Incidental Lung Nodules Research Articles

Radiologist Point-of-Care Clinical Decision Support and Adherence to Guidelines for Incidental Lung Nodules

PurposeTo evaluate the effect of a workstation-integrated, point-of-care, clinical decision support (CDS) tool on radiologist adherence to radiology department guidelines for follow-up of incidental pulmonary nodules detected on abdominal CT. MethodsThe CDS tool was developed to facilitate adherence to department guidelines for managing pulmonary nodules seen on abdominal CT. In October 2012, the tool was deployed within the radiology department of an academic medical center and could be used for a given abdominal CT at the discretion of the interpreting radiologist. We retrospectively identified consecutive patients who underwent abdominal CT (in the period from January 2012 to April 2013), had no comparison CT scans available, and were reported to have a solid, noncalcified, pulmonary nodule. Concordance between radiologist follow-up recommendation and department guidelines was compared among three groups: patients scanned before implementation of the CDS tool; and patients scanned after implementation, with versus without use of the tool. ResultsA total of 409 patients were identified, including 268 for the control group. Overall, guideline concordance was higher after CDS tool implementation (92 of 141 [65%] versus 133 of 268 [50%], P = .003). This finding was driven by the subset of post-CDS implementation cases in which the CDS tool was used (57 of 141 [40%]). In these cases, guideline concordance was significantly higher (54 of 57 [95%]), compared with post-implementation cases in which CDS was not used (38 of 84 [45%], P < .001), and to a control group of patients from before implementation (133 of 268 [50%]; P < .001). ConclusionsA point-of-care CDS tool was associated with improved adherence to guidelines for follow-up of incidental pulmonary nodules.

App Review Series Introduction

App Review Series Introduction

An appeal for safe and appropriate imaging of children.

DO YOU AGREE?○ That our nation’s children deserve safe and appropriate medical imaging.○ That when used properly, medical imaging is lifesaving.○ That there are risks to almost every aspect of health care. For medical imaging, one of the risks includes exposing children to radiation.○ That parents m

Fate of pulmonary nodules detected by computer-aided diagnosis and physician review on the computed tomography simulation images for hepatocellular carcinoma

PurposeTo investigate the frequency and clinical significance of detected incidental lung nodules found on computed tomography (CT) simulation images for hepatocellular carcinoma (HCC) using computer-aided diagnosis (CAD) and a physician review.Materials and MethodsSixty-seven treatment-naïve HCC patients treated with transcatheter arterial chemoembolization and radiotherapy (RT) were included for the study. Portal phase of simulation CT images was used for CAD analysis and a physician review for lung nodule detection. For automated nodule detection, a commercially available CAD system was used. To assess the performance of lung nodule detection for lung metastasis, the sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were calculated.ResultsForty-six patients had incidental nodules detected by CAD with a total of 109 nodules. Only 20 (18.3%) nodules were considered to be significant nodules by a physician review. The number of significant nodules detected by both of CAD or a physician review was 24 in 9 patients. Lung metastases developed in 11 of 46 patients who had any type of nodule. The sensitivities were 58.3% and 100% based on patient number and on the number of nodules, respectively. The NPVs were 91.4% and 100%, respectively. And the PPVs were 77.8% and 91.7%, respectively.ConclusionIncidental detection of metastatic nodules was not an uncommon event. From our study, CAD could be applied to CT simulation images allowing for an increase in detection of metastatic nodules.

P49 Incidental pulmonary nodules; are we doing too many follow up scans? Service review and value of PET-CT imaging

Incidental lung nodules are problematic. Their detection generates 2 years of CT scan follow-up, causing patient anxiety, immense cost and a high radiation burden. Few of these nodules are malignant....

P50 A local assessment of the escalating impact of pulmonary nodule surveillance and its relationship to patient outcomes in a DGH

IntroductionRecent national emphasis on increased awareness to improve detection of early lung cancer has led to dramatic increases in CT chest scans being performed. Consequently, increased detection of incidental lung...

2016 FATE OF INDERMINATE/SUSPICIOUS LESIONS FOUND INCIDENTALLY ON CTKUB FOR SUSPECTED RENAL COLIC ? OUTCOMES AFTER A MINIMUM FOLLOW-UP OF 15 MONTHS

INTRODUCTION AND OBJECTIVES: CT-KUB is the gold standard for the investigation of suspected renal colic. In addition to stone diagnosis additional pathology can be found in 5-20% of CTKUBs. Although most additional findings are minor, sometimes suspicious/indeterminate lesions are found. With increasing incidence of renal colic and stones these incidental but potentially serious lesions will pose a dilemma to surgeons and patients alike.The aim of this study was assess the fate of these indeterminate lesion found CT-KUB. METHODS: A retrospective review of 404 patients having CTKUB’s for suspected acute renal colic was undertaken between May 2010 and April 2011. Data was collected for patient demographics, presence or calculus disease and additional urological or non-urological pathologies and its clinical relevance. The indeterminate/suspicious lesions were followed up and the data was reviewed in September 2012. RESULTS: The mean age was 50 years (Range: 13-91 years), with 165 females (41%). Ureteric stone was found in 58 (14%), with renal stones in 85 (21%), combined ureteric and renal stones in 39 (10%) patients.The minimum follow up for each patient was 15 months. Clinically relevant non-calculus pathologies were found in 107 patients (26%). A total of 54 patients (13.4%) had indeterminate/suspicious lesion, which required either a follow-up or intervention or further imaging. Of these 6 (11%) patients required operative intervention for malignant or serious condition. A further 13 (24%) patients are still under follow-up imaging after one year. This was specially the case in incidental lung nodules where half of them (8/16) were still under follow-up after 15 months. In 35 (65%) patients a benign diagnosis was made after further imaging and or specialist multidisciplinary team meeting. CONCLUSIONS: CTKUBs are vital for stone diagnosis with a pick up rate of 45%.However, it does pick up other important potential malignant lesions which may need monitoring or intervention. In our study, a third of these lesions were either still under follow-up or had intervention after 15 months of being diagnosed.

P67 Lung Nodule Follow-Up Survey of London and East of England Hospitals: What Are We Actually Doing?

BackgroundThe widespread use of computed tomography (CT), to investigate both lung and non-lung pathology has led to the finding of increasing numbers of incidental pulmonary nodules. The BTS is currently...

Surgical Approach to the Small Detected Lung Nodule

In Brief Incidental small lung nodules are increasingly encountered due to the widespread application of thoracic computerized tomographic scanning and improvements in resolution. The evaluation of solitary nodules less than 2 cm is particularly challenging. Although management may include additional radiographic imaging or sampling biopsy, thoracoscopic (video-assisted thoracoscopic surgery [VATS]) excisional biopsy is often the best option. VATS wedge resection by itself may be therapeutic, or lobectomy can be undertaken during the same anesthesia, thereby providing diagnosis and therapy with one procedure. Even for patients who cannot undergo lobectomy, VATS wedge resection is preferred to ablation therapy for lung cancers. The characteristics of some lung cancers that are found as small incidental nodules may make them particularly well treated with sublobar resection, although this requires further study. Evaluation of small incidentally found lung nodules can be a perplexing problem. The best diagnostic test for many nodules is thoracoscopic removal. This article discusses an approach to the small pulmonary nodule that incorporates both diagnosis and treatment.

Incidental lung nodules on CT examinations of the abdomen: Prevalence and reporting rates in the PACS era

Objectives To retrospectively evaluate prevalence, reporting rates and clinical implications of incidental pulmonary nodules detected in multidetector computed tomography (MDCT) abdominal studies. Materials and methods Abdominal MDCT studies of 243 consecutive patients, 94 of whom had a history of cancer, were evaluated. Lung bases included in the scan were reviewed on a PACS workstation with different window settings and post-processing techniques. Nodules were classified according to their density (calcified, solid noncalcified, non-solid, part-solid) and size (<4 mm; 4–6 mm; 6–8 mm; >8 mm). The study findings were compared with the corresponding radiologic reports. Previous of following CT studies, when available from the PACS, were also reviewed to evaluate changes in number and size of the detected nodules. Results An average of 8.2 cm of lung parenchyma was imaged in each patient. 213 noncalcified nodules (NCNs) were identified in 95 patients (39.1%) but only 8 patients (8.4%) had it mentioned in the final report. Comparison CT studies were available for 44 out of the 95 positive patients showing disappearance of the nodules in 2 cases, no interval change in 26 and progression in size and/or number in 16 patients, in whom a final diagnosis of metastasis or primary lung cancers was achieved. Conclusion Radiologists tend to overlook lung portions on abdominal CT studies. Underreporting may affect patient care and have medico-legal implications since images are permanently stored in digital format on PACS and CD-ROMs. Management of the discovered nodules should be tailored to the clinical situation of the patient, and particular care should be reserved to patients with oncologic history.

Pulmonary Microcystic Fibromyxoma: Report of 3 Cases

Three cases of pulmonary myxoid tumors showing a variable degree of microcystic change are described. They are presented as incidental solitary peripheral lung nodules on routine radiologic studies. The patients included 2 women, 45 and 65 years old, and 1 man, 33 years old. Clinical work-up showed no evidence of neoplasia in other sites. Following surgical resection, no evidence of disease was observed after a mean follow-up of 48 months. The tumors ranged in size from 1 to 2.3 cm (mean 1.4 cm). Microscopically, the lesions were well circumscribed with conspicuous cystic change and myxoid stroma. Innocuous, widely-spaced, spindled to stellate tumor cells showed minimal nuclear pleomorphism and absence of mitotic activity. The myxoid stroma contained acid mucopolysaccharides, sensitive to hyaluronidase digestion. No epithelial, chondroid, neural, myofibroblastic, lipomatous or vascular differentiation was evident on immunohistochemical studies. Although these cases display cytologic features, myxoid stroma and benign clinical course characteristic of pulmonary myxomas; the presence of microcystic architecture is unique to the current series, and thus a descriptive designation "microcystic fibromyxoma" is suggested.

Primary chondrosarcoma of the lung recognized as a long-standing solitary nodule prior to resection

As the use of computed tomography (CT) increases, incidental lung nodules have become a clinical issue that is being addressed more than before. We detected a solitary lung nodule which was smooth-margined, round-shaped, 11 mm in size. Follow-up for 18 months after initial detection by chest CT did not show any interval change. To make a definitive diagnosis, video-assisted thoracic surgery was performed and the lesion was diagnosed as myxoid chondrosarcoma. In the 6-year postoperative follow-up, annual chest CT and bone scintigram did not reveal any abnormality, which excludes the possibility of a latent primary site other than the lung. Therefore, we considered the present case being of pulmonary origin. Accordingly, even though the lesion appeared unremarkable, surgical resection of solitary lung nodule should not be discouraged.