{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:10:03Z","timestamp":1792782603604,"version":"4.5.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:00:00Z","timestamp":1783123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100024181","name":"Grail","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100024181","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["EDDCPGM\\100002"],"award-info":[{"award-number":["EDDCPGM\\100002"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000289","name":"Cancer Research UK","doi-asserted-by":"publisher","award":["CTUQQR-Dec22\/100009"],"award-info":[{"award-number":["CTUQQR-Dec22\/100009"]}],"id":[{"id":"10.13039\/501100000289","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/W025051\/1"],"award-info":[{"award-number":["MR\/W025051\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/T02481X\/1"],"award-info":[{"award-number":["MR\/T02481X\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020252","name":"CRUK Lung Cancer Centre of Excellence","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100020252","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000833","name":"Rosetrees Trust","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100000833","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Longfonds BREATH Consortia","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"MRC UKRMP2 Consortia","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Garfield Weston Trust","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"University College London Hospitals Charitable Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"https:\/\/ror.org\/05mz0pr34","id-type":"ROR","asserted-by":"crossref"}]},{"DOI":"10.13039\/100009730","name":"Stand Up To Cancer","doi-asserted-by":"publisher","award":["SU2C-AACR-DT23-17"],"award-info":[{"award-number":["SU2C-AACR-DT23-17"]}],"id":[{"id":"10.13039\/100009730","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005247","name":"University of British Columbia","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100005247","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIHR","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"name":"Horizon Europe","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/100014013","name":"UK Research and Innovation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012317","name":"UCLH Biomedical Research Centre","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100012317","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine if a pragmatic, conservative approach to managing &lt;\u20093\u2009cm anterior mediastinal lesions in lung cancer screening (LCS) is safe.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>55- to 77-year-old current or former smokers underwent low-dose computed tomography (LDCT) screening. Anterior mediastinal lesions &lt;\u20093\u2009cm at baseline were managed conservatively with annual LDCT follow-up for up to 2 years. Lesions \u2265\u20093\u2009cm at baseline, growing during follow-up (based on visual assessment), or demonstrating concerning radiological characteristics were referred for further assessment. Outcomes for all anterior mediastinal lesions were assessed using follow-up LDCT images, electronic health records and the national cancer registry. Descriptive frequencies were calculated for all reported outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The baseline prevalence of anterior mediastinal lesions was 0.7% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200991\/12,961). Among 54 participants with &lt;\u20093\u2009cm lesions who underwent annual LDCT follow-up, 74.1% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940\/54) completed 2 years of surveillance, while 26.9% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914\/54) required further assessment due to interval growth. Four participants with growing lesions were diagnosed with thymoma following surgery, and one required adjuvant radiotherapy for an R1 resection margin. Among all participants with anterior mediastinal lesions, 16 underwent surgical resection, resulting in eight thymoma diagnoses. The benign resection rate was 50%. No thymic or anterior mediastinal malignancies have subsequently been diagnosed among participants with &lt;\u20093\u2009cm lesions who completed surveillance within the study over a median follow-up of 1997.5 days.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Screen-detected anterior mediastinal lesions &lt;\u20093\u2009cm at baseline without concerning radiological characteristics can be managed conservatively with annual LDCT follow-up. Referral for further assessment only in the event of interval growth does not appear to compromise clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>No standardised approach for managing anterior mediastinal lesions identified incidentally through lung cancer screening currently exists. We aimed to determine if utilising a 3\u2009cm baseline diameter referral threshold for screen-detected anterior mediastinal lesions is safe.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>74% of &lt;\u20093\u2009cm anterior mediastinal lesions remained stable over two annual screening rounds and did not require a secondary care referral. Four (out of 14) individuals with growing lesions during follow-up were diagnosed with thymoma, and one required adjuvant radiotherapy for an incomplete resection.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Utilising a 3\u2009cm baseline referral threshold is safe and may improve the efficiency of large-scale, population-based LCS by reducing referrals to secondary care.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12700-7","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T10:40:51Z","timestamp":1783161651000},"page":"8225-8235","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Conservative management of &lt;\u20093cm anterior mediastinal lesions in lung cancer screening is safe"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8575-6119","authenticated-orcid":false,"given":"Amyn","family":"Bhamani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuen R.","family":"Khaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Prendecki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyam","family":"Verghese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Creamer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Dickson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn","family":"Horst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Hall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Tisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Mullin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Patrick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"McCabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne-Marie","family":"Hacker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Farrelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Arthur-Darkwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal","family":"Navani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Devaraj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan","family":"Hackshaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"SUMMIT Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Nair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam M.","family":"Janes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,4]]},"reference":[{"key":"12700_CR1","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1056\/NEJMoa1102873","volume":"365","author":"DR Aberle","year":"2011","unstructured":"National Lung Screening Trial Research Team, Aberle DR, Adams AM et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395\u2013409. https:\/\/doi.org\/10.1056\/NEJMoa1102873","journal-title":"N Engl J Med"},{"key":"12700_CR2","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1056\/NEJMoa1911793","volume":"382","author":"HJ de Koning","year":"2020","unstructured":"de Koning HJ, van der Aalst CM, de Jong PA et al (2020) Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med 382:503\u2013513. https:\/\/doi.org\/10.1056\/NEJMoa1911793","journal-title":"N Engl J Med"},{"key":"12700_CR3","doi-asserted-by":"publisher","unstructured":"Lee RW, Nair A, Balata H et al (2026) Implementation of the NHS England Lung Cancer Screening Programme over 5 years. Nat Med. https:\/\/doi.org\/10.1038\/s41591-026-04292-y","DOI":"10.1038\/s41591-026-04292-y"},{"key":"12700_CR4","unstructured":"NHS England (2025) Quality assurance standards prepared for the Lung Cancer Screening Programme. Available via https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2019\/02\/PRN01867ii-quality-assurance-standards-prepared-for-the-lung-cancer-screening-programme-v3.pdf. Accessed 4 July 2025"},{"key":"12700_CR5","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/S1470-2045(25)00082-8","volume":"26","author":"A Bhamani","year":"2025","unstructured":"Bhamani A, Creamer A, Verghese P et al (2025) Low-dose CT for lung cancer screening in a high-risk population (SUMMIT): a prospective, longitudinal cohort study. Lancet Oncol 26:609\u2013619. https:\/\/doi.org\/10.1016\/S1470-2045(25)00082-8","journal-title":"Lancet Oncol"},{"key":"12700_CR6","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1148\/radiol.2303021726","volume":"230","author":"MK Kalra","year":"2004","unstructured":"Kalra MK, Maher MM, Toth TL et al (2004) Strategies for CT radiation dose optimization. Radiology 230:619\u2013628. https:\/\/doi.org\/10.1148\/radiol.2303021726","journal-title":"Radiology"},{"key":"12700_CR7","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1016\/j.ejro.2014.12.003","volume":"2","author":"T Araki","year":"2015","unstructured":"Araki T, Nishino M, Gao W et al (2015) Anterior mediastinal masses in the Framingham Heart Study: prevalence and CT image characteristics. Eur J Radiol Open 2:26\u201331. https:\/\/doi.org\/10.1016\/j.ejro.2014.12.003","journal-title":"Eur J Radiol Open"},{"key":"12700_CR8","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1148\/radiol.2392050261","volume":"239","author":"CI Henschke","year":"2006","unstructured":"Henschke CI, Lee IJ, Wu N et al (2006) CT screening for lung cancer: prevalence and incidence of mediastinal masses. Radiology 239:586\u2013590. https:\/\/doi.org\/10.1148\/radiol.2392050261","journal-title":"Radiology"},{"key":"12700_CR9","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/j.ejrad.2007.10.002","volume":"69","author":"N Tomiyama","year":"2009","unstructured":"Tomiyama N, Honda O, Tsubamoto M et al (2009) Anterior mediastinal tumors: diagnostic accuracy of CT and MRI. Eur J Radiol 69:280\u2013288. https:\/\/doi.org\/10.1016\/j.ejrad.2007.10.002","journal-title":"Eur J Radiol"},{"key":"12700_CR10","doi-asserted-by":"publisher","first-page":"1087","DOI":"10.1016\/j.jacr.2018.04.029","volume":"15","author":"RF Munden","year":"2018","unstructured":"Munden RF, Carter BW, Chiles C et al (2018) Managing incidental findings on thoracic CT: mediastinal and cardiovascular findings. A white paper of the ACR Incidental Findings Committee. J Am Coll Radiol 15:1087\u20131096. https:\/\/doi.org\/10.1016\/j.jacr.2018.04.029","journal-title":"J Am Coll Radiol"},{"key":"12700_CR11","doi-asserted-by":"publisher","first-page":"2300533","DOI":"10.1183\/13993003.00533-2023","volume":"62","author":"EL O\u2019Dowd","year":"2023","unstructured":"O\u2019Dowd EL, Tietzova I, Bartlett E et al (2023) ERS\/ESTS\/ESTRO\/ESR\/ESTI\/EFOMP statement on management of incidental findings from low dose CT screening for lung cancer. Eur Respir J 62:2300533. https:\/\/doi.org\/10.1183\/13993003.00533-2023","journal-title":"Eur Respir J"},{"key":"12700_CR12","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1136\/thoraxjnl-2020-215131","volume":"75","author":"C Horst","year":"2020","unstructured":"Horst C, Dickson JL, Tisi S et al (2020) Delivering low-dose CT screening for lung cancer: a pragmatic approach. Thorax 75:831\u2013832. https:\/\/doi.org\/10.1136\/thoraxjnl-2020-215131","journal-title":"Thorax"},{"key":"12700_CR13","doi-asserted-by":"crossref","unstructured":"U.S. Preventive Services Taskforce (2021) Lung cancer: screening. Available via https:\/\/www.uspreventiveservicestaskforce.org\/uspstf\/recommendation\/lung-cancer-screening. Accessed 1 Mar 2023","DOI":"10.1001\/jama.2021.1117"},{"key":"12700_CR14","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1093\/jnci\/djr173","volume":"103","author":"CM Tammemagi","year":"2011","unstructured":"Tammemagi CM, Pinsky PF, Caporaso NE et al (2011) Lung cancer risk prediction: prostate, lung, colorectal and ovarian cancer screening trial models and validation. J Natl Cancer Inst 103:1058\u20131068. https:\/\/doi.org\/10.1093\/jnci\/djr173","journal-title":"J Natl Cancer Inst"},{"key":"12700_CR15","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.jtho.2017.11.124","volume":"13","author":"SH Yoon","year":"2018","unstructured":"Yoon SH, Choi SH, Kang CH, Goo JM (2018) Incidental anterior mediastinal nodular lesions on chest CT in asymptomatic subjects. J Thorac Oncol 13:359\u2013366. https:\/\/doi.org\/10.1016\/j.jtho.2017.11.124","journal-title":"J Thorac Oncol"},{"key":"12700_CR16","doi-asserted-by":"publisher","unstructured":"Mura R, Pochepnia S, Kifjak D, Khenkina N, Prosch H (2024) A diagnostic approach to mediastinal masses in clinical practice. BJR Open. https:\/\/doi.org\/10.1093\/bjro\/tzaf009","DOI":"10.1093\/bjro\/tzaf009"},{"key":"12700_CR17","doi-asserted-by":"publisher","first-page":"41","DOI":"10.21037\/med-23-66","volume":"8","author":"S Koyasu","year":"2024","unstructured":"Koyasu S (2024) Imaging of thymic epithelial tumors\u2014a clinical practice review. Mediastinum 8:41. https:\/\/doi.org\/10.21037\/med-23-66","journal-title":"Mediastinum"},{"key":"12700_CR18","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1016\/j.jtho.2022.01.021","volume":"17","author":"AC Roden","year":"2022","unstructured":"Roden AC, Ahmad U, Cardillo G et al (2022) Thymic carcinomas\u2014a concise multidisciplinary update on recent developments from the Thymic Carcinoma Working Group of the International Thymic Malignancy Interest Group. J Thorac Oncol 17:637\u2013650. https:\/\/doi.org\/10.1016\/j.jtho.2022.01.021","journal-title":"J Thorac Oncol"},{"key":"12700_CR19","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1016\/j.crad.2024.03.003","volume":"79","author":"M Evison","year":"2024","unstructured":"Evison M, Robinson SD, Sharman A et al (2024) Making an accurate diagnosis of anterior mediastinal lesions: a proposal for a new diagnostic algorithm from the BTOG Thymic Malignancies Special Interest Group. Clin Radiol 79:404\u2013412. https:\/\/doi.org\/10.1016\/j.crad.2024.03.003","journal-title":"Clin Radiol"},{"key":"12700_CR20","doi-asserted-by":"publisher","first-page":"249","DOI":"10.2214\/ajr.145.2.249","volume":"145","author":"I Francis","year":"1985","unstructured":"Francis I, Glazer G, Bookstein F, Gross B (1985) The thymus: reexamination of age-related changes in size and shape. AJR Am J Roentgenol 145:249\u2013254. https:\/\/doi.org\/10.2214\/ajr.145.2.249","journal-title":"AJR Am J Roentgenol"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12700-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-026-12700-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12700-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:03:19Z","timestamp":1791936199000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-026-12700-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,4]]},"references-count":20,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,11]]}},"alternative-id":["12700"],"URL":"https:\/\/doi.org\/10.1007\/s00330-026-12700-7","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,4]]},"assertion":[{"value":"15 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 May 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 June 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 July 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The scientific guarantor of this publication is Sam M. Janes.","order":1,"name":"Ethics","label":"Guarantor","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"A.B., C.R.K., R.P., P.V., A.C., J.L.D., C.H., H.H., S.T. and J.M. were or are employed by University College London (UCL) through the SUMMIT Study funding provided by GRAIL, Inc. S.M.J. has received fees for advisory board membership in the last 3 years from Bard1 Lifescience. He has received grant income from GRAIL, Inc. He is an unpaid member of a GRAIL advisory board. He has received lecture fees for academic meetings from Cheisi and AstraZeneca. His wife works for AstraZeneca. N.N. reports consulting fees or honoraria for non-promotional educational talks from Amgen, AstraZeneca, AXANA, BeiGene, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, EQRx, Fujifilm, Guardant Health, Intuitive, Janssen, Lilly, Merck Sharp & Dohme, Olympus, Roche and Sanofi. He has received support for attending meetings and\/or travel from AstraZeneca, Fujifilm, Intuitive, Merck Sharp & Dohme and Olympus. He is a member of the British Thoracic Oncology Group steering committee, director of the UK Lung Cancer Coalition and Clinical Director of National Lung Cancer Audit. A.N. has received consultation fees from MSD and honoraria for speaking engagements from Mevis Medical Solutions. He is an executive committee member and travelling Professor for the British Society of Thoracic Imaging, Co-chair of the British Thoracic Society Pulmonary Nodule Guideline Development Group, Lung Taskforce member for the British Lung Foundation and former clinical lead for the NHS England Targeted Lung Health Checks Programme. A.H. has received support for travel for an advisory board meeting for Roche. He is on an academic scientific advisory board for each of Adela Bio, Roche and Luventix, which are developing multicancer blood or urine tests, but receives no payments\/honoraria for this from any of these companies. M.M. reports support for travel to an international conference from GRAIL, Inc. All authors perceive that these disclosures pose no academic conflict for this study and declare no other relationships or activities that could appear to have influenced the submitted work.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No complex statistical methods were necessary for this paper.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was obtained.","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"This cohort of study participants has not previously been reported.","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}