O’Dowd and colleagues published the ERS/ESTS/ESTRO/ESR/ESTI/EFOMP Statement on the management of incidental findings on thoracic low dose CT (LDCT) for lung cancer screening (LCS)(1). The kidney is partially imaged in 92% of people undergoing thoracic LDCT (median length of kidney visible 26%(2)). Therefore, incidental renal findings are common but challenging to characterise due to incomplete imaging, low radiation dose and absence of contrast. In the National Lung Screening Trial (NLST) cited by the ERS/ESTS/ESTRO/ESR/ESTI/EFOMP Statement, the prevalence of kidney cancer identified via thoracic LDCT was 0.26% (n =45/17,309) (3); however, please note that the ERS/ESTS/ESTRO/ESR/ESTI/EFOMP Statement(1) incorrectly reports the prevalence as 0.08% (this requires an article correction). In the Yorkshire Lung Screening Trial (YLST) the prevalence of histologically proven kidney cancer detected on or because of thoracic LDCT by two rounds of screening was 0.26% (N=17/6650; 95% CI 0.15%-0.41) (4, 5). The prevalence of kidney cancer identified via thoracic LDCT was consistent in NLST and YLST despite differences in study design (the former consists of a retrospective analysis of prospectively acquired data in a portion of the NLST cohort, whilst the latter represents a prospective analysis)(3-5). In the Yorkshire Kidney Screening Trial (YKST) individuals attending LCS underwent non-contrast abdominal CT and the additional prevalence of kidney cancer, in the previously unimaged areas of the kidneys, was 0.25% (N=10/4019; 95%CI 0.12-0.46%)(5, 6). With LCS expanding globally, there is a need for clear guidance on management of renal findings. The American College of Radiology (ACR) White Paper for incidental renal lesions(7) provides widely used recommendation consistent with European Association of Urology (EAU)(8) and National Institute for Health and Care Excellence (NICE)(9) guidelines. Whilst the ERS/ESTS/ESTRO/ESR/ESTI/EFOMP Statement(1) references the ACR White Paper(7), discrepancies exist which have been incorporated into the UK Lung Cancer Screening Quality Assurance process(10). We propose amendments to align the ERS/ESTS/ESTRO/ESR/ESTI/EFOMP Statement with existing evidence(7-9)
Rossi et al. (Wed,) studied this question.