Identifying false negative cases is an important quality metric in lung cancer screening but these have been infrequently and variably reported in previous studies. Although as a proportion of all screening participants, false negative cases are uncommon, such cases may constitute a significant proportion of all lung cancers diagnosed (up to 15%) within a screening programme. This article reviews the impact and causes of false negative lung cancer screening tests, including those related to radiological evaluation, nodule management protocols, and management decisions made by multidisciplinary teams. Following a review of data from international screening studies, this article discusses controversies within the screening literature surrounding the definition and classification of a false negative lung cancer screening test, and how data on false negative rates should be captured and recorded. Challenges, such as avoiding overly cautious surveillance of lung nodules whilst also minimizing over-diagnosis and investigation of indolent or benign lesions, are considered. Finally, the advantages and disadvantages of different approaches to dealing with false negative results in lung cancer screening are discussed.
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