P52 Incidental non-calcified pulmonary nodules: rationale for CT scanning and cost analysis

Abstract

pathways: 2WW 37, inpatients 15, angiograms 6, PE service 5, respiratory OPD 17, other MDT 4, OPD 11, GP 3. Only 4/107 patients (3.7%) had high suspicion for lung cancer at outset, -2 confirmed at surgery, 1 received radiotherapy (age 91yrs), 1 declined treatment. No further pathology was detected from surveillance. So far, a total of 246 CTs have been performed with 72 awaited (table 1). Fifteen patients had PET-CT (all low SUV). Fourteen underwent bronchoscopy (normal). Two had CT biopsy (benign), 2 declined biopsy, 2 were smaller at biopsy. One benign lesion was resected (patient choice). Only 28 patients have been discharged from surveillance; 10/28 resolved on 3month CT, 3/28 resolved on 6month CT, 15/28 stable on 12month CT. Fleischner guidance was accurately followed in 67%, most deviance due to delayed timing of 6month CT. Twenty-nine (27%) were discussed without documented nodule size. Conclusion Nodule surveillance has put a significant burden on local Thoracic-Oncology services. No unexpected pathology was encountered during this surveillance period. Until clear clinical and/or radiological identifying factors for high risk patients are understood and rationalised, nodule surveillance will have to continue. There are cost implications not only for Radiology and Respiratory services, but also to patients' emotional and physical well-being. This highlights the continued need for clear surveillance protocols supported by service development. A retrospective study to analyse the outcomes and costs of follow-up of incidental nodules (solitary and multiple) referred to our Department from 2010-2011. Method Consecutive nodule cases were identified by reviewing CT reports of 619 patients discussed at our Lung Cancer MDT from 2010-2011. Only clinically incidental nodules were included. Information was gathered using PACS and hospital records. In our department incidental nodules are seen once in clinic and then largely managed 'remotely' via correspondence. All nodules are managed to Fleischner guidelines.Costs for investigations/procedures/appointments were calculated using local 2012-13 reference costs. Manpower costs for MDTs and correspondence were calculated using a 'bottom-up' costing approach. Results 62 patients were referred with a new incidental nodule (s). Mean age was 66(34-92) with a 1:1 male:female ratio. 56% (35/62) had PS 0-1 and 56%(35/62) were current/ex-smokers. 66%(41/62) had a SPN. Mean size of largest nodule was 9mm. 11%(7/62) were diagnosed with malignancy, 6%(4/62) of pulmonary origin. The 3 non-pulmonary malignancies were renal, breast and metastatic squamous cell. New clinically important diagnoses were made in a further 11%(7/62) including TB/amyloid/ILD, whilst 78%(48/62) were benign.In the malignancy group, 71% (5/7) were current/ex-smokers, 86% (6/7) had a SPN with mean size 7.7mm and there was a higher likelihood of nodules enlarging on follow-up CTs (40% versus 2% at 2nd CT). 75%(3/4) of patients with lung malignancy underwent curative treatment. In the benign group (48), the me...

Review of the British Thoracic Society Winter Meeting 2013, 4–6 December, London, UK

“…This year's poster sessions highlighted the increasing interest in the investigation and management of incidental pulmonary nodules30 –33 and the use of PET-CT for the detection of nodal disease34 and non-nodal extra-thoracic metastases 35. In the ‘mechanisms in carcinogenesis’ spoken session, work from Professor Janes’ group (London) offered some hope for identifying novel treatments for lung cancer36 and pleural mesothelioma,37 as well as the identification of novel targets 38.…”