Department of Radiology, Stony Brook University Medical Center, Stony Brook, NY, United States.
Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, United States.
Lung Cancer. 2018 Jun;120:1-6. doi: 10.1016/j.lungcan.2018.03.017. Epub 2018 Mar 20.
To describe the frequency, distribution and reporting patterns of incidental findings receiving the Lung-RADS S modifier on low-dose chest computed tomography (CT) among lung cancer screening participants.
This retrospective investigation included 581 individuals who received baseline low-dose chest CT for lung cancer screening between October 2013 and June 2017 at a single center. Incidental findings resulting in assignment of Lung-RADS S modifier were recorded as were incidental abnormalities detailed within the body of the radiology report only. A subset of 60 randomly selected CTs was reviewed by a second (blinded) radiologist to evaluate inter-rater variability of Lung-RADS reporting.
A total of 261 (45%) participants received the Lung-RADS S modifier on baseline CT with 369 incidental findings indicated as potentially clinically significant. Coronary artery calcification was most commonly reported, accounting for 182 of the 369 (49%) findings. An additional 141 incidentalomas of the same types as these 369 findings were described in reports but were not labelled with the S modifier. Therefore, as high as 69% (402 of 581) of participants could have received the S modifier if reporting was uniform. Inter-radiologist concordance of S modifier reporting in a subset of 60 participants was poor (42% agreement, kappa = 0.2).
Incidental findings are commonly identified on chest CT for lung cancer screening, yet reporting of the S modifier within Lung-RADS is inconsistent. Specific guidelines are necessary to better define potentially clinically significant abnormalities and to improve reporting uniformity.
描述肺癌筛查参与者接受低剂量胸部 CT 时偶然发现并获得 Lung-RADS S 修饰符的频率、分布和报告模式。
本回顾性研究纳入了 2013 年 10 月至 2017 年 6 月期间在单一中心接受基线低剂量胸部 CT 的 581 名个体。记录了导致 Lung-RADS S 修饰符分配的偶然发现，并仅记录在放射学报告正文中详细描述的偶然异常。随机选择 60 份 CT 由第二位（盲法）放射科医生进行审查，以评估 Lung-RADS 报告的组内变异。
共有 261 名（45%）参与者在基线 CT 上获得 Lung-RADS S 修饰符，其中 369 个偶然发现被认为具有潜在临床意义。冠状动脉钙化是最常报告的，占 369 个发现中的 182 个。在报告中还描述了另外 141 个与这 369 个发现相同类型的偶然瘤，但未标记 S 修饰符。因此，如果报告一致，高达 69%（581 名参与者中的 402 名）可能会获得 S 修饰符。在 60 名参与者的子集的 S 修饰符报告中，两位放射科医生的一致性较差（42%一致，kappa 值为 0.2）。
肺癌筛查的胸部 CT 上经常发现偶然发现，但 Lung-RADS 内 S 修饰符的报告不一致。需要特定的指南来更好地定义潜在的具有临床意义的异常，并提高报告的一致性。
