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NCCN Flash Updates: NCCN Guidelines Updated for Lung Cancer Screening

NCCN has published updates to the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines^®), and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™) for Lung Cancer Screening. These NCCN Guidelines^® are currently available as Version 1.2024.

Link directly to the Updates section of the NCCN Guidelines: Lung Cancer Screening

General

• Throughout PET/CT was revised to FDG-PET/CT.
• Throughout PET was revised to FDG-PET.

LCS-1A

• Footnotes revised:
  • Footnote a: It is recommended that institutions performing lung cancer screening use a multidisciplinary approach for nodule management that includes the specialties of thoracic radiology, pulmonary medicine, and thoracic surgery. Some institutions also include medical oncology, radiation oncology, and/or pathology.
  • Footnote e: Documented sustained and substantially elevated radon exposure, which substantially increases the risk for lung cancer in patients who also have a history of heavy smoking. Many state websites have information more specific to local areas, including areas of known elevated radon.
  • Footnote i: NCCN encourages providers to consider using risk calculators, if possible, because additional candidates at high risk for lung cancer may be identified for lung screening. See Tammemagi lung cancer risk calculator. Sands J, et al. J Thorac Oncol 2021:16:37-53.
  • Footnote j: Shared decision-making aids may assist in counseling patients about the risks and benefits of in determining if screening should be performed. Examples of decision-making aids can be found at: http://www.shouldiscreen.com/benefits-and-harms-screening. Use of risk models may identify patients with a lower risk or higher risk within the current recommendations.
  • Footnote k: Curative intent treatment includes surgery,and stereotactic body radiation therapy (SBRT), also known as stereotactic ablative body radiotherapy (SABR), or ablation. Ablative techniques, such as radiofrequency ablation (RFA), are additional alternatives for curative intent treatment. SBRT or ablation may be used for medically inoperable patients with cardiac disease or severe COPD. See also the NCCN Guidelines for Non-Small Cell Lung Cancer.
  • Footnote m: It has been shown that Black and African American individuals with less smoking exposure have a similar risk for lung cancer as white individuals with more smoking exposure. This increased risk for Black/African Americans should be considered in shared decision-making and risk assessment. Aldrich M, et al. JAMA Oncol 2019;5:1318-1324.

LCS-2A

• Footnote r revised: A nodule is a rounded opacity, measuring up to 3 cm in diameter. A solid nodule has a homogeneous soft-tissue attenuation, a nonsolid nodule (also known as a ground-glass nodule) has hazy increased attenuation that does not obliterate bronchial and vascular margins, and a part-solid nodule has elements of both solid and nonsolid nodules. Nodules should be evaluated and measured on LDCT using lung windows... (Also pages LCS-3A, LCS-4A, LCS-5, LCS-6, LCS-7A, LCS-8A, LCS-9A, LCS-10A, and LCS-11)

LCS-3

• Follow-up of Screening Findings, following ≥15 mm, option revised: Chest CT ± + contrast and/or FDG-PET/CT and/or tissue sampling.
• Bottom pathway following Bronchoscopy, new pathways added going to: No cancer, Annual screening LDCT until patient is no longer a candidate for definitive treatment and Cancer confirmed, See NCCN Guidelines for Non-Small Cell Lung Cancer.

LCS-3A

• Footnotes revised:
  • Footnote z: Patients with a strong clinical suspicion of stage I or II lung cancer (based on risk factors and radiologic appearance) do not require a biopsy before surgery. A biopsy adds time, cost, and procedural risk and may not be needed for treatment decisions. A preoperative biopsy may be appropriate if a non-lung cancer diagnosis is strongly suspected, which can be diagnosed by bronchoscopy, core biopsy, or fine-needle aspiration (FNA), or if an intraoperative diagnosis appears difficult or very risky...
  • Footnote bb: Stereotactic ablative body radiotherapy (SABR) is also an appropriate option for patients with high surgical risk. This should include a multidisciplinary evaluation, including at least thoracic surgery and radiation oncology. See Principles of Radiation Therapy in the NCCN Guidelines for Non-Small Cell Lung Cancer. (Also pages LCS-4A, LCS-7A, LCS-8A, LCS-9A, and LCS-10A).

LCS-4A

• Footnote dd revised: It is crucial that all nonsolid lesions be reviewed at thin (<≤1.5 mm) slices to exclude any solid components. (Also page LCS-5, LCS-9A, LCS-10A, and LCS-11)

LCS-5

• Footnote ee revised: Lung-RADS 1.1 has increased the size of a nonsolid nodule that can continue with annual screening to <30 mm, rather than <20 mm as recommended in the previous version. The NCCN Guidelines Panel has not harmonized this portion of the Lung-RADS update, as the consensus among panel members feel is that baseline or new nonsolid nodules ≥20 mm should have an earlier evaluation at 6 months. (Also page LCS-10A)

LCS-10A

• New footnote hh added: Patient preferences should be taken into account when deciding whether to follow-up with LDCT in 6 months or use invasive procedures.

LCS-A 1 of 2

• Slice width revised: ≤2.5 mm; ≤1.0 ≤1.5 mm preferred for characterization of nodule consistency, particularly for small nodules.

LCS-A 2 of 2

• Footnote e revised: It is crucial that all nonsolid lesions be reviewed at thin (< ≤1.5 mm) slices to exclude any solid components. Any solid component in the nodule requires management of the lesion with the part-solid recommendations (LCS-9).

ABBR-1

• New abbreviations added:
  • CAC coronary arterial calcification
  • CAD computer-aided detection
  • CPT current procedural terminology
  • FDG Fluorodeoxyglucose
  • ILD interstitial lung disease
  • MIP maxium intensity projection
  • RFA radiofrequency ablation
  • SBRT sterotactic body radiation therapy
• Abbreviations removed:
  • ACT American College of Radiology
  • CT computed tomography
  • PET/CT positron emission tomography/computed tomography
  • STR Society of Thoracic Radiology

 

 

For the complete updated versions of the NCCN Guidelines, NCCN Guidelines with NCCN Evidence Blocks™, the NCCN Drugs & Biologics Compendium (NCCN Compendium^®), the NCCN Biomarkers Compendium^®, the NCCN Chemotherapy Order Templates (NCCN Templates^®), the NCCN Radiation Therapy Compendium™, and the NCCN Imaging Appropriate Use Criteria (NCCN Imaging AUC™), please visit NCCN.org.

To view the NCCN Guidelines for Patients^®, please visit NCCN.org/patientguidelines.

Free NCCN Guidelines apps for iPhone, iPad, and Android devices are now available! Visit NCCN.org/apps.

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