There are two types of people who are recommended for lung cancer surveillance CT imaging: (1) those who meet criteria based on age and smoking history and (2) those who had a suspicious (Lung-RADS 3-4) lung nodule incidentally discovered. This investigation looked into which group was at higher risk at a large community practice. Among 6684 patients eligible per age/smoking history, 910 (14%) had Lung-RADS 3-4 lesions of whom 162 (18%) ultimately received a cancer diagnosis. Among 12,645 eligible per incidentally discovered suspicious nodule, 2497 (20%) also met criteria per age/smoking history of whom 531 (21%) received a cancer diagnosis; the remainder who did not meet age/smoking history criteria had a subsequent rate of cancer diagnosis of 4.4%—a number not to be ignored. Importantly, the majority of all of these cancers were stage I-II. The bottom line here is that an incidentally discovered Lung-Rads 3-4 nodule should be taken very seriously regardless of, but especially in the presence of, a notable smoking history. | Osarogiagbon, JAMA NetwOpen 2023
