1207 - Pilot/Feasibility Study of Early Lung Cancer Detection from Standard CT Simulation for Breast Cancer Radiotherapy
Presenter(s)
F. Gregucci1, K. Coffey2, M. B. Fenton-Kerimian1, V. Chen1, R. Pennell1, M. Patel1, F. Talebi1, J. NG1, and S. C. Formenti1; 1Department of Radiation Oncology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY, 2Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
Purpose/Objective(s): 1. To prospectively evaluate the feasibility and diagnostic yield of incidental lung nodules by a radiological review of CT simulation scans performed as routing planning of radiotherapy in women aged =45 years, 2. To generate a preliminary dataset for assessing the clinical value of this routinely acquired but underutilized imaging resource.
Materials/Methods: With 210 patients, the study had >90% probability of detecting suspicious nodules in =15 patients (expected prevalence ~10%) as first endpoint and >80% probability of identifying at least one confirmed lung cancer as second endpoint, assuming a 20% confirmation rate for cancer.
Results: 210 breast cancer patients undergoing CT simulation for radiotherapy between January 2024 and January 2026 prospectively consented for the study. CT scans were systematically reviewed by a dedicated chest radiologist for pulmonary abnormalities. Indeterminate lung nodules were defined according to the 2017 Fleischner Society Guidelines. Demographic and clinical data were collected. All 210 patients were enrolled; 185 scans have been reviewed to date, while the other 25 are currently under review. Median age was 65 years (range 45–90). Incidental abnormalities were identified in 51/185 patients (27%), including indeterminate lung nodules in 34 (18%). Additional findings included lung nodules with non-pulmonary abnormalities (3%) and other non-pulmonary findings (6%). Among the total 51 patients with incidental findings, 30 (58.8%) completed follow-up imaging; 26/30 (87%) confirmed true positives lung nodules, leading to recommendation for additional chest CT follow up, and 4 (13%) were false positives (lung nodules were confirmed). Follow-up is pending in 11 patients (21.5%), and 10 (19.6%) declined additional imaging.
Conclusion: Breast radiotherapy CT simulation scans can be feasibly repurposed to detect incidental pulmonary nodules and other clinically relevant findings. The high confirmation rate of lung nodules among patients undergoing follow-up supports the potential clinical utility of this approach for early lung cancer detection. Integration with automated or AI-based image analysis may further enhance the cost-effectiveness and clinical impact of this highly feasible approach.