Surgically removed benign changes in lung cancer screening program

<bold>Objective:</bold> Although low-dose CT lung cancer screening (LCS) remains an important link between early diagnosis and survival, concerns about unnecessary surgery due to benign lung nodules remain. The aim of this research is to evaluate the prevalence of surgically removed benign changes verified during the 3 years of the LCS program in Serbia. <bold>Methods:</bold> Data was derived from the Institute for Pulmonary Diseases of Vojvodina health base of patients underwent the LCS from September 2020 to December 2023. Analysis was performed in order to determine the rate of surgical lung resection (SLR) and invasive non-surgical diagnostic procedures for lung cancer (LC) and benign disease (BD). <bold>Results:</bold> Out of 4,005 screened participants, 389 (9.7%) had positive screening results. LC was confirmed in 87 (2.1%) and BD in 41 (1.0%) of screened. The total rate of invasive procedures was 3.2% (130/4,005), 0.9% (40/4,005) for BD, and 2.3% (90/4,005) for LC. Out of 60 bronchoscopies or CT-guided biopsies, 58 (96.6%) were performed in LC patients. The prevalence of SLR was 0.8% (32/4005) for BD and 1.1% (46/4005) for LC. VATS lobectomy was more common in LC (60.8% vs. 6.3%, p˂ 0.001), while atypical resection was more common in BD (84.4% vs. 26.1%, p˂0.001). The SLR complications rate was 6.4% (5/78), and no deaths after invasive procedures were observed. <bold>Conclusions:</bold> Despite the low complications rate, and no deaths after SLR, any invasive intervention poses a risk. A multidisciplinary team approach, including radiologists, pathologists, and thoracic surgeons, is critical for adequate decision-making and an appropriate intervention rate in order to decrease the unnecessary risk of surgical interventions.