Evaluating the Impact of Lung Cancer Screening Results on Pathological Workflows and Diagnostic Pathways

Based on a recent study, lung cancer screening programs achieved guideline-concordant evaluation in only 59.7% of screened seniors after a positive low-dose CT, revealing a major follow‑up shortfall that will shift diagnostic workloads for pathology services.

Overall, 59.7% of seniors received guideline-concordant care after a positive low-dose CT screen.

This gap implies a substantial minority will present later or require repeat diagnostic procedures, increasing counts of core biopsies, cytology specimens, and higher-complexity resections. Pathology teams should therefore anticipate both higher specimen volumes and a concentration of more advanced-stage cases among those with delayed evaluation—translating into predictable increases in urgent diagnostic workload and longer per-case processing needs.

Higher Lung-RADS scores were associated with greater likelihood of guideline-concordant follow-up, concentrating immediate diagnostic urgency in patients with 4A–4X findings. The report also identified disparities by race, smoking status, and screening episode: non-Hispanic Black patients and current smokers were less likely to receive guideline-intensity care at lower score strata. Diagnostic demand will therefore be uneven across patient cohorts and screening sites, creating localized bottlenecks where high scores and vulnerable populations overlap.

To manage this predictable surge, pathology labs should operationalize screening-aware triage: combine Lung-RADS, clinical urgency, and radiology concordance into priority rules; institute pre-analytic flags for screen-positive cases; streamline rapid on‑site evaluation (ROSE) and core‑needle biopsy workflows; and route flagged specimens for expedited accessioning. At the specimen level, require explicit screen-positive labeling, institute reflex immunostains when invasive carcinoma is likely, and direct high‑probability cases early to molecular platforms—steps that focus resources on cases most likely to change management.

Operational measures include adding a screening-derived triage code to the laboratory information system, holding regular batch triage huddles with radiology and surgery, and parallelizing histology processing with upfront molecular triage for high-Lung-RADS specimens. Without alignment between pathology workflows and screening pathways, programs risk repeat procedures, greater diagnostic uncertainty, and extra specimen processing. Targeted changes can shorten median turnaround time, reduce repeat interventions, and stabilize throughput for teams managing screen-positive patients.

Key Takeaways:

• What’s new: A 59.7% guideline-concordant rate after positive lung screening reveals a major adherence gap
• Who’s affected: pathology labs and multidisciplinary teams managing screen-positive seniors
• What changes next: implement screening-aware triage and expedited routing to manage increased urgent diagnostic load.