Abstract
BackgroundAppropriate management of lung nodules detected incidentally or through lung cancer screening can increase the rate of early-stage diagnoses and potentially improve treatment outcomes. However, the implementation and management of comprehensive lung nodule programs is challenging.MethodsThis single-center, retrospective report describes the development and outcomes of a comprehensive lung nodule program at a community practice in Tennessee. Computed tomography (CT) scans potentially revealing incidental lung nodules were identified by a computerized search. Incidental or screening-identified lung nodules that were enlarging or not seen in prior scans were entered into a nodule database and guideline-based review determined whether to conduct a diagnostic intervention or radiologic follow-up. Referral rates, diagnosis methods, stage distribution, treatment modalities, and days to treatment are reported.ResultsThe number of patients with lung nodules referred to the program increased over 2 years, from 665 patients in Year 1 to 745 patients in Year 2. Most nodules were incidental (62–65%). Nodules identified with symptoms (15.2% in Year 1) or through screening (12.6% in Year 1) were less common. In Year 1, 27% (182/665) of nodules required a diagnostic intervention and 18% (121/665) were malignant. Most diagnostic interventions were image-guided bronchoscopy (88%) or percutaneous biopsy (9%). The proportion of Stage I-II cancer diagnoses increased from 23% prior to program implementation to 36% in Year 1 and 38% in Year 2. In screening cases, 71% of patients completed follow-up scans within 18 months. Only 2% of Year 1 patients under watchful waiting required a diagnostic intervention, of which 1% received a cancer diagnosis.ConclusionsThe current study reports outcomes over the first 2 years of a lung cancer screening and incidental nodule program. The results show that the program was successful, given the appropriate level of data management and oversight. Comprehensive lung nodule programs have the potential to benefit the patient, physician, and hospital system.
Highlights
Appropriate management of lung nodules detected incidentally or through lung cancer screening can increase the rate of early-stage diagnoses and potentially improve treatment outcomes
Age-standardized life years lost due to lung cancer is significantly worse in the southeastern United States compared to national averages [2]
While early detection markedly improves survival, only 16% of lung cancers in the United States are detected at localized stages [3]
Summary
Appropriate management of lung nodules detected incidentally or through lung cancer screening can increase the rate of early-stage diagnoses and potentially improve treatment outcomes. Dedicated programs to identify and manage lung nodules may facilitate early detection and improve survival. In an integrated health system report between 2006 and 2012, approximately 25–30% of all chest CT scans revealed positive findings This corresponds to the identification of an estimated 1.57 million new lung nodules annually [5]. The false positive rate is high, with only about 5% of identified nodules receiving a lung cancer diagnosis within 2 years [5]. Lung cancer screening in appropriate patients has increased early-stage detection (36–71% Stage I) [8] and reduced long-term mortality rates [9,10,11,12]. Screening implementation is challenged by insufficient resources to manage positive cases according to guidelines, which is currently a requirement for reimbursement [16]
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