ESR Essentials: lung cancer screening with low-dose CT-practice recommendations by the European Society of Thoracic Imaging.
Authors
Affiliations (17)
Affiliations (17)
- Department of Radiology, Cochin Hospital, Université Paris Cité, Paris, France. [email protected].
- Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Lung Research Center (DZL), Heidelberg, Germany.
- Faculty of Medicine, University of Latvia, Riga, Latvia.
- Faculty of Medicine, Christian-Albrechts-Universität zu Kiel, Kiel, Germany.
- Department of Radiology, University College London Hospital, London, UK.
- Division of Medicine-Respiratory Medicine, University College London, London, UK.
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy.
- Department of Medical Imaging, Radboud University Center, Nijmegen, The Netherlands.
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium.
- Department of Radiology, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
- Department of Radiology, Haraldsplass Deaconess Hospital, Bergen, Norway.
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Department of Radiological and Hematological Sciences, Catholic University of the Sacred Heart, Rome, Italy.
- Department of Diagnostic Imaging and Oncological Radiotherapy, Advanced Radiology Center, "A. Gemelli" University Polyclinic Foundation IRCCS, Rome, Italy.
Abstract
Low-dose CT screening for lung cancer reduces the risk of death from lung cancer by at least 21% in high-risk participants and should be offered to people aged between 50 and 75 with at least 20 pack-years of smoking. Iterative reconstruction or deep learning algorithms should be used to keep the effective dose below 1 mSv. Deep learning algorithms are required to facilitate the detection of nodules and the measurement of their volumetric growth. Only large solid nodules larger than 500 mm<sup>3</sup> or those with spiculations, bubble-like lucencies, or pleural indentation and complex cysts should be investigated further. Short-term follow-up at 3 or 6 months is required for solid nodules of 100 to 500 mm<sup>3</sup>. A watchful waiting approach is recommended for most subsolid nodules, to limit the risk of overtreatment. Finally, the description of additional findings must be limited if LCS is to be cost-effective. KEY POINTS: Low-dose CT screening reduces the risk of death from lung cancer by at least 21% in high-risk individuals, with a greater benefit in women. Quality assurance of screening is essential to control radiation dose and the number of false positives. Screening with low-dose CT scans detects incidental findings of variable clinical relevance, only those of importance should be reported.