Incidental Pulmonary Nodules – What Do We Know in 2022

Abstract

Lung cancer (LC) is the leading cause of cancer-related mortality worldwide, and early LC diagnosis can significantly improve outcomes and survival rates in affected patients. Implementation of LC screening programs using low-dose computed tomography CT in high-risk subjects aims to detect LC as early as possible, but so far, adoption of screening programs into routine clinical care has been very slow. In recent years, the use of CT has significantly increased the rate of incidentally detected pulmonary nodules. Although most of those incidental pulmonary nodules (IPNs) are benign, some of them represent early-stage LC. Given the large number of IPNs detected in the range of several millions each year, this represents an additional, maybe even larger, opportunity to drive stage shift in LC diagnosis, next to LC screening programs. Comprehensive evaluation and targeted work-up of IPNs are mandatory to identify the malignant nodules from the crowd, and several guidelines provide radiologists and physicians’ guidance on IPN assessment and management. However, IPNs still seem to be inadequately processed due to various reasons including insufficient reporting in the radiological report, missing communication between stakeholders, absence of patient tracking systems, and uncertainty regarding responsibilities for the IPN management. In recent years, several approaches such as lung nodule programs, patient tracking software, artificial intelligence, and communication software were introduced into clinical practice to address those shortcomings. This review evaluates the current situation of IPN management and highlights recent developments in process improvement to achieve first steps toward stage shift in LC diagnosis.

Consequences of Losing Incidental Pulmonary Nodules to Follow-Up: Unmonitored Nodules Progressing to Stage IV Lung Cancer

“…These initiatives have shown promising outcomes, manifesting in a heightened incidence of early-stage lung cancer diagnoses. Within Europe, the present state of nodule management remains relatively unexplored [21]. However, this study offers valuable insights, revealing rates of inadequate follow-up that, while not as severe, still share common explanations for the lack of proper monitoring [22].…”

Assessing the Impact of Socioeconomic Status on Incidental Lung Nodules at an Urban Safety Net Hospital

“…Other studies have highlighted the advantages of combined LCS and ILN programs [9,10,12,22] to capture higher-risk groups, which leads to improved early lung cancer diagnosis and guideline concordant care. However, SES factors in these studies were not consistently reported, and these studies included mostly individuals of White ethnicity, which made it challenging to evaluate the effect of the programs when accounting for SES, race, and ethnic inequalities [23]. To elucidate the in uence of SES on lung cancer, we undertook a retrospective analysis of all individuals ≥ 18 years of age with incidental lung nodules on CT chest who were referred to the pulmonary clinic at an urban, tertiary care hospital in Brooklyn, New York over a 3-year period.…”

Incidental pulmonary nodules – current guidelines and management

“…sie aber nicht allein dafür verantwortlich sind, dass IPN häufig vernachlässigt werden. Unterschiedliche Gesundheitsdienstleister und Patienten stellen ebenfalls wichtige Faktoren für den Erfolg des IPN-Managements dar [65].…”