Clinicians who routinely manage patients screened for lung cancer with low-dose CT have a new 1-page printout to illuminate evidence-based care pathways when faced with significant but questionably urgent incidental findings.
The resource was commissioned by the American College of Radiology’s steering committee on lung cancer screening and is laid out in a paper posted Dec. 9 in JACR [1].
Lead author Debra Dyer of National Jewish Health in Denver, senior author Ella Kazerooni of the University of Michigan and colleagues drafted the paper and comprised the ACR’s subcommittee on LCS incidental findings.
For the most part, the guide’s insights and recommendations amplify those from previous research.
For example, Dyer and co-authors found that incidental findings turn up in almost 20% of patients undergoing lung cancer screening with low-dose CT, but most of these “incidentalomas” call for no urgent diagnostic or therapeutic action.
Still, the authors report, some 95% of participating end-users representing 49 screening programs rated the guide as useful or extremely so during a pilot rollout.
Further, Dyer and colleagues state theirs is the first report in the literature that “defines the commonly encountered incidental findings in lung cancer screening and provides recommendations for those that are actionable.”
The team developed the guide after analyzing data in the ACR Lung Cancer Screening Registry, reviewing 12 relevant ACR white papers and other published literature and soliciting input from various medical subspecialists.
Co-authors and reviewers of the guide included cardiothoracic radiologists, a pulmonologist and two primary care providers.
The resulting guide contains 45 case-specific recommendations involving 15 separate organs across seven anatomic regions: abdominal, cardiovascular, breast, esophagus, lung/pleura, mediastinum and thyroid.
Major recommendations include:
- In reporting significant or potentially significant incidental findings on lung cancer screening with low-dose CT, radiologists should use the Lung-RADS S modifier to indicate that these findings are actionable.
- Ordering providers have the responsibility to address actionable incidental findings identified and ensure that the findings are appropriately and adequately managed.
“The management of incidental findings as a potential barrier to lung cancer screening implementation is well recognized and well documented in the literature,” Dyer et al. write.
The ACR Lung Cancer Screening CT Incidental Findings Quick Reference Guide, they state, “is concise and useful and can serve as a valuable resource to lung cancer screening program navigators and ordering providers tasked with managing lung cancer screening incidental findings.”
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.