P213 The efficacy of the Southwest Chest X-Ray Reporting Tool (SW CXR RT) in identifying patients with a new diagnosis of lung cancer, subsequently managed via the national optimal lung cancer pathway (NOLCP)

Abstract

<h3>Introduction and Objectives</h3> The Southwest Lung Cancer Alliance introduced the Southwest CXR Reporting Tool (SW CXR RT) to help identify patients requiring reflex CT scans to streamline the first part of the NOLCP. The SW CXR RT identifies 3 categories: CX1 (normal), CX2 (abnormal pathology of uncertain significance), CX3 (highly suggestive of lung cancer). CX3 reported XR have a reflex CT; for CX2 the CT decision is at the discretion of the general practitioner (GP). We audited the efficacy of using the SW CXR RT in identifying patients with a new diagnosis of lung cancer, subsequently managed via the NOLCP. <h3>Methods</h3> Results were collated over a 10-month period (1st March – 31st December 2019). The CTs of patients with CX2 and CX3 reported chest x-rays were reviewed. <h3>Results</h3> The 65 reflex CTs for CX3 identified the following diagnoses: 41 (63%) malignant condition, 16 (25%) non-malignant, and 8 (12%) undergoing further surveillance. Of malignant diagnoses, 40 (98%) were lung cancer and 1 (2%) was non-thoracic malignancy. 9 (23%) lung cancer diagnoses received radical treatment and 31 (78%) supportive management. The average time from CX3 CXR to CT was 5.8 days. The average time from CT to report was 2.3 days. The average time from CX3 CXR to CT report was 8.1 days. The 367 separately-requested CTs for CX2 identified the following diagnoses: 64 (17%) malignant condition, 257 (70%) non-malignant, and 46 (13%) undergoing further surveillance. Of malignant diagnoses, 52 (81%) were lung cancer and 12 (19%) were non-thoracic malignancy. 16 (31%) lung cancer diagnoses received radical treatment and 36 (69%) supportive management. The average time from CX2 CXR to CT was 9.8 days. The average time from CT to report was 2.6 days. The average time from CX2 CXR to CT report was 12.4 days. In total, 92/432 (21%) CTs were lung cancer diagnoses; 25/92 (27%) were treated radically. <h3>Conclusion</h3> The discretion for CT imaging in CX2 is with GPs. Further work is needed to streamline CT imaging to ensure prompt time to diagnosis and treatment in CX2 patients with lung cancer given a greater proportion were radically treatable versus CX3.