Purpose: Although lung cancer screening using lowdose computerized tomography (LDCT) has become a standard of care for heavy smokers, the potential benefits and harms of LDCT screening in never-smokers remains unclear. The aim of this study was to determine the prevalence of nodules considered for invasive biopsy, and evaluate the final diagnosis and complications related to procedures in never-smokers who undergo LDCT screening. Method: This retrospective cohort study evaluated 37,436 adults who received LDCT screening for lung cancer between January 2009 and December 2018 at a tertiary center in South Korea. Data were collected on cases of nodule detection, follow-ups, diagnostic procedures, and clinical outcomes, and analyzed according to smoking history. Result: Of the 17,968 never-smokers, 2,908 (16.2%) were detected with positive nodules during the study period, of which 51.2% had ground-glass nodules. 139 (0.77%) subjects received invasive biopsy for pathologic diagnosis, and 84 (0.47%) were diagnosed with lung cancer. Among the subjects who underwent invasive diagnosis, 50 (36.0%) were diagnosed benign, with a significant proportion of mycobacterial disease. 20 (14.4%) experienced procedure-related complication, with no case of death. Among 84 lung cancer patients, 82 (97.6%) had adenocarcinomas, and 75 (89.3%) presented with stage I disease, resulting in favorable treatment outcomes. Conclusion: LDCT screening in never-smokers resulted in a significant detection rate of lung nodules which led to invasive biopsy. The complication rates, false-positive rates, and lung cancer detection rates were fairly comparable to ever-smokers. Accordingly, benefits and harms of LDCT screening in never-smokers, especially in Asian population, should be actively discussed.