Association of the Intensity of Diagnostic Evaluation With Outcomes in Incidentally Detected Lung Nodules

Farjah, Farhood; Monsell, Sarah E.; Gould, Michael K.; Smith‐Bindman, Rebecca; Banegas, Matthew P.; Heagerty, Patrick J.; Keast, Erin; Ramaprasan, Arvind; Schoen, Kurt; Brewer, Elena G.; Greenlee, Robert T.; Buist, Diana S.M.

doi:10.1001/jamainternmed.2020.8250

Cited by 24 publications

(13 citation statements)

References 46 publications

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“…17 This study also demonstrated a 3-year overall survival (OS) rate of 63.6% versus 30.3% for symptomatic cancers and this is supported by another study, 18 which confirmed a median OS benefit of 38.9 months versus 16.1 months. However in contrast, recent evidence has suggested 19 that intensive diagnostic evaluation of pulmonary nodules is associated with greater procedural complications and unnecessary radiation exposure with little benefit. Certainly, in the retrospective audit five patients with indeterminate nodules were advised to have a six-month follow-up CT scan to determine any changes and to exclude a small lung malignancy.…”

Section: Discussionmentioning

confidence: 94%

The identification of abnormalities on radiotherapy CT planning scans: a retrospective audit

Cameron

2022

J Radiother Pract

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Introduction: Therapeutic radiographers are an essential part of a cancer patient’s journey and play a vital and changing role in the delivery of radiotherapy services. This retrospective audit highlights the number of incidental abnormalities found by a Breast Advanced Practitioner on radiotherapy computed tomography (CT) planning scans and their subsequent management. Methods: This retrospective audit investigated the incidental abnormalities found by the Breast Advanced Practitioner on routine CT planning scans for breast cancer patients 2016–2021. Any breast cancer patient found to have an abnormality had their planning scan uploaded to the national picture archiving and communication systems (PACS) system for radiology review. Further formal CT imaging was requested or direct referral to an appropriate multi-disciplinary team meeting. Results: Sixty-three significant abnormalities were found over the five-year period, of these thirty seven were malignant and the majority of these were lung lesions. Seven patients went on to have surgery alone, surgery plus chemoradiation or stereotactic ablative radiotherapy for their newly diagnosed lung primaries. Five patients were found to have liver metastases that unfortunately changed their treatment plan to palliative. Conclusion: This retrospective audit has demonstrated that CT planning for radiotherapy offers an opportunity to identify malignant abnormalities at a potentially early stage, thereby improving prognosis and survival. Radiographers have a duty of care to appraise these CT scans to ensure any abnormalities can be addressed in a timely manner.

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Section: Discussionmentioning

confidence: 94%

The identification of abnormalities on radiotherapy CT planning scans: a retrospective audit

Cameron

2022

J Radiother Pract

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“…In this retrospective cohort study, we found that almost 1 in 3 patients received unnecessary lung cancer screening, and the rate dramatically varied by different characteristics. Previous study suggested the disadvantage of unnecessary Chest CT, and there were studies about overuse of Chest CT in patients with breast cancer or studies about lung cancer screening inconsistent with USPSTF, [16][17][18] but to our knowledge, this is the rst study to assess the overuse of Chest CT during follow-up after nding nodules suspicious for lung cancer.…”

Section: Discussionmentioning

confidence: 98%

Overuse of follow-up chest computed tomography in patients with incidentally identified nodules suspicious for lung cancer

Guo

Zhang

et al. 2021

J Cancer Res Clin Oncol

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Purpose: Regardless of professional societies agreed that CT screening inconsistent with recommendation leads to radiation-related cancer and unexpected cost, many patients undergo unnecessary chest CT before treatment. The goal of this study was to assess the overuse of Chest CT in different type of patients. Methods: Data on 1853 patients who underwent pulmonary resection from May 2019 to May 2020 were retrospectively analyzed. Data collected include age, sex, follow-up time, density and size of nodules and frequency of undergoing Chest CT. Pearson χ2 test and logistic regression were conducted to compare the receipt of CT screening.Results: Among 1853 patients in the study, 689 (37.2%) had overused Chest CT during follow-up of the lung cancer. This rate was 16.2% among patients with solid nodules, 57.5% among patients with pure ground glass opacity (pGGO), and 41.4% among patients with mixed ground glass opacity (mGGO) (P<.001). 50.7% in the "age ≤40" group, 39.8% in the "41≤age ≤50" group, 38.7% in the "51≤age ≤60" group, 32.3% in the "61≤age ≤70" group, 27.8% in the ">70" group underwent unnecessary CT (P<.001).Female get more unnecessary CT than male (40.6% vs 32.8%, P<.001). Factors associated with a greater likelihood of Chest CT is the density of nodules (odds ratios [ORs] of 0.53 for mGGO; 0.15 for solid nodule, P<.0001, vs patients with pGGO). Conclusion: roughly 37% patients with pulmonary nodules received Chest CT too frequently despite national recommendations against the practice. Closer adherence to clinical guidelines is likely to result in more cost-effective care.

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“…There is no clinical or radiological feature that definitively identifies malignant SPNs, and SPNs often require endobronchial or transthoracic tissue biopsy to rule out malignancy [2,4]. For small, peripheral, or sub-solid nodules, the diagnostic yield of biopsies is low, leading to patient anxiety, increased healthcare costs, additional procedures, and prolonged radiographic surveillance [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Targeted detection of cancer cells during biopsy allows real-time diagnosis of pulmonary nodules

Kennedy

Azari

Bernstein

et al. 2022

Eur J Nucl Med Mol Imaging

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Background The diagnostic yield of biopsies of solitary pulmonary nodules (SPNs) is low, particularly in sub-solid lesions. We developed a method (NIR-nCLE) to achieve cellular level cancer detection during biopsy by integrating (i) near-infrared (NIR) imaging using a cancer-targeted tracer (pafolacianine), and (ii) a flexible NIR confocal laser endomicroscopy (CLE) system that can fit within a biopsy needle. Our goal was to assess the diagnostic accuracy of NIR-nCLE ex vivo in SPNs. Methods Twenty patients with SPNs were preoperatively infused with pafolacianine. Following resection, specimens were inspected to identify the lesion of interest. NIR-nCLE imaging followed by tissue biopsy was performed within the lesion and in normal lung tissue. All imaging sequences (n = 115) were scored by 5 blinded raters on the presence of fluorescent cancer cells and compared to diagnoses by a thoracic pathologist. Results Most lesions (n = 15, 71%) were adenocarcinoma-spectrum malignancies, including 7 ground glass opacities (33%). Mean fluorescence intensity (MFI) by NIR-nCLE for tumor biopsy was 20.6 arbitrary units (A.U.) and mean MFI for normal lung was 6.4 A.U. (p < 0.001). Receiver operating characteristic analysis yielded a high area under the curve for MFI (AUC = 0.951). Blinded raters scored the NIR-nCLE sequences on the presence of fluorescent cancer cells with sensitivity and specificity of 98% and 97%, respectively. Overall diagnostic accuracy was 97%. The inter-observer agreement of the five raters was excellent (κ = 0.95). Conclusions NIR-nCLE allows sensitive and specific detection of cancer cells in SPNs. This technology has far-reaching implications for diagnostic needle biopsies and intraprocedural decision-making.

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Association of the Intensity of Diagnostic Evaluation With Outcomes in Incidentally Detected Lung Nodules

Cited by 24 publications

References 46 publications

The identification of abnormalities on radiotherapy CT planning scans: a retrospective audit

The identification of abnormalities on radiotherapy CT planning scans: a retrospective audit

Overuse of follow-up chest computed tomography in patients with incidentally identified nodules suspicious for lung cancer

Targeted detection of cancer cells during biopsy allows real-time diagnosis of pulmonary nodules

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