Large cell carcinoma of the lung: LDCT features and survival in screen-detected cases

Large Cell Carcinoma (LCC) observed in low-dose computed tomography (LDCT) screening trials typically presented as a single solid peripheral nodule or mass, often with lobulated margins (panels A-D), and exhibited a fast growth (panels E-F and G-H). The 5-year survival (panel I) reflected the stage at diagnosis and was fair (15/20 alive) for stages I-II (dashed line) and poor (1/10 alive) (continuous line) for stages III-IV. [Display omitted] •LDCT screening enables the definition of early radiological features of LCC.•LCC was diagnosed in 30 (4%) of 750 subjects with LDCT screen-detected lung cancers.•LCC appeared as a peripheral solid nodule/mass often (43%) with lobulated margins.•5 years after diagnosis, 5/20 stages I-II and 9/10 stages III-IV subjects had died of LCC.•Survival of screen-detected LCC depends on the stage at diagnosis. To investigate the early radiological features and survival of Large Cell Carcinoma (LCC) cases diagnosed in low-dose computed tomography (LDCT) screening trials. Two radiologists jointly reviewed the radiological features of screen-detected LCCs observed in NLST, ITALUNG, and LUSI trials between 2002 and 2016, comprising a total of 29,744 subjects who underwent 3–5 annual screening LDCT examinations. Survival or causes of death were established according to the mortality registries extending more than 12 years since randomization. LCC was diagnosed in 30 (4 %) of 750 subjects with screen-detected lung cancer (LC), including 15 prevalent and 15 incident cases. Three additional LCCs occurred as interval cancers during the screening period. LDCT images were available for 29 cases of screen-detected LCCs, and 28 showed a single, peripheral, and well-defined solid nodule or mass with regularly smooth (39 %), lobulated (43 %), or spiculated (18 %) margins. One case presented as hilar mass. In 9 incident LCCs, smaller solid nodules were identified in prior LDCT examinations, allowing us to calculate a mean Volume Doubling Time (VDT) of 98.7 ± 47.8 days. The overall five-year survival rate was 50 %, with a significant (p = 0.0001) difference between stages I-II (75 % alive) and stages III-IV (10 % alive). LCC is a fast-growing neoplasm that can escape detection by annual LDCT screening. LCC typically presents as a single solid peripheral nodule or mass, often with lobulated margins, and exhibits a short VDT. The 5-year survival reflects the stage at diagnosis.