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Solitary Pulmonary Nodule Follow-up: An Audit of Compliance With International Guidelines in a Tertiary Referral Center FREE TO VIEW

Deirdre Fitzgerald, MBBCh; Oisin O'Connell; Conor Houlihan; Marcus Kennedy; Barry Plant; Desmond Murphy; Michael Henry
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Cork University Hospital, Cork, Ireland

Chest. 2014;146(4_MeetingAbstracts):601A. doi:10.1378/chest.1993318
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SESSION TITLE: Lung Cancer Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: The importance of appropriate investigation of pulmonary nodules has recently been highlighted. We performed an audit of all incidentally-found new pulmonary nodules on CT Thorax between January and June 2010, with the aim of assessing compliance with follow up according to internationally recognised criteria.

METHODS: Follow-up of new pulmonary nodules over a two year period was documented. Medical records were used for recording patient demographics and diagnoses. Statistical analysis was performed using the Chi Squared Test and Pearson’s coefficient.

RESULTS: Of 873 scans, pulmonary nodules were identified in 230 (26.35%). 95 of these were new nodules with malignant potential. 46% were followed up appropriately, 43% had inadequate follow up and 10% had excessive CT follow-up. Pulmonologists were involved in 38 cases. Of these, 65% were followed up appropriately according to Fleischner guidelines vs. 31% of those who were followed up by other services (p<0.0005). Patients are twice as likely to be followed appropriately by pulmonologists as other services (RR 2.01).

CONCLUSIONS: The appropriate follow-up of pulmonary nodules with malignant potential is essential, particularly given new evidence of improved outcomes with lung cancer screening. As guidelines have been altered to include semisolid and ground-glass nodules, follow-up has become more complicated and would be better performed by specialists in pulmonology. Our data is in agreement with this. Awareness of and adherence to Fleischner criteria in this centre is suboptimal and systems need to be implemented to ensure appropriate follow up of pulmonary nodules.

CLINICAL IMPLICATIONS: Based on this data, we would suggest the introduction of an alert system when pulmonary nodules are found incidentally on CT. This, combined with improved education for physicians in other specialties, should result in improved follow-up and prompt referral to a pulmonary physician. We believe this would ultimately lead to earlier detection of pulmonary malignancies and therefore improve survival.

DISCLOSURE: The following authors have nothing to disclose: Deirdre Fitzgerald, Oisin O'Connell, Conor Houlihan, Marcus Kennedy, Barry Plant, Desmond Murphy, Michael Henry

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