Abstract
Objective
Pulmonary nodules found incidentally or by lung cancer screening differ in prevalence,
risk profile, and diagnostic intervention. The results of surgical intervention for
incidental versus screening lung nodules during multidisciplinary Pulmonary Nodule
and Lung Cancer Screening Clinic (PNLCSC) follow-up have not been reported.
Methods
All patients evaluated at a PNLCSC from 2012 to 2018 following referral by primary
care physicians, specialist physicians, or self-referral after computed tomography
(CT) identified nodules on routine diagnostic CT (incidental group) or lung cancer
screening CT (screening group) were included. Follow-up interval, invasive intervention,
histology, postoperative events, survival, and recurrence were compared.
Results
Of 747 patients evaluated in the PNLCSC, 129 (17.2%) underwent surgical intervention.
The surgical cohort consisted of 104 (80.6%) incidental and 25 (19.3%) screening patients
followed over a mean of 122 and 70 days, respectively. More benign lesions were excised
in the incidental group (20.2%, 21/104)—representing 3.3% (21/632) of all incidental
nodules evaluated—than in the screening group (4%, 1/25) (P = .038). Operative mortality was zero. Among 99 patients with primary lung cancer,
87% (screening) and 86.8% (incidental) were pathologic stage Ia. Complete follow-up
was available in 725 of 747 (97%), and no patient developed progressive disease. Disease-free
survival at 5 years was 74.9% (incidental) and 89.3% (screening) (P = .48).
Conclusions
A unique multidisciplinary PNLCSC for incidental and lung cancer screening–detected
nodules with individualized risk assessment reliably identifies primary and metastatic
tumors while exposing few patients to diagnostic excision for benign disease. Longer-term
outcomes, strategies to limit radiation exposure, and cost control need further study.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
CT (computed tomography), lung-RADS (lung imaging reporting and data system), MGH (Massachusetts General Hospital), PET (positron emission tomography), PNLCSC (Pulmonary Nodule and Lung Cancer Screening Clinic), SBRT (stereotactic body radiation therapy)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: September 24, 2019
Accepted:
September 7,
2019
Received in revised form:
August 22,
2019
Received:
January 29,
2019
Footnotes
Drs Madariaga and Lennes contributed equally to this article.
Identification
Copyright
© 2019 by The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- The “multispecialty clinic”: Toward a new paradigm in thoracic oncology?The Journal of Thoracic and Cardiovascular SurgeryVol. 160Issue 3
- PreviewWe read with interest the article “Multidisciplinary Selection of Pulmonary Nodules for Surgical Resection: Diagnostic Results and Long-term Outcomes” by Madariaga and colleagues.1 We want to comment from a somewhat philosophical point of view. We began a similar multispecialty pulmonary nodule clinic in early 2013 and briefly reported our preliminary experience in 2015.2 At the root of this initiative was an intuition that the nature of pulmonary oncology was changing. We were seeing more and more frail patients with multiple health issues.
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