Development and outcomes of a comprehensive multidisciplinary incidental lung nodule and lung cancer screening program

Abstract

Background: 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. However, the implementation and management of comprehensive lung nodule programs is challenging. Methods: This 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. Results: The 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. Conclusions: The current study reports outcomes over the first two 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.

Complementary Approaches to Lung Cancer Detection in High-Risk Populations

“…The study results by Osarogiagbon et al, 19 coupled with those previously published, 20,21 highlight the complementary benefits of two multidisciplinary approaches, LCS and ILN programs, for early detection of lung cancer. First, in previous studies, 20,21 most nodules were detected incidentally, supporting the importance of an established ILN program to implement guideline-concordant management of incidental nodules that may represent early-stage lung cancer. Second, in the study by Osarogiagbon et al, 19 most patients diagnosed with lung cancer in the ILN program were not eligible for screening by 2021 USPSTF criteria.…”

“…Previous studies have reported the benefits of concurrent multidisciplinary LCS and ILN programs. 20,21 A study of over 1,000 patients, of which 89.2% were White, seen at a multidisciplinary LCS and ILN management clinic, showed that (1) the majority (80%) of nodules were detected incidentally, (2) nearly 95% of patients diagnosed with lung cancer had early-stage disease, (3) a shorter time to diagnosis, < 50 days, and (4) significantly higher adherence rate to diagnostic and treatment recommendations. However, the low proportion of minority patients in the study limited generalizability, hampering the ability to assess the impact of the parallel programs on racial and ethnic disparities in lung nodule management.…”

“…20 Another recent single-center, retrospective study reported outcomes of a multidisciplinary lung nodule management approach that included a Pulmonary Nodule and Lung Cancer Screening Clinic (PNLCSC) at a community practice in Tennessee, a state with a high burden of lung cancer. 21 The PNLCSC had an internal database to track patients and a dedicated nurse navigator. The majority of nodules, about 65%, were detected incidentally.…”