Significance of Incidental Thyroid Findings in a Large Community-based Lung Cancer Screening Cohort

Objectives: Investigate incidental findings of neck pathology on lung cancer screening computer tomography scans and determine clinical relevance in a population of heavy smokers.

Methods: A retrospective chart review was conducted utilizing a database of patients who underwent a chest computed tomography (CT) through a robust community-based hospital lung cancer screening program in 2019 and 2020. Demographics, medical history, imaging reports, and any pathology results were analyzed.

Results: A total of 1738 patients received a lung screening scan during the study period. The median age of the patient population was 64 (range: 50-79), 886 (51%) were male, and 1599 (92%) were Caucasian. Ninety-four (5.4%) were found to have neck findings on their CT report, including thyroid nodules, calcifications, heterogeneity or enlargements, pathologic appearing lymph nodes, or parathyroids. Forty-two patients had evidence of follow-up for their thyroid findings, and three of these ultimately underwent surgical intervention.

Conclusion: The results of our study demonstrate that lung cancer screening chest scans can discover clinically relevant findings in the neck. The risks and benefits of screening needs to be thoroughly evaluated. Given the relatively low incidence of findings in this population, a prospective study in conjunction with screening questionnaire for symptoms may increase the yield of incidental findings.

Level of evidence: 3 Laryngoscope, 135:964-968, 2025.