More than half of incidental lung nodules detected at a large New York hospital system did not receive the follow-up their radiology reports recommended, according to a retrospective observational study published in BMC Pulmonary Medicine. The finding matters because incidental lung nodules, which are commonly spotted on imaging done for other reasons, are occasionally early lung cancers, and the study notes that late-stage diagnosis contributes to poor prognosis in lung cancer.
Researchers at Mount Sinai Morningside and Mount Sinai West hospitals analyzed radiology reports from January 1, 2022, to June 30, 2022, using natural language processing to identify patients with incidental lung nodules. From 3,925 identified cases, 1,266 patients met the inclusion criteria. The team then carried out systematic chart review to extract demographic data, insurance status, smoking history, comorbidities, and follow-up details, with adherence to follow-up recommendations as the primary outcome.
The cohort had a median age of 70 years, with an interquartile range of 54 to 86, and a slight female predominance at 57.5 percent. The racial distribution included White patients at 43.4 percent, Black patients at 22.5 percent, Asian patients at 5.4 percent, patients of Other race at 26.1 percent, and 2.6 percent with race not reported. As a diverse urban population, the cohort offered the researchers an opportunity to examine how demographic, socioeconomic, and clinical variables relate to whether nodules are actually tracked.
The headline result was stark: overall adherence to recommended follow-up was just 41.3 percent. This is consistent with the study's background observation that more than 60 percent of incidental lung nodules do not receive appropriate surveillance, despite established follow-up protocols. Among the patients in this cohort who did complete follow-up, 5.7 percent were diagnosed with lung cancer, underscoring that a small but consequential share of these incidental findings turn out to be malignant.
The study’s statistical approach distinguished between simpler and more fully adjusted models. In demographic and clinical models, Black patients and patients categorized as Other race showed lower odds of completing follow-up. When the researchers built an integrated multivariable model combining demographic, clinical, and imaging predictors, those racial associations were attenuated, with confidence intervals crossing one, but the direction of effect persisted: Black patients had an adjusted odds ratio of 0.774 (95 percent CI 0.559 to 1.070) and Other-race patients an adjusted odds ratio of 0.779 (95 percent CI 0.574 to 1.056). The authors interpret this attenuation as suggesting that other measured factors account for part of the apparent racial disparity, while noting the directional pattern remained.
Socioeconomic markers told a similar story. Medicaid coverage and lacking insurance were both associated with reduced follow-up rates, pointing to insurance status as one of the structural factors intertwined with whether nodules are surveilled. Because the analysis adjusted across domains in the integrated model, these associations reflect independent contributions after accounting for other measured variables, though as an observational single-center study they cannot establish causation.
The strongest and most consistent predictor was where and when the imaging happened. Nodules identified on imaging obtained in the emergency department had markedly lower odds of follow-up, with an adjusted odds ratio of 0.451 (95 percent CI 0.318 to 0.635), and imaging during inpatient admission was also associated with lower odds, at an adjusted odds ratio of 0.531 (95 percent CI 0.355 to 0.783). By contrast, imaging performed during standard working hours was associated with higher odds of follow-up, as was documented emphysema.
The authors conclude that follow-up adherence for incidental lung nodules remains suboptimal and that imaging setting remained an important determinant even after integrated adjustment. They propose structured tracking systems, patient navigation programs, and standardized reporting protocols as targeted interventions that could improve follow-up rates and mitigate healthcare disparities in lung cancer care. Because incidental lung nodules are detected in roughly 1.6 million cases annually in the United States, and up to 6 percent may represent early-stage lung cancer, the gap between detection and surveillance represents a measurable opportunity for earlier diagnosis, the study argues.
As a retrospective single-center study covering a six-month window at two New York hospitals, the findings describe one health system’s experience and identify associations rather than tested interventions. Still, the pattern it documents, that nodules found in emergency and inpatient settings slip through more often than those found during routine daytime imaging, offers a concrete target for health systems seeking to close a surveillance gap that sits upstream of lung cancer mortality.
Subject of Research: Adherence to follow-up recommendations for incidental lung nodules and associated demographic, socioeconomic, and imaging-setting factors in a diverse urban hospital population.
Article Title: Predictors and disparities in surveillance of incidental lung nodules in a diverse urban population: a retrospective observational study
Article References: Wang, H. Y., Lim, S., Ayoub, N., Qi, J., Akeke, O., Lam, N., Adler, S., SanJuan, M., & Zulueta, J. J. (2026). Predictors and disparities in surveillance of incidental lung nodules in a diverse urban population: a retrospective observational study. BMC Pulmonary Medicine. https://doi.org/10.1186/s12890-026-04833-8
Image Credits: AI Generated
DOI: 10.1186/s12890-026-04833-8
Keywords: incidental lung nodules, lung cancer surveillance, follow-up adherence, health disparities, retrospective cohort study, natural language processing, emergency department imaging, insurance status, Mount Sinai, BMC Pulmonary Medicine, patient navigation, radiology reporting
News Source: Ophelia Keating. (October 29, 2026). Fewer than half of incidental lung nodules get recommended follow-up in New York study. Scienmag.
