ArticleEuropean radiology2026
Negligible impact of perifissural nodules in an AI-first reader workflow from UK lung screening trial.
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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Abstract
objectiveTo evaluate the effect of perifissural nodules (PFNs) on radiologist workload within an AI-first reader workflow for lung cancer screening, given that AI cannot morphologically classify benign PFNs measuring ≥ 100 mm MATERIALS AND
methodsOne thousand two hundred fifty baseline low-dose CT scans from the UK Lung Screening (UKLS) Trial were analyzed. A commercially available AI software automatically identified all nodules with solid components ≥ 100 mm³ per the NELSON 2.0-European Position Statement (EUPS) guideline. Three readers independently performed PFN classification, with a senior radiologist with over 20 years of experience performing an arbitration read for the final reference classification (typical PFN, atypical PFN, or non-PFN). Histological outcomes for all fissure-attached nodules were reviewed to confirm benignity. The proportion of participants where a benign typical PFN was the sole finding of nodule presence ≥ 100 mm³ was calculated, representing the extra workload for radiologists to review.
resultsA total of 1252 participants (mean age, 68.5 ± 4.0 years; 928 men [74%]) were analyzed. AI detected 838 nodules with solid components ≥ 100 mm³ in 431 (34%) participants. 57 nodules in 49 (3.9%) participants were classified as typical PFNs by the reference standard. Only 24 of 1252 participants (1.9%) had a typical PFN ≥ 100 mm³ as the sole finding that added extra workload. No typical PFNs (0/57) were malignant.
conclusionThe impact of typical PFNs on the maximum achievable radiologist workload reduction in an AI-first reader workflow is negligible, with only 1.9% of participants requiring additional radiologist review triggered solely by these benign nodules. KEY POINTS: Question In an AI-first lung cancer screening workflow, do typical PFNs ≥ 100 mm
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