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Correspondence |

National Trends in Benign Pulmonary ResectionsBenign Pulmonary Resections and Imaging: Association With CT and PET Imaging FREE TO VIEW

Lin Hsu, MD; Jacqueline M. Achkar, MD; Steven M. Keller, MD, FCCP; Jason J. Bailey, MD; Hillel W. Cohen, DrPH, MPH; Linda B. Haramati, MD, FCCP
Author and Funding Information

From the Department of Radiology (Drs Hsu, Bailey, and Haramati), the Department of Medicine (Drs Achkar and Haramati), the Division of Infectious Diseases (Dr Achkar), the Department of Cardiovascular and Thoracic Surgery (Dr Keller), and the Department of Epidemiology and Population Health (Dr Cohen), Albert Einstein College of Medicine, Montefiore Medical Center.

CORRESPONDENCE TO: Linda B. Haramati, MD, FCCP, Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 St, Bronx, NY 10467; e-mail: lharamati@gmail.com


Drs Hsu and Bailey are currently at the University of Michigan Department of Radiology (Ann Arbor, MI).

Preliminary analysis was presented at the Radiological Society of North America Annual Meeting, November 27, 2012, Chicago, IL.

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST the following conflicts of interest: Dr Haramati’s spouse is a board member of Kryon Systems, LTD; Bioprotect, LTD; and OrthoSpace, LTD. Drs Hsu, Achkar, Keller, Bailey, and Cohen have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

FUNDING/SUPPORT: Supported in part by the Clinical and Translational Science Award [Grant 1 UL1 TR001073-01, 1 TL1 TR001072-01, 1 KL2 TR001071-01] from the National Center for Advancing Translational Sciences, a component of the National Institutes of Health; the National Institute of Allergy and Infectious Diseases [Grants AI096213 and AI096213 to Dr Achkar]; and the Center for AIDS Research (CFAR) at the Albert Einstein College of Medicine [AI-51519 to Dr Achkar].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(2):e61-e62. doi:10.1378/chest.14-2423
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To the Editor:

Benign pulmonary resections confer unnecessary risk and cost without concomitant benefit.1 At our institution, in the Bronx, New York, we noted an increase in the proportion of benign granuloma resections after we acquired a PET scanner.2 However, our institution has a large HIV clinic and an ethnically diverse patient population, with many immigrants from countries where TB is endemic. We set out to determine the relationship between imaging and benign pulmonary resections on a national level.

We retrospectively identified patients who underwent pulmonary resections between 1993 and 2008 using the Nationwide Inpatient Sample (> 588 million hospitalizations). Those patients who were discharged with diagnoses that could present as a PET scan-avid pulmonary nodule were included in this analysis. Annual CT and PET scan use was derived from IMV (a data source that compiles imaging data). We examined the number of benign pulmonary resections and the proportion of benign resections (benign/total) for the 15-year period from 1993 to 2008, adjusting for annual national adult population estimates.

Pulmonary resections overall increased from 43,000 in 1993 to 51,000 in 2008, and benign pulmonary resections increased from 8,000 to 13,000. The proportion of benign resections increased from 18% in 1993 to 24% in 2001 and remained stable at about 25% from 2002 to 2008 (Fig 1). A linear increase in CT scan use was observed (r = 0.99, P < .001) during the study period (1993-2008) from about 16 million to almost 62 million CT scans (Fig 2A). Starting in 2001, when data became available, there was a similar linear increase (r = 0.92, P < .001) in PET scan use from 0.24 million to almost 1.3 million scans (Fig 2B).

Figure Jump LinkFigure 1 –  Population-adjusted proportion (%) of benign lung resections by year, 1993-2008.Grahic Jump Location
Figure Jump LinkFigure 2 –  A, Population-adjusted number of CT scans (millions) by year, 1993-2008. B, Population-adjusted number of PET scans (millions) by year, 2001-2008.Grahic Jump Location

Pulmonary resections with a benign diagnosis increased in the United States from 18% of total pulmonary resections in 1993 to 25% in 2008, coinciding with a dramatic increase in CT scan use. The bulk of the increase occurred before 2001, when PET scanning came into broad clinical use3 and subsequently stabilized at one-fourth of all resections from 2002 to 2008. Results of PET scanning may have prevented an ongoing increase in the proportion of benign pulmonary resections or perhaps the stabilization reflects the population prevalence of benign disease.

The US Preventive Services Task Force recommendation4 supporting CT scan screening for lung cancer, if adopted into clinical practice, will result in the identification of many lung nodules. Further investigation is urgently needed to define whether additional imaging or biomarker diagnostics5 could help reduce the undesirably high proportion of benign pulmonary resections.

Acknowledgments

Role of sponsors: The sponsors had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.

Gould MK, Fletcher J, Iannettoni MD, et al. Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3_suppl):108S-130S. [CrossRef] [PubMed]
 
May BJ, Levsky JM, Godelman A, et al. Should CT play a greater role in preventing the resection of granulomas in the era of PET? AJR Am J Roentgenol. 2011;196(4):795-800. [CrossRef] [PubMed]
 
National Coverage Determination (NCD) for PET scans (50-36). Centers for Medicare & Medicaid Services website. https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=211. Published May 2002. Accessed March 5, 2012.
 
Lung cancer: screening. US Preventive Services Task Force website. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lung-cancer-screening. Accessed November 17, 2014.
 
Li XJ, Hayward C, Fong PY, et al. A blood-based proteomic classifier for the molecular characterization of pulmonary nodules. Sci Transl Med. 2013;5(207):207ra142. [CrossRef] [PubMed]
 

Figures

Figure Jump LinkFigure 1 –  Population-adjusted proportion (%) of benign lung resections by year, 1993-2008.Grahic Jump Location
Figure Jump LinkFigure 2 –  A, Population-adjusted number of CT scans (millions) by year, 1993-2008. B, Population-adjusted number of PET scans (millions) by year, 2001-2008.Grahic Jump Location

Tables

References

Gould MK, Fletcher J, Iannettoni MD, et al. Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3_suppl):108S-130S. [CrossRef] [PubMed]
 
May BJ, Levsky JM, Godelman A, et al. Should CT play a greater role in preventing the resection of granulomas in the era of PET? AJR Am J Roentgenol. 2011;196(4):795-800. [CrossRef] [PubMed]
 
National Coverage Determination (NCD) for PET scans (50-36). Centers for Medicare & Medicaid Services website. https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=211. Published May 2002. Accessed March 5, 2012.
 
Lung cancer: screening. US Preventive Services Task Force website. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lung-cancer-screening. Accessed November 17, 2014.
 
Li XJ, Hayward C, Fong PY, et al. A blood-based proteomic classifier for the molecular characterization of pulmonary nodules. Sci Transl Med. 2013;5(207):207ra142. [CrossRef] [PubMed]
 
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