Method:
This was a retrospective review of all patients who had a PET-CT discussed at the lung cancer MDT meeting in Heartlands Hospital between 1st January 2017 and 31st December 2017.
Incidental findings on PET-CT were identified from reviewing scan reports on the electronic patient records.
Using the records,
the following were analysed:
•Extra-thoracic Incidental findings
•Documentation of these in the MDT outcomes vs PET-CT report
•Actions taken by MDT following identification of extra-thoracic findings
•Outcomes of incidental finding investigation for each patient
Results:
A total of 245 PET-CT scans discussed in lung cancer MDT between 1st Jan to 31st Dec 2017.
In our cohort,
most common site of extra-thoracic uptake was GI tract accounting for 28 patients (30.7%) followed by head and neck uptake in 26 patients (28.6%).
Isolated organ uptake was mostly noticed in parotid glands (n=8) followed by thyroid (n=6).
Out of 245 patients we found 90 cases (37%) where PET-CT scans had incidental findings not linked to the main thoracic area of concern.
Appropriate follow up was requested in 41 of these 90 patients (46%).
49 patients (54%) had no documentation of follow up being arranged.
The 41 patients where recommendation were made to follow up including further investigations,
24 (27%) of them were subsequently reviewed and discharged,
active treatment required in 7 of them (8%),
5 (5.5%) patients were monitored and the last 5 (5.5%) were lost to follow up due to various reasons.
Potential causes for missed follow up cases:
A significant number of cases where incidental findings were not further investigated or followed up,
we noticed on PET-CT conclusion or MDT outcome documentation there was a lack of either of the following:
- Clear documentation of incidental finding site and significance
- What the recommended actions are
- Clear Ownership of who will act on recommendations.
Measures taken:
The 49 patients for whom we found no follow up have been arranged for,
a seperate mini-MDT,
consisting of participant from both radiology and clinical teams,
was organised to look into the cases divinding into three categories,
a) no further action required,
b) would potentially require further action and c) serious incidence