Lung cancer detected through CT surveillance of incidental lung nodules

Congress:

ESTI 2019

Poster Number:

P-0023

Type:

Scientific Poster

Keywords:

Quality assurance, Cancer, Health policy and practice, Decision analysis, Audit and standards, CT, Thorax, Oncology, Lung

Authors:

H. R. ALOMAISH¹, A. Suhail², C. Crocker², V. Luong², D. Manos³; ¹Toronto, ON/CA, ²Halifax/CA, ³Halifax, NS/CA

DOI:

10.26044/esti2019/P-0023

DOI-Link:

https://dx.doi.org/10.26044/esti2019/P-0023

Fig. 5: Serial axial CT images over 3.5 years in a 73 year old woman. She had a 20...

Fig. 2: Minimally invasive adenocarcinoma in a 52 year old woman with a 20 packyear...

Fig. 3: Clinical Indication for testing that eventually led to the diagnosis of lung...

Table 1: Smoking status, cancer stage and cancer histology for lung cancers diagnosed in...

Purpose

Lung nodules are found in up to 50% of adults and are often an incidental asymptomatic finding (1,2). For many nodules, several well-established guidelines recommend surveillance CT to exclude malignancy (3,4).However, the risk of lung cancer in patients with some nodules is very low (5-10). Radiologists do not always adhere to nodule follow up guidelines (11-13). It is possible that radiologists do not always see the value in surveillance CT or tire from performing nodule follow up studies. Some radiologists do not report all nodules...

Methods & Materials

LOCATION: Nova Scotia, a province in Eastern Canada with a population of 954 000. 17.8% of Nova Scotian residents are current smokers. DATABASE: All primary lung cancer cases diagnosed in Nova Scotia, Canada in 2014 (identified through the provincial cancer registry). Lung cancer is a reportable disease in Nova Scotia and all cases are identified using the SEER (surveillance, epidemiology and end results) based standards of the North American Association of Central Cancer Registries and the Canadian Council of Cancer Registries (16). PATIENT DATA: Age,...

Results

972 lung cancers were diagnosed in Nova Scotia in 2014. Data were available for 967 cancers in 946 patients. 98 cancers (10.1%) were detected through lung nodule CT surveillance (fig. 1). 13 cancers were detected through a lung cancer screening research project. The patients who were diagnosed with lung cancer through surveillance CT were compared to those with lung cancer diagnosed either through imaging requested for evaluation of lung cancer symptoms or as a coincidental finding on imaging requested for another reason (see methods section...

Conclusion

A minority (10%) of lung cancers are diagnosed through CT surveillance programs of low or intermediate risk pulmonary nodules. Nonetheless, nodule follow up CTs are an important pathway to lung cancer diagnosis, predominantly in patients with a smoking history. Cancers detected through nodule surveillance programs are more likely to be adenocarcinomas and more likely to be at early stages of disease. In our health care region, radiologist failure to compare with remote images as well as false negative work up, including false negative biopsy or...

References

1. van Klaveren RJ, Oudkerk M, Prokop M et al. Management of lung nodules detected by volume CT scanning. N Engl J Med. 2009; 361:2221-2229. 2. Fischbach F, Knollmann F, Griesshaber V, et al. Detection of pulmonary nodules by multislice computed tomography: improved detection rate with reduced slice thickness. Eur Radiol. 2003;13:2378-83. 3. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner society. Radiology. 2017;284:228-243. 4. Gould MK, Donington J, Lynch WR,...

Personal Information

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