PURPOSE
To determine the prevalence of actionable incidental findings (AIFs) in a high-risk lung cancer screening cohort within a universal healthcare setting and identify potential opportunities in system-level quality improvement for AIF detection and management.
METHODS
This retrospective cohort study identified all individuals that presented for a baseline lung cancer screening exam between August 2019 and September 2025. Structured computed tomography (CT) report text was extracted and included an affirmation of whether an AIF was present, a description of the AIF, and a management recommendation. AIF type and prevalence were compared to guideline literature to identify areas of lower-than-expected reporting. Comparisons were performed using t-tests or chi-square tests.
RESULTS
There were 3169 unique individuals with eligible CT reports (37.2% female, 64.0 ± 5.2 years of age) with 424 AIFs identified in 370 (11.7%) individuals. AIFs were associated with higher body mass index, active smoking, Lung-RADS score, and less common with a personal history of cancer (P < .05). Moderate or severe coronary artery calcification (n = 106, 3.3%), thyroid lesions (n = 43, 1.4%), and interstitial lung abnormalities (n = 41, 1.3%) were most common. Bone mineral density (0%), vertebral fractures (0.1%), and indeterminate adrenal lesions (0.1%) were infrequently reported despite guidelines suggesting clinical relevance. Management recommendations were generally aligned with provincial program-specific guidance.
CONCLUSION
AIFs were common, but prevalence was relatively low for several key, potentially significant findings. Standardized reporting of AIFs and program-specific guidance is required considering the downstream costs associated with systematic identification of these AIFs.
Adam Gaisinsky, Lara Gabrielle Lim, Hussain Alshimali et al.· Canadian Association of Radi...· 0 citations
BACKGROUND
Combined pulmonary fibrosis and emphysema (CPFE) is an important phenotype in patients with fibrotic interstitial lung disease (ILD).
RESEARCH QUESTIONS
(1) What is the prevalence of CPFE? (2) What is the predictive performance of the CPFE Index and of physiological airflow obstruction for computed tomography (CT) emphysema extents? (3) Is extent of CT emphysema associated with outcomes in patients with fibrotic ILD?
STUDY DESIGN AND METHODS
Consecutive patients with idiopathic pulmonary fibrosis (IPF) and non-IPF fibrotic ILD who had a standardized visual assessment of the baseline high-resolution CT chest from a prospective registry were included. CPFE was defined as CT emphysema extent of ≥15%, with sensitivity analyses using different thresholds: ≥5%, ≥10%, and ≥20%. Emphysema subtypes were categorized based on their predominant distribution: centrilobular, paraseptal, or panlobular. The CPFE Index was derived using measurements of spirometry and diffusion capacity for carbon dioxide.
RESULTS
The prevalence of CPFE at baseline was 20% for IPF (92/455) and 7% in non-IPF fibrotic ILD (84/1121). Both FEV1/FVC ratio < lower limit of normal and <0.70 had poor sensitivity (IPF: 11.1-18.9%; non-IPF fibrotic ILD: 13.1-23.7%) for detecting CT emphysema, although high specificity (IPF: 96.2-98.8%; non-IPF fibrotic ILD: 92.8-95.8%). The CPFE Index was moderately correlated with CT emphysema extent in both IPF (r=0.48) and non-IPF fibrotic ILD (r=0.41), but with poor agreement and wide limits of agreement on Bland-Altman analysis. CT emphysema extent ≥20% was consistently associated with differences in lung function trajectories and worse transplant-free survival in IPF and non-IPF fibrotic ILD. There were no significant relationships between emphysema subtypes and health outcomes.
Y. Khor, Daniel-Costin Marinescu, H. Manganas et al.· Chest· 0 citations
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