CT Follow-up Strategy Optimises Lung Cancer Screening

Short-interval CT demonstrated spontaneous resolution of consolidation in more than 50% of lung cancer screening participants, while persistent consolidation showed a 29.8% risk for malignancy. This conservative approach rather than immediate PET-CT could save £47,600 per 10,000 screening CTs.
METHODOLOGY:
Researchers conducted a retrospective study to assess the safety of a short-term follow-up low-dose CT (LDCT) scan for consolidation in a regional lung cancer screening programme in the United Kingdom.
Participants aged 55-74 years who were ever smokers underwent lung health checks and risk assessment, and those meeting specific risk thresholds qualified for an LDCT scan.
Overall, 10,247 CT studies from 8778 participants (mean age, 68 years) were analysed; consolidation was detected in 113 participants, and they underwent a 6-week repeat LDCT scan.
Study outcomes included the proportion of participants with non-resolving consolidation at 6 weeks, the risk for malignancy at the 6-week follow-up period, and the risk for upstaging over a 6-week delay. Cost savings were estimated on the basis of the National Schedule of National Health Service costs.
TAKEAWAY:
Among 110 participants who attended a follow-up CT scan, consolidation spontaneously resolved or significantly shrank in 57.3% of participants.
Of 47 participants with persistent consolidation, 32 underwent PET-CT imaging, with 13 cases subsequently confirmed as malignant.
Among those for whom final outcomes were available, the risk for malignancy in those with indeterminate consolidation on the initial scan was 13.5%, increasing to 29.8% in those with non-resolving consolidation (stage IA, n = 8; stage IB, n = 2; stage IIA, n = 3; and stage IE [lymphoma], n = 1).
None of the patients with stage IIA malignancy experienced upstaging during the 6-week follow-up period.
A cost analysis revealed potential savings of £47,600 per 10,000 screening CTs through the implementation of short-term interval CT vs immediate PET-CT investigation.
IN PRACTICE:
"In conclusion, short-interval LDCT imaging for focal indeterminate consolidation in LCS [lung cancer screening] is a cost-effective and safe strategy that reduces unnecessary investigation of inflammatory spontaneously resolving abnormalities. This could be a reasonable approach in a national screening programme, thereby reducing costs of investigation whilst ensuring appropriate follow-up of indeterminate consolidation," the authors wrote.
SOURCE:
This study was led by Emily C. Bartlett, Department of Radiology, Royal Brompton Hospital, London, England. It was published online on May 02, 2025, in European Radiology .
LIMITATIONS:
The evaluation of indeterminate focal consolidation warranting a 6-week CT scan was based on the judgement of the reporting radiologist, which may have varied according to reader expertise and judgement. Long-term outcomes were unknown for some participants who attended the 6-week follow-up scan, limiting the completeness of the data. Additionally, the results did not apply to consolidation identified at 3-month nodule follow-up CT, which was not evaluated in this study, nor to clearly mass-like or lobar consolidation.
DISCLOSURES:
This study did not receive any specific funding . Several authors reported receiving speaker or consulting fees and having other ties with various sources.

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