The Future of Lung Cancer Screening: Current Challenges and Research Priorities

Figures & data

Table 1 Management Protocol for Common Incidental Findings on LDCT in Lung Cancer Screening (NHS England Targeted Lung Health Check Programme)

Finding	Reporting Recommendation	Recommended Action
Emphysema	Classification into mild, moderate, and severe	● Offer smoking cessation  ● Offer referral to local respiratory team if moderate or severe
Bronchiectasis	Classification into mild, moderate, and severe	● No action if mild/borderline  ● Refer to respiratory clinic if moderate or severe and chronic cough or recurrent LRTI. If asymptomatic offer referral or communicate findings to patient and primary care physician and give advice regarding standard management
Bronchial wall thickening	Do not report	● Nil
RB-ILD	Report	● Offer smoking cessation
Interstitial lung abnormalities	Report % reticulation	● Nil action if <5%  ● Consider referral if >10% or >5% with restrictive spirometry
Consolidation	Report if likely inflammatory or possibly malignant	● Consider 3-month interval CT if appears inflammatory  ● Refer to lung cancer MDT if suspicion of malignancy  ● Correlate clinically if infection suspected and prescribe antibiotics if necessary
TB	Report and offer differential	● Refer to TB services
Mediastinal mass	Report size, position, and appearance	● Options include surveillance or further investigation based on features  ● Consider referral to lung cancer or screening review MDT
Coronary calcification	Report severity as mild/moderate/severe	● Assess cardiovascular risk  ● Consider primary prevention
Aortic valve disease	Report severity	● Primary care physician to refer for echocardiogram
Aortic aneurysm	Report location and size	Thoracic:  ● <4cm: nil action  ● 4–5.5cm: refer  ● >5.5cm: refer urgently Abdominal:  ● 3–5cm: refer  ● >5cm: refer urgently
Breast nodules	Report location and size	● Refer breast MDT
Liver or renal lesions	Classify as malignant, indeterminate, and benign or unable to evaluate	● Follow local pathways
Bone abnormalities		● Primary care physician to refer for bone density evaluation for >50% osteoporotic fractures and assess for bone protection
Thyroid abnormalities	Report only if local lymphadenopathy and/or punctate calcification	● Refer to thyroid MDT
Adrenal lesions	Report size and attenuation	● <1cm or <10HU^8: nil action  ● 1–4cm and >10HU^8: 12-month surveillance scan  ● >4cm: refer to local endocrine team
Pleural effusions/thickening	Report size and whether malignant features present	● Refer to respiratory or lung cancer services