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Lung-Reporting and Data System Category (Lung-RADS) and Adherence to Low-Dose Computed Tomography Screening and Recommended Follow-Up: A Multicenter Cohort Study

Year: 2026

Type: article

Abstract: Background Adherence to guideline-recommended low-dose CT (LDCT) screening and follow-up remains suboptimal, and determinants may vary by Lung Imaging Reporting and Data System (Lung-RADS) category. Methods This retrospective, multi-site cohort study used electronic medical records from adults aged 50–80. Eligible individuals had at least one primary care visit in the prior 12 months, no lung cancer diagnosis in the preceding 5 years, and underwent an index LDCT between 2016 and 2021. Participants were followed through 2022. Adherence to follow-up chest CT within 11–15 months (Lung-RADS 1–2) and category-specific recommended follow-up (Lung-RADS 3–4X) were assessed using mixed-effects logistic regression to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results Among 22,034 individuals with Lung-RADS 1–2, 21.67% completed follow-up CT within 11–15 months. The odds of adherence were higher among individuals aged ≥65 years (vs <65) (aOR: 1.22; 95% CI: 1.14–1.31) and those with COPD (aOR: 1.18; 95% CI: 1.09–1.27), and lower among Black (vs White) individuals (aOR: 0.87; 95% CI: 0.79–0.96) and frail (vs non-frail) individuals (aOR: 0.88; 95% CI: 0.80–0.98). Among 4,518 individuals with Lung-RADS 3–4X, 28.51% adhered to category-specific follow-up; COPD was the only significant factor associated with adherence (aOR: 1.22; 95% CI: 1.06–1.40). Conclusions Adherence to follow-up CT and recommended care remains low in real-world settings; older age and COPD predicted higher adherence, while lower adherence among Black individuals identifies a key target for improving LCS retention.

Source: JTO Clinical and Research Reports

DOI: 10.1016/j.jtocrr.2026.101077