Incidentally Detected Adrenal Nodules on Lung Cancer Screening CT

Objective

To assess adherence to ACR recommendations for managing incidental adrenal lesions detected on lung cancer screening (LCS) CT examinations.

Methods

We performed a retrospective analysis of all LCS CT examinations within our health care system from January 2015 to August 2023. We included CTs that were reported with Lung-RADS “S” modifier for a focal adrenal lesion. We recorded whether follow-up imaging and biochemical testing were recommended and whether they were performed. Follow-up recommendations in reports were assessed for adherence to ACR recommendations.

Results

During the study period, 191 patients had a focal adrenal nodule reported. Per ACR recommendations, 36 of 191 (19%) warranted follow-up, but only 23 of 36 (64%) of these received follow-up recommendations. Of those 191, 155 (81%) did not require follow-up per ACR, and 25 of those 155 (16%) received follow-up recommendations. Of those who were advised follow-up, 34 of 48 (71%) received dedicated follow-up, 9 of 48 (19%) received follow-up imaging for another reason, and 5 of 48 (10%) did not receive any follow-up. Among those in whom follow-up was not recommended, 21 of 143 (15%) received dedicated follow-up, 101 of 143 (71%) received follow-up imaging for another reason, and 21 of 143 (15%) did not receive any follow-up. No malignant lesions were diagnosed. Per ACR recommendations, 183 of 191 (96%) of patients should have received biochemical testing; however, it was recommended in only 4 patients (2%).

Discussion

There was suboptimal adherence to ACR recommendations for managing incidental adrenal lesions on LCS CTs, with both unnecessary and missing follow-up recommendations. Recommendations for biochemical testing were nearly nonexistent, despite being part of the ACR algorithm.