Assessment of delays in diagnosis of lung cancer in interstitial lung disease.

Tician Schnitzler, Ali Nowroozi, Maya Vella, Jonathan Liu, Shravan Sridhar, Erica Farrand, Jae Ho Sohn

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Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Tician SchnitzlerDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.

Ali NowrooziDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.

Maya VellaDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.

Jonathan LiuDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.

Shravan SridharDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.

Erica FarrandDepartment of Medicine, University of California, San Francisco, CA, USA.

Jae Ho SohnDepartment of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA. jaeho.sohn@ucsf.edu.ORCID http://orcid.org/0000-0002-6733-7551

Funding

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6 · The paper itself

Abstract

objectivesTo evaluate diagnostic delays in lung cancer among patients with interstitial lung disease (ILD), assess tumor characteristics and outcomes, and identify radiologic factors contributing to missed or delayed detection. MATERIALS AND

methodsIn this retrospective study, 54 ILD patients with concurrent lung cancer from two tertiary ILD referral centers were reviewed. A panel of four thoracic radiologists determined the earliest callable date-when the majority would have raised concern about a nodule-compared to the date of first clinical suspicion. Tumor size, morphology, staging, growth rate (volume doubling time), treatment regimens, and survival were analyzed. For delayed cases, radiologic causes of missed detection were categorized by consensus.

resultsDiagnostic delays occurred in 50% of cases (27/54), with a mean delay of 3.18 years (IQR: 0.94-4.51). Delayed cases showed significantly slower tumor growth (mean volume doubling time: 1.42 vs. 0.22 years, p < 0.0001). The most common radiologic factors contributing to missed detection were obscuration by fibrosis, ground-glass opacity, or bronchovascular bundles (63%), misinterpretation as infection or exacerbation (15%), minimal interval growth (11%), and invisibility on CT (15%). Tumor size, morphology, stage, and histologic subtype-most commonly adenocarcinoma (56%)-were similar between groups. No significant difference in survival was observed between delayed and non-delayed cases (χ² = 0.4, p = 0.5).

conclusionHalf of the lung cancer cases in ILD patients were diagnosed with significant delay, primarily due to parenchymal masking and subtle imaging findings, rather than biologically aggressive disease. Despite delays, survival outcomes and tumor characteristics did not differ significantly, suggesting a less aggressive tumor phenotype in delayed cases. KEY POINTS: Question To evaluate diagnostic delays in lung cancer among patients with interstitial lung disease (ILD), assess tumor characteristics and outcomes, and identify radiologic factors contributing to missed or delayed detection. Findings Half of lung cancer cases in ILD patients had diagnostic delays, mainly due to parenchymal masking. Delayed cases showed slower growth but no survival difference; tumor size and histology were indifferent. Clinical relevance This study shows that lung cancer diagnosis is often delayed in ILD patients (avg. > 3 years). Clinicians should stay alert for malignancy in peripheral fibrotic regions with slow-growing nodules. Despite no clear survival impact, future work should assess the risks and benefits of earlier detection.

Indexed as

Delayed DiagnosisLung Diseases, InterstitialLung NeoplasmsTomography, X-Ray ComputedAgedFemaleHumansMaleMiddle AgedRetrospective StudiesDiagnostic delayFibrosisInterstitial lung diseaseLung cancerSurvival analysis

Identifiers

PMID40990985

DOI10.1007/s00330-025-12015-z

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