{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:12:33Z","timestamp":1792476753278,"version":"4.5.0"},"reference-count":50,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:sec id=\"ab-ioi230024-4\"><jats:title>Importance<\/jats:title><jats:p>Low-dose computed tomography (LDCT) lung screening has been shown to reduce lung cancer mortality. Significant incidental findings (SIFs) have been widely reported in patients undergoing LDCT lung screening. However, the exact nature of these SIF findings has not been described.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230024-5\"><jats:title>Objective<\/jats:title><jats:p>To describe SIFs reported in the LDCT arm of the National Lung Screening Trial and classify SIFs as reportable or not reportable to the referring clinician (RC) using the American College of Radiology\u2019s white papers on incidental findings.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230024-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This was a retrospective case series study of 26\u202f455 participants in the National Lung Screening Trial who underwent at least 1 screening examination with LDCT. The trial was conducted from 2002 to 2009, and data were collected at 33 US academic medical centers.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230024-7\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Significant incident findings were defined as a final diagnosis of a negative screen result with significant abnormalities that were not suspicious for lung cancer or a positive screen result with emphysema, significant cardiovascular abnormality, or significant abnormality above or below the diaphragm.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230024-8\"><jats:title>Results<\/jats:title><jats:p>Of 26\u202f455 participants, 10\u202f833 (41.0%) were women, the mean (SD) age was 61.4 (5.0) years, and there were 1179 (4.5%) Black, 470 (1.8%) Hispanic\/Latino, and 24\u202f123 (91.2%) White individuals. Participants were scheduled to undergo 3 screenings during the course of the trial; the present study included 75\u202f126 LDCT screening examinations performed for 26\u202f455 participants. A SIF was reported for 8954 (33.8%) of 26\u202f455 participants who were screened with LDCT. Of screening tests with a SIF detected, 12\u202f228 (89.1%) had a SIF considered reportable to the RC, with a higher proportion of reportable SIFs among those with a positive screen result for lung cancer (7632 [94.1%]) compared with those with a negative screen result (4596 [81.8%]). The most common SIFs reported included emphysema (8677 [43.0%] of 20\u202f156 SIFs reported), coronary artery calcium (2432 [12.1%]), and masses or suspicious lesions (1493 [7.4%]). Masses included kidney (647 [3.2%]), liver (420 [2.1%]), adrenal (265 [1.3%]), and breast (161 [0.8%]) abnormalities. Classification was based on free-text comments; 2205 of 13\u202f299 comments (16.6%) could not be classified. The hierarchical reporting of final diagnosis in NLST may have been associated with an overestimate of severe emphysema in participants with a positive screen result for lung cancer.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi230024-9\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This case series study found that SIFs were commonly reported in the LDCT arm of the National Lung Screening Trial, and most of these SIFs were considered reportable to the RC and likely to require follow-up. Future screening trials should standardize SIF reporting.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2023.1116","type":"journal-article","created":{"date-parts":[[2023,5,8]],"date-time":"2023-05-08T16:38:27Z","timestamp":1683563907000},"page":"677","source":"Crossref","is-referenced-by-count":50,"title":["Significant Incidental Findings in the National Lung Screening Trial"],"prefix":"10.1001","volume":"183","author":[{"given":"Ilana F.","family":"Gareen","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island"},{"name":"Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roee","family":"Gutman","sequence":"additional","affiliation":[{"name":"Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island"},{"name":"Department of Biostatistics, 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