Practices in reporting incidental findings in lung cancer screening by low-dose CT: a European Survey of Radiologists by SOLACE

OBJECTIVE: Lung cancer screening (LCS) is complicated by a high prevalence of incidental findings (IFs), defined as abnormalities detected on low-dose computed tomography (LDCT) of the chest that are outside the scope of LCS. Although the detection of some abnormalities might lead to the diagnosis of conditions of clinical relevance, LDCT protocols are not adequate for the characterisation of most IFs and thus, further investigations are usually necessary. Thus, the detection of such findings is perceived as a double-edged sword, and radiologists still widely disagree on which IFs should be reported. MATERIALS AND METHODS: A survey was circulated amongst radiologists involved in LCS programmes across Europe to investigate their opinions regarding the reporting of IFs, based on their personal experiences and perspectives, as well as national regulations. The responses of 147 European radiologists were included in the final analysis. RESULTS: The survey revealed a lack of standardised regulations and limited awareness among European radiologists regarding IFs reporting in LCS. LDCT is perceived as unreliable for evaluating solid organs outside the mediastinum, and mandatory reporting is supported only for clinically relevant findings. CONCLUSION: With radiologists still partly disagreeing on which IFs should be reported, international evidence-based guidelines around IFs reporting and management are highly awaited but challenging. CRITICAL RELEVANCE STATEMENT: This study critically highlights the lack of standardised regulations and consensus on IFs reporting in European LCS, underscoring the urgent need for harmonised, evidence-based guidelines to advance consistency and quality in clinical radiology practice. KEY POINT: European radiologists report a lack of standardised regulations and awareness regarding IFs in LCS. LDCT is widely perceived as unreliable for assessing solid organs outside the mediastinum, limiting support for mandatory reporting of extra-thoracic findings. International, evidence-based guidelines are urgently needed to harmonise IFs reporting and management in LCS across Europe.