Incidental Findings in Lung Cancer Screening

Simple Summary Low-dose computed tomography (LDCT) scans often reveal incidental findings (IFs) not directly associated with lung cancer screening (LCS). These findings can pose challenges in LDCT interpretation and clinical management. This narrative review examines the imaging spectrums of IFs that are commonly encountered in LDCT. The prevalence, clinical significance, and recommended management in accordance with current guidelines will be discussed. This work aims to provide radiologists and clinicians with the knowledge necessary to optimize patient care in LDCT for LCS.Abstract While low-dose computed tomography (LDCT) for lung cancer screening (LCS) has been recognized for its effectiveness in reducing lung cancer mortality, it often simultaneously leads to the detection of incidental findings (IFs) unrelated to the primary screening indication. These IFs present diagnostic and management challenges, potentially causing unnecessary anxiety and further invasive diagnostic procedures for patients. This review article provides an overview of IFs encountered in LDCT, emphasizing their clinical significance and recommended management strategies. We categorize IFs based on their anatomical locations (intrathoracic-intrapulmonary, intrathoracic-extrapulmonary, and extrathoracic) and discuss the most common findings. We highlight the importance of utilizing guidelines and standardized reporting systems by the American College of Radiology (ACR) to guide appropriate follow-ups. For each category, we present specific IF examples, their radiologic features, and the suggested management approach. This review aims to provide radiologists and clinicians with a comprehensive understanding of IFs in LCS for accurate assessment and management, ultimately enhancing patient care. Finally, we outline a few key aspects for future research and development in managing IFs.