{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:19:48Z","timestamp":1788175188873,"version":"build-2803163510"},"reference-count":13,"publisher":"Walter de Gruyter GmbH","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"j_dx-2025-0074_abs_001\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Low-dose CT (LDCT) screening is critical for early lung cancer detection. We assessed diagnostic uncertainty following positive LDCTs in the National Lung Screening Trial (NLST). We defined this pathway as an \u201cPotential missed diagnostic opportunity\u201d for participants eventually diagnosed with lung cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2025-0074_abs_002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This is a secondary analysis of the NLST trial, examining potential missed diagnostic opportunity among screen-detected participants who were diagnosed with lung cancer in the LDCT arm.\n                      <jats:italic>Potential missed diagnostic opportunity (PMDO)<\/jats:italic>\n                      defined as no lung cancer diagnosis following a positive LDCT, which was then followed by a subsequent annual positive LDCT that did lead to lung cancer diagnosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2025-0074_abs_003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 1,089 lung cancers diagnosed in the LDCT arm, 58\u202f% (630 individuals) were adherent screen-detected at risk for a\n                      <jats:italic>PMDO<\/jats:italic>\n                      (605 [55\u202f%] using Lung-RADS). Overall, 37.3\u202f% (235 of 630) experienced\u00a0\u22651 PMDO (33.1\u202f% using Lung-RADS). Among the 235 participants who experienced a\n                      <jats:italic>PMDO<\/jats:italic>\n                      , only 1.7\u202f% (four individuals) received a diagnostic resection or biopsy, and 35.7\u202f% (84 individuals) had little to no diagnostic procedures following their first positive LDCT. Once diagnosed, the group that experienced\n                      <jats:italic>PMDO<\/jats:italic>\n                      tended to have earlier stage lung cancer and longer survival rates compared to those without such events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_dx-2025-0074_abs_004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While LDCT is a vital screening tool, a substantial proportion of lung cancer patients experience a period of diagnostic uncertainty after an initial positive screen. This pathway highlights a critical area for process improvement. Understanding the clinical decision-making during these periods is essential to fully optimize the benefits of early detection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/dx-2025-0074","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T21:12:56Z","timestamp":1773954776000},"page":"430-438","source":"Crossref","is-referenced-by-count":0,"title":["Potential missed diagnostic opportunities after low dose CT screening for lung cancer: results from the National Lung Cancer Screening Trial"],"prefix":"10.1515","volume":"13","author":[{"given":"Ahmed","family":"Hassoon","sequence":"first","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology , Baltimore , MD , USA"},{"name":"Johns Hopkins Medicine, Department of Neurology , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Hussain","sequence":"additional","affiliation":[{"name":"Johns Hopkins Medicine, Department of Internal Medicine , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panagis","family":"Galiatsatos","sequence":"additional","affiliation":[{"name":"The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins School of Medicine , Baltimore , MD , USA"},{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harold","family":"Lehmann","sequence":"additional","affiliation":[{"name":"Johns Hopkins Medicine, Department of Internal Medicine , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"McDonald","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Nursing , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Berg","sequence":"additional","affiliation":[{"name":"National Cancer Institute (Retired) , Bethesda , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otis","family":"Brawley","sequence":"additional","affiliation":[{"name":"The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins School of Medicine , Baltimore , MD , USA"},{"name":"Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"2026083110583450400_j_dx-2025-0074_ref_001","doi-asserted-by":"crossref","unstructured":"Siegel, RL, Miller, KD, Wagle, NS, Jemal, A. Cancer statistics, 2023. CA Cancer J Clin 2023;73:17\u201348. https:\/\/doi.org\/10.3322\/CAAC.21763.","DOI":"10.3322\/caac.21763"},{"key":"2026083110583450400_j_dx-2025-0074_ref_002","doi-asserted-by":"crossref","unstructured":"Results of initial low-dose computed tomographic screening for lung cancer. N\u00a0Engl J Med 2013;368:1980\u201391. https:\/\/doi.org\/10.1056\/NEJMOA1209120\/SUPPL_FILE\/NEJMOA1209120_DISCLOSURES.PDF.","DOI":"10.1056\/NEJMoa1209120"},{"key":"2026083110583450400_j_dx-2025-0074_ref_003","doi-asserted-by":"crossref","unstructured":"Bonney, A, Malouf, R, Marchal, C, Manners, D, Fong, KM, Marshall, HM, et al.. Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. 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