Objectives Focal consolidation on CT may be inflammatory or malignant, and PET-CT imaging is rarely discriminatory. Furthermore, consolidation may demonstrate spontaneous resolution obviating the need for PET-CT imaging. This retrospective study sought to assess the safety and cost-effectiveness of short-interval 6-week follow-up CT for consolidation in a lung cancer screening programme. Methods Between January 2019 and January 2024, participants in a regional lung cancer screening programme with focal indeterminate consolidation underwent a 6-week repeat CT rather than immediate PET-CT and invasive investigation. The proportion of participants with non-resolving consolidation, the risk of malignancy in consolidation at a 6-week follow-up, and the risk of upstaging over a 6-week delay were determined. Cost savings were estimated from National Health Service reference costs. Results In 10,247 CT studies, focal indeterminate consolidation was detected in 113 participants (1.1%) (mean age 68 years, range 55–76, 65 males). Consolidation spontaneously resolved at 6 weeks in 63/110 (57%) who attended follow-up; 14/110 (12.7%) participants had malignancy; no patients upstaged during follow-up. An estimated cost saving of £47,600/10,000 screening CTs performed might be obtained through a conservative approach of short-term interval CT, rather than immediate PET-CT and further investigation. Conclusion Early repeat CT avoids PET-CT in more than half of patients with consolidation and can be utilised to reduce over-investigation of screen-detected consolidation, which may demonstrate spontaneous resolution. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Is short-term interval follow-up CT in lung cancer screening a safe and cost-effective approach to managing indeterminate (inflammatory or malignant) consolidation? <Emphasis Type="BoldItalic">Findings</Emphasis> Short-interval CT imaging demonstrates spontaneous resolution of consolidation in over 50% participants in this study, whilst persistent consolidation has a high likelihood of malignancy. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Short-interval CT did not result in upstaging of malignancy and therefore can be considered a safe strategy to prevent the over-investigation of screen-detected consolidation, supporting recent European and American screening recommendations. Graphical Abstract

Evaluation of the safety of short-term follow-up CT for the management of consolidation in lung cancer screening

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2025年5月2日

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Emily C. Bartlett,
Ley Chan,
Justin Garner,
Sujal R. Desai,
Samuel V. Kemp,
Simon Padley,
Bhavin Rawal,
Carole A. Ridge,
James Addis,
Anand Devaraj

摘要

Objectives

Focal consolidation on CT may be inflammatory or malignant, and PET-CT imaging is rarely discriminatory. Furthermore, consolidation may demonstrate spontaneous resolution obviating the need for PET-CT imaging. This retrospective study sought to assess the safety and cost-effectiveness of short-interval 6-week follow-up CT for consolidation in a lung cancer screening programme.

Methods

Between January 2019 and January 2024, participants in a regional lung cancer screening programme with focal indeterminate consolidation underwent a 6-week repeat CT rather than immediate PET-CT and invasive investigation. The proportion of participants with non-resolving consolidation, the risk of malignancy in consolidation at a 6-week follow-up, and the risk of upstaging over a 6-week delay were determined. Cost savings were estimated from National Health Service reference costs.

Results

In 10,247 CT studies, focal indeterminate consolidation was detected in 113 participants (1.1%) (mean age 68 years, range 55–76, 65 males). Consolidation spontaneously resolved at 6 weeks in 63/110 (57%) who attended follow-up; 14/110 (12.7%) participants had malignancy; no patients upstaged during follow-up. An estimated cost saving of £47,600/10,000 screening CTs performed might be obtained through a conservative approach of short-term interval CT, rather than immediate PET-CT and further investigation.

Conclusion

Early repeat CT avoids PET-CT in more than half of patients with consolidation and can be utilised to reduce over-investigation of screen-detected consolidation, which may demonstrate spontaneous resolution.

Key Points

Question Is short-term interval follow-up CT in lung cancer screening a safe and cost-effective approach to managing indeterminate (inflammatory or malignant) consolidation?

Findings Short-interval CT imaging demonstrates spontaneous resolution of consolidation in over 50% participants in this study, whilst persistent consolidation has a high likelihood of malignancy.

Clinical relevance Short-interval CT did not result in upstaging of malignancy and therefore can be considered a safe strategy to prevent the over-investigation of screen-detected consolidation, supporting recent European and American screening recommendations.

Graphical Abstract