Invasive procedures rarely follow false-positive lung cancer screenings

Key takeaways:

• Patients with false-positive lung cancer screening findings did not often undergo Invasive procedures.
• Procedure complications rarely occurred in patients without malignancy.

Invasive procedures aimed at clearing up imaging abnormalities found on lung cancer screening scans occurred infrequently, according to results published in CHEST.

“We report low rates of invasive procedures and complications for false-positive findings in the clinical practice of an [lung cancer screening] program,” Anton Manyak, MD, of the section of graduate medical education at Virginia Mason Medical Center, Virginia Mason Franciscan Health, and the department of graduate education at Loma Linda University, and colleagues wrote.

In a single-center retrospective study, Manyak and colleagues assessed 2,003 patients (mean age at first screening, 66 years; 44% women; 82% white) with lung cancer screening scans from a community-based program between 2016 and 2019 to determine the number of patients that undergo invasive procedures and experience complications because of the procedure.

Of the total cohort, 103 patients (5.1%) underwent invasive procedures, and during this assessment, 160 invasive procedures took place.

Most of the procedures performed did not involve surgery (103 nonsurgical), but researchers did observe 53 thoracic surgeries and six extrapulmonary surgeries. One patient died after receiving thoracic surgery.

Following review of screening results, researchers found that a small percentage of the patient population had malignancy (n = 71; 3.5%), such as lung cancer (n = 58; 2.9%).

Of the invasive procedures performed in those with malignancy, 70 did not involve surgery and 48 came in the form of thoracic surgery. The complication rate was higher in thoracic surgeries vs. nonsurgical procedures (27% vs. 6%).

Researchers found 31 malignancies during these thoracic surgeries.

When analyzing Lung Imaging Reporting and Data System category 4A nodules proven benign (162 nodules), evaluation was primarily done through noninvasive vs. invasive procedures.

Notably, some patients who underwent an invasive procedure did not have malignancy (n = 34; 1.7%). In this set of patients, 38 procedures took place.

Slightly more of these patients had incidental findings judged as benign but clinically important (n =19; 0.95%) than false-positive findings in any location (0.8%).

According to researchers, a majority (68%; n = 13) of the individuals that had a procedure because of benign findings ended up receiving treatment or a change in management. Fewer patients received a new diagnosis (n = 2).

In the cohort lacking malignancy, three complications occurred due to invasive procedures, but no patients died.

“These results add to accumulating evidence that most false-positive findings related to [lung cancer screening] can be resolved safely and noninvasively in clinical practice,” Manyak and colleagues wrote.

According to researchers, improved nodule management algorithms and a multidisciplinary approach to nodule management impacted the rate of invasive procedures in this study.

“Incidental imaging abnormalities result in invasive procedure rates that often result in clinical benefit, but exceed rates for false-positive lung nodules, suggesting the need for standardized approaches to these findings,” Manyak and colleagues wrote.