Incidental findings from community-based mobile low-dose CT lung screening among older adults: a multicenter retrospective observational study in China

Low-dose computed tomography (LDCT) is an effective screening tool for early lung cancer detection; however, it frequently reveals incidental findings (IFs) beyond suspicious pulmonary nodules. We conducted a multicenter observational analysis using data from a community-based, non-risk-stratified mobile LDCT screening program implemented across ten screening regions in China between August 2024 and December 2025. Participants aged ≥50 years completed a structured questionnaire and underwent LDCT screening. IFs were classified into pulmonary, cardiovascular, and extra-pulmonary domains and further categorized as non-actionable, potentially actionable, or actionable. Among 39,910 participants, Lung-RADS IV findings were detected in 697 participants (1.75%). Overall, 37,994 participants (95.20%) had at least one IF, including 28,581 (71.61%) with pulmonary IFs, 27,639 (69.25%) with cardiovascular IFs, and 21,278 (53.31%) with extra-pulmonary IFs. Frequent findings included pulmonary infectious or inflammatory abnormalities, emphysema, aortic or pulmonary artery abnormalities, coronary artery calcification, and liver and kidney/urinary abnormalities. In multivariable analyses, Lung-RADS IV status was associated with extra-pulmonary IFs, potentially actionable IFs, and potentially actionable or actionable IFs, but not with overall IF occurrence or actionable IFs alone. Standardized, actionability-based reporting and management pathways are needed to maximize clinical value while minimizing unnecessary follow-up and healthcare burden.