Centralized Lung Nodule Management at A Veterans Hospital Using A Multidisciplinary Lung Nodule Evaluation Team(LNET)
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摘要
Introduction: Lung nodules are frequently identified on imaging studies and can represent early lung cancers. We instituted the Lung Nodule Evaluation Team(LNET) to optimize management of these nodules by a lung specialist physician. All lung nodules identified by a radiologist prompted a direct consultation to this service. We report our initial experience with this process. Methods: This is a retrospective review of patients with lung nodules at a single institution from 2008 to 2015. Since October 2014, lung nodules >3 mm identified on computed tomography(CT) scanning of the chest generate an automatic consult to LNET from the radiology service. Demographic, nodule and follow up data was entered into a surveillance database and summarized.Results: There were 1,873 patients identified in the database. Of these, 900 patients were undergoing active surveillance. Consults increased from 5.5 to 93 per month after the start of the new consult program. Lung nodules were identified on 64% of chest CT scans. Prior to the direct radiology consult the average size of a nodule was 1.7 cm and 0.7 cm after. The overall time from initial nodule imaging to initiating a management plan by a thoracic specialist physician was 3.7 days. Conclusion: Assessment of lung nodules by a specialist physician is important to ensure appropriate long term management and optimize utilization of diagnostic interventions. A direct radiology consult to a specialized team of chest physicians decreased the time in initiating a management plan, identified smaller nodules and may lead to a more judicious use of health care resources in the management of lung nodules.
Introduction: Lung nodules are frequently identified on imaging studies and can represent early lung cancers. We instituted the Lung Nodule Evaluation Team(LNET) to optimize management of these nodules by a lung specialist physician. All lung nodules identified by a radiologist prompted a direct consultation to this service. We report our initial experience with this process. Methods: This is a retrospective review of patients with lung nodules at a single institution from 2008 to 2015. Since October 2014, lung nodules >3 mm identified on computed tomography(CT) scanning of the chest generate an automatic consult to LNET from the radiology service. Demographic, nodule and follow up data was entered into a surveillance database and summarized.Results: There were 1,873 patients identified in the database. Of these, 900 patients were undergoing active surveillance. Consults increased from 5.5 to 93 per month after the start of the new consult program. Lung nodules were identified on 64% of chest CT scans. Prior to the direct radiology consult the average size of a nodule was 1.7 cm and 0.7 cm after. The overall time from initial nodule imaging to initiating a management plan by a thoracic specialist physician was 3.7 days. Conclusion: Assessment of lung nodules by a specialist physician is important to ensure appropriate long term management and optimize utilization of diagnostic interventions. A direct radiology consult to a specialized team of chest physicians decreased the time in initiating a management plan, identified smaller nodules and may lead to a more judicious use of health care resources in the management of lung nodules.
Introduction: Lung nodules are frequently identified on imaging studies and can represent early lung cancers. We instituted the Lung Nodule Evaluation Team(LNET) to optimize management of these nodules by a lung specialist physician. All lung nodules identified by a radiologist prompted a direct consultation to this service. We report our initial experience with this process. Methods: This is a retrospective review of patients with lung nodules at a single institution from 2008 to 2015. Since October 2014, lung nodules >3 mm identified on computed tomography(CT) scanning of the chest generate an automatic consult to LNET from the radiology service. Demographic, nodule and follow up data was entered into a surveillance database and summarized.Results: There were 1,873 patients identified in the database. Of these, 900 patients were undergoing active surveillance. Consults increased from 5.5 to 93 per month after the start of the new consult program. Lung nodules were identified on 64% of chest CT scans. Prior to the direct radiology consult the average size of a nodule was 1.7 cm and 0.7 cm after. The overall time from initial nodule imaging to initiating a management plan by a thoracic specialist physician was 3.7 days. Conclusion: Assessment of lung nodules by a specialist physician is important to ensure appropriate long term management and optimize utilization of diagnostic interventions. A direct radiology consult to a specialized team of chest physicians decreased the time in initiating a management plan, identified smaller nodules and may lead to a more judicious use of health care resources in the management of lung nodules.
引文
1 Wahidi MM,Govert JA,Goudar RK,et al.Evidence for the treatment of patients with pulmonary nodules:when is it lung cancer?ACCPevidence-based clinical practice guidelines(2nd edition).Chest,2007,132(Suppl 3):94S-107S.doi:10.1378/chest.07-1352
2 Tanner NT,Aggarwal J,Gould MK,et al.Management of pulmonary nodules by community pulmonologists:a multicenter observational study.Chest,2015,148(6):1405-1414.doi:10.1378/chest.15-0630
3 Horeweg N,Van Rosmalen J,Heuvelmans M A,et al.Lung cancer probabi l it y i n pat ients w it h CT-detected pu l mona r y nodu les:a prespecified analysis of data from the NELSON trial of low-dose CTscreening.Lancet Oncol,2014,15(12):1332-1341.doi:10.1016/S1470-2045(14)70389-4
4 National Comprehensive Cancer Network NCCN Clinical Practice Guidelines in Oncology.Non-small cell lung cancer.Version 7.2015.Website:http://w w w.tri-kobe.org/nccn/guideline/lung/english/non_small.pdf.Accessed August 11,2017.
5 Zullig LL,Carpenter WR,Provenzale DT,et al.The association of race with timeliness of care and survival among Veterans A ffairs health care system patients with late-stage non-small cell lung cancer.Cancer Manag Res,2013,5:157-163.doi:10.2147/CMAR.S46688
6 Powel l A A,Schu ltz EM,Ord in DL,et al.Ti mel iness across t he continuum of care in veterans with lung cancer.J Thorac Oncol,2008,3(9):951-957.doi:10.1097/JTO.0b013e3181839b60
7 Schultz EM,Powell A A,McMillan A,et al.Hospital characteristics associated w ith timel iness of care in veterans w ith lung cancer.A m J Respir Crit Care Med,2009,179(7):595-600.doi:10.1164/rccm.200806-890OC
8 MacMahon H,Naidich DP,Goo JM,et al.Guidelines for management of incidental pulmonary nodules detected on CT images:from the F leischner Societ y 2017.R ad iolog y,2017,28 4(1):161-163.doi:10.1148/radiol.2017161659
9 National Lung Screening Trial Research Team,Aberle DR,Adams A M,et al.Reduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med,2011,365(5):395-409.doi:10.1056/NEJMoa1102873
10 MacMahon H,Austin JH,Gamsu G,et al.Guidelines for management of small pulmonary nodules detected on CT scans:a statement from the Fleischner Society.Radiology,2005,237(2):395-400.doi:10.1148/radiol.2372041887
11 Gierada DS,Pilgram TK,Ford M,et al.Lung cancer:interobserver ag reement on inter pretation of pu l mona r y f ind ings at low-dose CT screening.R adiolog y,20 08,2 4 6(1):265-272.doi:10.1148/radiol.2461062097
12 Singh S,Pinsky P,Fineberg NS,et al.Evaluation of reader variability in the interpretation of follow-up CT scans at lung cancer screening.Radiology,2011,259(1):263-270.doi:10.1148/radiol.10101254
2 Tanner NT,Aggarwal J,Gould MK,et al.Management of pulmonary nodules by community pulmonologists:a multicenter observational study.Chest,2015,148(6):1405-1414.doi:10.1378/chest.15-0630
3 Horeweg N,Van Rosmalen J,Heuvelmans M A,et al.Lung cancer probabi l it y i n pat ients w it h CT-detected pu l mona r y nodu les:a prespecified analysis of data from the NELSON trial of low-dose CTscreening.Lancet Oncol,2014,15(12):1332-1341.doi:10.1016/S1470-2045(14)70389-4
4 National Comprehensive Cancer Network NCCN Clinical Practice Guidelines in Oncology.Non-small cell lung cancer.Version 7.2015.Website:http://w w w.tri-kobe.org/nccn/guideline/lung/english/non_small.pdf.Accessed August 11,2017.
5 Zullig LL,Carpenter WR,Provenzale DT,et al.The association of race with timeliness of care and survival among Veterans A ffairs health care system patients with late-stage non-small cell lung cancer.Cancer Manag Res,2013,5:157-163.doi:10.2147/CMAR.S46688
6 Powel l A A,Schu ltz EM,Ord in DL,et al.Ti mel iness across t he continuum of care in veterans with lung cancer.J Thorac Oncol,2008,3(9):951-957.doi:10.1097/JTO.0b013e3181839b60
7 Schultz EM,Powell A A,McMillan A,et al.Hospital characteristics associated w ith timel iness of care in veterans w ith lung cancer.A m J Respir Crit Care Med,2009,179(7):595-600.doi:10.1164/rccm.200806-890OC
8 MacMahon H,Naidich DP,Goo JM,et al.Guidelines for management of incidental pulmonary nodules detected on CT images:from the F leischner Societ y 2017.R ad iolog y,2017,28 4(1):161-163.doi:10.1148/radiol.2017161659
9 National Lung Screening Trial Research Team,Aberle DR,Adams A M,et al.Reduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med,2011,365(5):395-409.doi:10.1056/NEJMoa1102873
10 MacMahon H,Austin JH,Gamsu G,et al.Guidelines for management of small pulmonary nodules detected on CT scans:a statement from the Fleischner Society.Radiology,2005,237(2):395-400.doi:10.1148/radiol.2372041887
11 Gierada DS,Pilgram TK,Ford M,et al.Lung cancer:interobserver ag reement on inter pretation of pu l mona r y f ind ings at low-dose CT screening.R adiolog y,20 08,2 4 6(1):265-272.doi:10.1148/radiol.2461062097
12 Singh S,Pinsky P,Fineberg NS,et al.Evaluation of reader variability in the interpretation of follow-up CT scans at lung cancer screening.Radiology,2011,259(1):263-270.doi:10.1148/radiol.10101254
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