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NCCN Guidelines for Patients



Lung Cancer Screening, Version 1.2017


What happens after the first test? Overview of screening tests

Overview of screening tests

Screening tests are repeated over time to assess if a

nodule may be cancer.

See Guide 4

. The schedule

and type of screening test depend on whether there

are changes in a nodule’s size, density, or both.

Often, the use of one LDCT detects a nodule but isn’t

clear whether the nodule is lung cancer or not. Thus,

the first LDCT—the baseline test—is compared to

follow-up LDCTs. Your doctors will look for increases

in size or density. Such changes may be a sign of


If needed, other tests can be done during follow-up.

They are a chest CT scan (CT scan of the lungs)

or PET (






omography) scan. The

standard dose of radiation is used for the chest CT;

a low dose is not used as is for LDCT. A PET scan

would check further for disease in your body not

just the chest area. Modern PET scanners are often

called PET/CT (










omography) scans.

More about PET scans

A PET scan may be used to look at a nodule that is

found on a screening LDCT. A PET scan involves an

injection of a small and safe amount of a radioactive

sugar called glucose. After you get the glucose,

pictures will be taken of the inside of your body. The

doctor will look to see if the glucose has deposited

inside a lung nodule. Nodules that are cancer appear

brighter on the pictures. This happens because

cancer cells use sugar more quickly than normal

cells. However, very small nodules are not easily

seen on PET. These nodules could be the size of a

large pea or smaller. Cancers of that size don’t use

enough sugar to be detected. Therefore, PET scans

are not recommended for most nodules found on

screening LDCT.

If you are high risk for lung cancer you will have

an LDCT test. Your doctor will check for anything

abnormal like a lung nodule. You will then follow a

plan based on what the doctor finds on your first

(baseline) screening LDCT test. You will learn more

about what happens next when there are no nodules.

In the guides below, you can read about the next

steps if a solid lung nodule, part-solid lung nodule, or

non-solid lung nodule is found.

Next steps if no lung nodules

If no lung nodules are found, your next LDCT should

be in 1 year. This would be your first follow-up LDCT

test. Screening with LDCT should occur every year

until a diagnosis of cancer that would not be able

to get curative treatment. This treatment would be

given with a plan to cure the cancer. Doctors are not

completely sure how long screening should be and

at what age it should stop. Your doctor will be able

to look at your individual needs and decide how long

screening should continue.

Guide 4. Screening tests

Time of screening

First (baseline) screening LDCT

First follow-up screening LDCT

Follow-up or yearly screening LDCT

If needed, chest CT or PET/CT