P74 Out with the old, and in with the current (guidance) – getting the follow up of incidental lung nodules right

Abstract

Background and aims Our local nodule service is a virtual clinic where patients with incidental lung nodules found on cross sectional imaging are jointly reviewed by consultant thoracic radiologists and respiratory physicians. The British Thoracic Society Guidelines for the Investigation and Management of Pulmonary Nodules were introduced in 2015, replacing the previously used Fleishner Society guidance. We assessed the compliance of general radiologists with the current guidance and the impact on nodule management. Method 64 patients completed their follow up in the virtual nodule clinic (VNC) in 2017. The original radiology reports for their initial cross sectional imaging were reviewed retrospectively. These were assessed using the current British Thoracic Society (BTS) guidelines and compared to outcomes from the VNC for consistency. The VNC categorised nodules by type and size according to the limbs of the BTS pulmonary nodule guideline algorithm. Where multiple nodules were identified, the largest nodule was selected for analysis. Results The mean age of the patients at their first scan was 66 years old and 22 (34%) patients were documented smokers. 28 (43%) patients were directly discharged by the nodule service. 52 (81%) patients were identified with solid nodules and 12 (19%) patients were found to have subsolid nodules. Altogether 26 (41%) of the original radiology reports were compliant with BTS guidelines. Non-compliance was either due to recommendations based on the 2005 Fleishner guidelines in 5 (8%) cases, 14 (22%) were neither BTS nor Fleischner, not specifying an appropriate management plan in 14 (22%) cases or in 5 (8%) cases not making a recommendation at all. Thoracic radiologists where non-compliant were found to be following the Fleischner guidelines. Conclusion Our nodule service has a role in reducing the length of follow up of incidental nodules with a separate pathway that relieves pressure on the lung cancer service. The relatively short follow up period may reflect the increasing use of volumetric assessment. There remains room for improvement in raising awareness of the BTS guidelines among general radiologists in our department.