Lung Cancer Screening and Incidental Findings: A Research Agenda: An Official American Thoracic Society Research Statement
Louise M. Henderson, Roger Y. Kim, Nichole T. Tanner, Emily B. Tsai, Abbie Begnaud, Farouk Dako, Michael Gieske, Kimberly Kallianos, Ilana B. Richman, Lori C. Sakoda, Ronald G. Schwartz, Joseph Yeboah, Kwun M. Fong, Stephen Lam, Pyng Lee, Mary Pasquinelli, Robert A. Smith, Matthew Triplette, L.T. Tanoue, M. Patricia Rivera
Abstract
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.