arjun, Silva Mario, Gratama Jan Willem C, van der Aalst Carlijn M, de Koning Harry J, Oudkerk Matthijs
Аннотация
INTRODUCTION: Low-dose CT lung cancer screening (LCS) inevitably detects incidental findings (IFs) beyond its primary purpose; while some offer clinical benefit, they also risk overdiagnosis, overtreatment, and increased healthcare costs. This study evaluated the clinical urgency of IFs during the first year of the 4-IN-THE-LUNG-RUN LCS program.
METHODS: Participants in the Dutch arm of the 4-IN-THE-LUNG-RUN program who underwent baseline and annual CT screening between December-2022 and May-2025 were included. Clinical urgency was assessed by the proportion of radiologist-described IFs that, following centralized expert adjudication, were reported to primary care, referred for further work-up, or required (urgent) referral or intervention. At annual screening, all previously reported IFs were classified as new, stable, progressing, or surgically intervened.
RESULTS: Among 4122 participants (56.5% male, median age 68 years), IFs were described in 291 participants (7.1%) across both screening rounds. Following centralized adjudication, 75 participants (1.8%) had an IF reported to primary care, of whom 19 (0.5%) were referred for further work-up. At baseline, 67 IFs in 58 participants (1.4%) were reported to primary care, with 10 referred for clinical work-up, including one urgent referral. Four received surgical intervention, two cardiovascular IFs were non-symptomatic and thus screening-driven. At annual screening, the remaining baseline IFs were predominantly stable (59/63), only four showed progression and were subsequently re-reported. New IFs at annual screening were rare.
CONCLUSION: While lung cancer screening inevitably reveals findings beyond lung cancer, the majority are not clinically relevant, rarely require urgent intervention, and can be effectively managed within the screening program.
METHODS: Participants in the Dutch arm of the 4-IN-THE-LUNG-RUN program who underwent baseline and annual CT screening between December-2022 and May-2025 were included. Clinical urgency was assessed by the proportion of radiologist-described IFs that, following centralized expert adjudication, were reported to primary care, referred for further work-up, or required (urgent) referral or intervention. At annual screening, all previously reported IFs were classified as new, stable, progressing, or surgically intervened.
RESULTS: Among 4122 participants (56.5% male, median age 68 years), IFs were described in 291 participants (7.1%) across both screening rounds. Following centralized adjudication, 75 participants (1.8%) had an IF reported to primary care, of whom 19 (0.5%) were referred for further work-up. At baseline, 67 IFs in 58 participants (1.4%) were reported to primary care, with 10 referred for clinical work-up, including one urgent referral. Four received surgical intervention, two cardiovascular IFs were non-symptomatic and thus screening-driven. At annual screening, the remaining baseline IFs were predominantly stable (59/63), only four showed progression and were subsequently re-reported. New IFs at annual screening were rare.
CONCLUSION: While lung cancer screening inevitably reveals findings beyond lung cancer, the majority are not clinically relevant, rarely require urgent intervention, and can be effectively managed within the screening program.