Lung cancer screening with low-dose CT: definition of positive, indeterminate, and negative screen results. A nodule management recommendation from the European Society of Thoracic Imaging.

Journal: European radiology
Published Date: Jul 1, 2025

Abstract

Early detection of lung cancer through low-dose CT lung cancer screening in a high-risk population has proven to reduce lung cancer-specific mortality. Nodule management plays a pivotal role in early detection and further diagnostic approaches. The European Society of Thoracic Imaging (ESTI) has established a nodule management recommendation to improve the handling of pulmonary nodules detected during screening. For solid nodules, the primary method for assessing the likelihood of malignancy is to monitor nodule growth using volumetry software. For subsolid nodules, the aggressiveness is determined by measuring the solid part. The ESTI-recommendation enhances existing protocols but puts a stronger focus on lesion aggressiveness. The main goals are to minimise the overall number of follow-up examinations while preventing the risk of a major stage shift and reducing the risk of overtreatment. KEY POINTS: Question Assessment of nodule growth and management according to guidelines is essential in lung cancer screening. Findings Assessment of nodule aggressiveness defines follow-up in lung cancer screening. Clinical relevance The ESTI nodule management recommendation aims to reduce follow-up examinations while preventing major stage shift and overtreatment.

Authors

  • Annemiek Snoeckx
    Department of Radiology, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
  • Mario Silva
    Department of Medicine and Surgery, University of Parma, Parma, Italy.
  • Helmut Prosch
    Universitätsklinik für Radiologie und Nuklearmedizin, Computational Imaging Research Lab, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
  • Jürgen Biederer
    Department of Diagnostic and Interventional Radiology, University Hospital of Heidelberg, Heidelberg, Germany.
  • Thomas Frauenfelder
  • Fergus Gleeson
    Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
  • Colin Jacobs
    Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Hans-Ulrich Kauczor
    Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
  • Anagha P Parkar
    Department of Radiology, Haraldsplass Deaconess Hospital, Bergen, Norway. apparkar@gmail.com.
  • Cornelia Schaefer-Prokop
    Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Mathias Prokop
    Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands.
  • Marie-Pierre Revel
    Department of Radiology (G.C., S.D., M.P.R.) and Respiratory Medicine and National Cystic Reference Center (P.R.B.), Groupe Hospitalier Cochin-Hotel Dieu, AP-HP, Université Paris Descartes, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Grande Voie des Vignes, Chatenay Malabry, France (G.C., E.I.Z., N.P.); U1016 Inserm, Institut Cochin, Paris, France (G.C., P.R.B., C.M., M.P.R.); Radiology Department (S.B.) and Pulmonary Department (R.C.), Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, Montpellier, France; ERN-Lung CF Network, France (P.R.B., C.M.); and TheraPanacea, Paris-Biotech-Santé, Paris, France (N.P.).

Keywords

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