Clinical Significance of Incidental Head and Neck Findings in a Large Community-Based Lung Cancer Screening Cohort

ABSTRACT

Introduction: Lung cancer is the third most common cancer in the United States, with the highest incidence among cigarette smokers. Approximately 70% to 80% of head and neck cancers have also been linked to tobacco use, making it the strongest risk factor. Though not associated with smoking, thyroid nodules are an extremely common pathology, estimated in up to 50% of the adult population on autopsy, with most nodules found incidentally. With current lung cancer screening guidelines among heavy smokers, 15 million people are eligible for screening with low-dose chest computerized tomography (CT). The purpose of this study is to investigate incidental findings of head and neck pathology and determine their clinical relevance in this population of heavy smokers. Method(s) A retrospective chart review was conducted utilizing a database of patients who underwent a chest CT through a successful community-based hospital lung cancer screening program in 2020. Demographics, medical history, imaging reports, and any pathology results were analyzed. Result(s) A total of 1227 patients received a lung screening CT scan in 2020. The median age of the patient population was 64 (range 50-79) years. Of the patients, 612 (50%) were male, and 1133 (92%) were White. Only 15 (.01%) were found to have thyroid findings noted on their CT report. Two patients were excluded from further analysis due to insufficient availability of chart information. Six patients did receive follow-up for their thyroid findings, and 2 had surgery with benign pathology. Conclusion(s) The results of our study demonstrate a lack of significant thyroid findings on lung cancer screening CT for heavy smokers. Of those with significant thyroid findings, we found that few patients underwent further workup. Given the low incidence of findings in this cohort, which may have had lower numbers than other years because of the COVID-19 pandemic, we plan to increase the power of our study by including the prior 5 years of data.