Characterization of population’s follow-up in a centralized lung nodule consultation

Abstract

Follow-up of incidental pulmonary nodules in daily practice is not always consistent with radiology guidelines. To deal with this in March 2018 we centralized these cases in a virtual lung nodule consultation. Our aim was to analyse the virtual consultation population according to their follow-up. Methods: Observational prospective study of patients evaluated in the virtual lung nodule consultation, between March and September 2018. Clinical data, computed tomographies, nodule/s characteristics and recommendations were recorded. 2017 Fleischner’s Society guidelines were used. Recommendations were divided in discharge, follow-up or submit to lung cancer diagnostic track. Discharges were stratified in correct follow-up, over-follow-up and no indicated follow-up. Participant characteristics were compared using the Student t test, Mann-Whitney U or Kruskal-Wallis tests for skewed data. All tests were two-sided; p values Results: 239 patients (57.3% men; mean age 63 (SD = 11.9)) were included. 61.5% had smoking history. Most nodules were solids (83.7%) and multiple (56.1%), and had a median diameter of 6.00 mm [IQR; 4.00 - 8.00]. 45.2% of patients were discharged. Over-followed-up patients (28.4%) were older (66 [56.0;73.0]), had more history of COPD, most had multiple nodules (74.2%) and nodule median diameter was 7.00 mm [4.50 - 8.00]. Non-indicated follow-up patients (36.7%) were more women (55%), non-smokers (75%), with more history of asthma (20%) and occupational exposures (22.5%). Conclusion: To centralize incidental lung nodule surveillance in a virtual consultation may provide a more accurate management of patients and avoid unnecessary control.