Retrospective Lung-RADS v2022 Review of Fatal Lung Cancers in NLST: Small and Juxtapleural Nodules Frequently Missed

In 91 NLST participants who died of lung cancer with prior negative screens, 24% had visible-in-retrospect suspicious nodules missed per Lung-RADS v2022, 18% had visible nodules not meeting suspicion criteria (75% <6 mm, 56% juxtapleural), and 55% had no visible nodule.

• Missed suspicious nodules (n=22) were frequently juxtapleural (41%), obscured (50%), or irregularly bordered (68%); nodules not meeting suspicion criteria (n=16) were often <6 mm (75%), juxtapleural (56%), or irregularly bordered (56%).
• This case series is highly selected and results should not be interpreted as population-level Lung-RADS performance estimates.

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