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Chen D, Yang L, Zhang W, Shen J, Van Schil PEY, Divisi D, Seetharamu N, Gu J. Prevalence and management of pulmonary nodules: a systematic review and meta-analysis. J Thorac Dis 2024; 16:4619-4632. [PMID: 39144359 PMCID: PMC11320231 DOI: 10.21037/jtd-24-874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024]
Abstract
Background Pulmonary nodules are small, focal lesions often identified via computed tomography (CT) scans. Although the majority are benign, a small percentage of them may be malignant or potentially become malignant, underscoring the importance of early detection and effective management. This study systematically reviews the epidemiology, risk factors, and management strategies for pulmonary nodules, comparing findings across Chinese and non-Chinese populations to better inform the actuarial calculations for predicting the demand of medical services for patients with pulmonary nodules. Methods We performed a systematic analysis of the PubMed and China Knowledge Infrastructure (CNKI) databases for studies reporting the detection rate of pulmonary nodules through CT scans. Both cross-sectional studies and the baseline data from longitudinal studies were included. A modified version of the Newcastle-Ottawa Scale was used to assess the risk of bias and random effect models were used to estimate the overall prevalence. Results We identified 32 studies and included 24 of them in our meta-analysis. Pooled analysis showed that the overall prevalence of pulmonary nodules was 0.27 (95% confidence interval: 0.25-0.29) after outliers removal. Subgroup analysis showed that there was no significant difference for prevalence between Chinese and non-Chinese populations. Males (0.38) were shown to have slightly higher prevalence compared to females (0.36), but not significant (P=0.88). Age and smoking are the most frequently reported risk factors by studies. Conclusions Overall, 27% of participants were positive for pulmonary nodules. Advancing age and smoking were consistently identified as a key risk factor for the incidence of pulmonary nodules. Although the management strategies are different across studies, recent guidelines recommend personalized management strategies, prioritizing nodule size, characteristics, and individual risk factors to optimize outcomes.
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Affiliation(s)
- Dan Chen
- International Medical Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liyun Yang
- International Medical Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenhong Zhang
- International Medical Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jieyun Shen
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai University, Shanghai, China
| | - Paul E. Y. Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Duilio Divisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, Thoracic Surgery Unit, “Giuseppe Mazzini” Hospital of Teramo, Teramo, Italy
| | - Nagarashee Seetharamu
- Division of Medical Oncology and Hematology, Northwell Health Cancer Institute, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY, USA
| | - Jie Gu
- International Medical Center, Zhongshan Hospital, Fudan University, Shanghai, China
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2
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Park D. Advanced Bronchoscopic Diagnostic Techniques in Lung Cancer. Tuberc Respir Dis (Seoul) 2024; 87:282-291. [PMID: 38414369 PMCID: PMC11222101 DOI: 10.4046/trd.2023.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/28/2023] [Accepted: 02/22/2024] [Indexed: 02/29/2024] Open
Abstract
The increasing incidence of incidental pulmonary nodules necessitates effective biopsy techniques for accurate diagnosis and treatment planning. This paper reviews the widely used advanced bronchoscopic techniques, such as radial endobronchial ultrasound-guided transbronchial lung biopsy, electromagnetic navigation bronchoscopy, and the cutting-edge robotic-assisted bronchoscopy. In addition, the cryobiopsy technique, which can enhance diagnostic yield by combination with conventional biopsy tools, is described for application to peripheral pulmonary lesions and mediastinal lesions, respectively.
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Affiliation(s)
- Dongil Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Republic of Korea
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3
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Glandorf J, Vogel-Claussen J. Incidental pulmonary nodules - current guidelines and management. ROFO-FORTSCHR RONTG 2024; 196:582-590. [PMID: 38065544 DOI: 10.1055/a-2185-8714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND Due to the greater use of high-resolution cross-sectional imaging, the number of incidental pulmonary nodules detected each year is increasing. Although the vast majority of incidental pulmonary nodules are benign, many early lung carcinomas could be diagnosed with consistent follow-up. However, for a variety of reasons, the existing recommendations are often not implemented correctly. Therefore, potential for improvement with respect to competence, communication, structure, and process is described. METHODS This article presents the recommendations for incidental pulmonary nodules from the current S3 guideline for lung cancer (July 2023). The internationally established recommendations (BTS guidelines and Fleischner criteria) are compared and further studies on optimized management were included after a systematic literature search in PubMed. RESULTS AND CONCLUSION In particular, AI-based software solutions are promising, as they can be used in a support capacity on several levels at once and can lead to simpler and more automated management. However, to be applicable in routine clinical practice, software must fit well into the radiology workflow and be integrated. In addition, "Lung Nodule Management" programs or clinics that follow a high-quality procedure for patients with incidental lung nodules or nodules detected by screening have been established in the USA. Similar structures might also be implemented in Germany in a future screening program in which patients with incidental pulmonary nodules could be included. KEY POINTS · Incidental pulmonary nodules are common but are often not adequately managed. · The updated S3 guideline for lung cancer now includes recommendations for incidental pulmonary nodules. · Competence, communication, structure, and process levels offer significant potential for improvement. CITATION FORMAT · Glandorf J, Vogel-Claussen J, . Incidental pulmonary nodules - current guidelines and management. Fortschr Röntgenstr 2024; 196: 582 - 590.
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Affiliation(s)
- Julian Glandorf
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
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Headrick JR, Parker MJ, Miller AD. Artificial Intelligence: Can It Save Lives, Hospitals, and Lung Screening? Ann Thorac Surg 2024:S0003-4975(24)00391-6. [PMID: 38815854 DOI: 10.1016/j.athoracsur.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 04/08/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Early detection is essential in lung cancer survival. Lung screening or incidental detection on unrelated imaging holds the most promise for early detection. With the large volume of imaging performed today, management of incidental pulmonary nodules can be difficult. We hypothesized an artificial intelligence (AI) tool could reliably read all imaging reports, detect, and effectively triage indeterminate pulmonary nodules without adding additional personnel, helping save lives. METHODS An incidental lung nodule clinic (ILNC) was created using AI and an existing nurse practitioner. Over 26 months, the software read all radiology reports, visualizing any lung tissue. Patients with nodules >3 mm and considered indeterminate by the nurse practitioner were referred to the ILNC. High-risk patients with benign nodules were offered entry into the lung screening program. RESULTS Of 502,632 imaging reports analyzed, 22,136 (4.4%) had positive findings. Follow-up data were lacking in 11,797 (2.3%), 911 (7.7%) were verified lost, and 518 (4.4%) were referred to the ILNC. There were 393 patients with benign nodules and accepted enrollment in the lung screening program. Mean age of enrolled patients was 61 years, and 53% were men. Workup included 499 diagnostic computed tomographic scans, 39 positron emission tomographic scans, and 27 biopsy samples that identified 15 malignancies (2.9%), with 14 lung cancers (8 stage I, 4 stage III, and 2 stage IV). Treatment included 5 lobectomies, and 4 underwent stereotactic body radiation therapy. Financials were favorable. CONCLUSIONS AI software can supplement practitioners, help diagnose lung cancer earlier, save lives, and generate value-based revenue for the hospital.
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Affiliation(s)
- James R Headrick
- Department of Thoracic Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee; CHI Memorial Thoracic Surgery, Chattanooga, Tennessee
| | - Mitchell J Parker
- Department of Thoracic Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee; CHI Memorial Thoracic Surgery, Chattanooga, Tennessee
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Fernandez-Bussy S, Garza-Salas A, Barrios-Ruiz A, Balasubramanian P, Yu Lee-Mateus A, Koirala T, Hazelett BN, Chadha R, Patel NM, Reisenauer JS, Abia-Trujillo D. Shape-Sensing Robotic-Assisted Bronchoscopy in the Multiple Pulmonary Nodule Diagnosis during a Single Anesthetic Event. Respiration 2024; 103:397-405. [PMID: 38648757 DOI: 10.1159/000538910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION The widespread use of computed tomography as a screening tool for early lung cancer has increased detection of pulmonary lesions. It is common to encounter patients with more than one peripheral pulmonary nodule (PPN) of uncertain etiology. Shape-sensing robotic-assisted bronchoscopy (ssRAB) emerges as a potential alternative to biopsy multiple PPN, in addition to mediastinal staging in single anesthetic procedure. METHODS This is a single-center, retrospective review of 22 patients who underwent ssRAB for evaluation of two or more PPN, between November 2021 and April 2023 at Mayo Clinic, FL, USA. RESULTS A total of 46 PPNs were biopsied in 22 patients. All lesions were ≤2 cm with a median minimum and maximum cross-sectional lesion size of 1.40 cm and 1.05 cm, respectively. Diagnostic yield was 86.9% (n = 40), and target reach was 91.3% (n = 42). Most lesions were in the upper lobes, a solid pattern was found in 78.3% (n = 36), bronchus sign was present in 82.6% of cases (n = 38), 54.4% (n = 25) were malignant nodules, and 32.6% (n = 15) were benign. Fourteen patients had at least one malignant lesion out of two or more nodules sampled, and 10 patients had a malignant diagnosis for all sampled lesions. The complication rate was 9% (n = 2) with one case of bleeding and one of pneumothorax. CONCLUSION This study is, to our knowledge, the first to assess the use and safety of ssRAB for diagnosis of multiple PPN in a single anesthetic event. This procedure will mainly impact management decisions and subsequently shorten the time from diagnosis to treatment.
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Affiliation(s)
| | - Ana Garza-Salas
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Alanna Barrios-Ruiz
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Tapendra Koirala
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Britney N Hazelett
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan Chadha
- Division of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Neal M Patel
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Janani S Reisenauer
- Department of Surgery, Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - David Abia-Trujillo
- Division of Pulmonary, Allergy, and Sleep Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Gulati S, Ivic-Pavlicic T, Joasil J, Flores R, Taioli E. Outcomes in Incidentally Versus Screening Detected Stage I Lung Cancer Surgery Patients. J Thorac Oncol 2024; 19:581-588. [PMID: 37977487 DOI: 10.1016/j.jtho.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Although the importance of lung cancer screening for early diagnosis is established, because of poor enrollment, incidental findings still play a role in diagnosis of patients who qualify. Nevertheless, analysis of this incidental cohort is lacking. We present a retrospective analysis comparing patients with thoracic surgery with incidental versus screening detected stage I lung cancer. METHODS Thoracic surgery cases at Mount Sinai Hospital from March, 1, 2012, to June, 30, 2022, were queried for patients eligible for lung cancer screening and a stage I diagnosis. The basis of lung nodule detection (incidental versus screening detected) was identified. We compared demographic variables, comorbidities, tumor staging, procedure details, and postoperative outcomes between the cohorts. RESULTS Of the patients eligible for screening with lung cancer resection and stage I diagnosis at Mount Sinai, 153 were identified incidentally and 67 through screening. The patients in the incidental cohort were older (p = 0.005), more likely to have quit smoking (p = 0.04), and had a greater number of comorbidities (p = 0.0002). There was no statistically significant difference between the groups with regard to pack-year smoking history, lung cancer histological type, location or size of tumor, and surgical approach, length of surgery or stay, number of postoperative outcomes, and survival. CONCLUSIONS In stage I lung cancers, no significant differences were identified between incidentally and screening detected lung nodules with regard to tumor characteristics, surgical approach, and postoperative outcomes. Imaging conducted for other reasons should be considered as a valid and important diagnostic tool, similar to traditional low-dose computed tomography, in patients who qualify for screening.
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Affiliation(s)
- Shubham Gulati
- Icahn School of Medicine at Mount Sinai, New York, New York; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Tara Ivic-Pavlicic
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Raja Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emanuela Taioli
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Borg M, Rasmussen TR, Hilberg O. Introduction of the Danish Lung Nodule Registry: A part of the Danish Lung Cancer Registry. Cancer Epidemiol 2024; 89:102543. [PMID: 38364359 DOI: 10.1016/j.canep.2024.102543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND The majority of lung cancer cases are diagnosed late, resulting in poor prognosis and high mortality rates. Early detection and management of lung cancer can improve patient outcomes and reduce mortality rates. Pulmonary nodules are key factors in the early detection of lung cancer, they are common in high-risk populations and require correct classification to determine whether they are benign or malignant. Over the last decade a steep increase in the number of thoracic CT scans has been seen in Denmark, resulting in substantial resources allocated to CT follow-up of incidentally detected pulmonary nodules. The implementation of a nationwide Danish prospective pulmonary nodule registry is to methodically record pulmonary nodules and thereby evaluate the scope of pulmonary nodule follow-up, the nature of the nodules, and the clinical progression of patients with pulmonary nodules. METHODS A prospective pulmonary nodule registry (Danish Lung Nodule Registry) will be a natural appendix to the Danish Lung Cancer Registry. Three new ICD-10 classification codes will be introduced, defining the type of nodule: /DR91.1/ Solid nodule /DR91.2/ Part-solid nodule; /DR91.3/ Non-solid nodule. Furthermore, an additional letter will describe whether the imaging exam is performed on suspicion of lung cancer (A), or the finding is incidental (B). Registration of the nodules will be performed by the departments of respiratory medicine who manage follow-up of pulmonary nodules. It is estimated that around 7000 nodules will be registered annually. DISCUSSION The registration of patients in the lung nodule registry complies with current Danish legislation. The registry will be seamlessly integrated with other nationwide Danish registries, including the Danish Lung Cancer Registry, to collect additional patient data and improve the quality and scope of the data acquired. The results from these comprehensive epidemiological studies will be of significant interest and offer valuable research opportunities.
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Affiliation(s)
- Morten Borg
- Department of Internal Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark.
| | - Torben Riis Rasmussen
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Ole Hilberg
- Department of Internal Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark
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8
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Digby GC, Habert J, Sahota J, Zhu L, Manos D. Incidental pulmonary nodule management in Canada: exploring current state through a narrative literature review and expert interviews. J Thorac Dis 2024; 16:1537-1551. [PMID: 38505054 PMCID: PMC10944736 DOI: 10.21037/jtd-23-1453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/21/2023] [Indexed: 03/21/2024]
Abstract
Background and Objective Incidental pulmonary nodules (IPNs) are common and increasingly detected with the overall rise of radiologic imaging. Effective IPN management is necessary to ensure lung cancer is not missed. This study aims to describe the current landscape of IPN management in Canada, understand barriers to optimal IPN management, and identify opportunities for improvement. Methods We performed a narrative literature review by searching biomedical electronic databases for relevant articles published between January 1, 2010, and November 22, 2023. To validate and complement the identified literature, we conducted structured interviews with multidisciplinary experts involved in the pathway of patients with IPNs across Canada. Interviews between December 2021 and May 2022 were audiovisual recorded, transcribed, and thematically analyzed. Key Content and Findings A total of 1,299 records were identified, of which 37 studies were included for analysis. Most studies were conducted in Canada and the United States and highlighted variability in radiology reporting of IPNs and patient management, and limited adherence to recommended follow-up imaging. Twenty experts were interviewed, including radiologists, respirologists, thoracic surgeons, primary care physicians, medical oncologists, and an epidemiologist. Three themes emerged from the interviews, supported by the literature, including: variability in radiology reporting of IPNs, suboptimal communication, and variability in guideline adherence and patient management. Conclusions Despite general awareness of guidelines, there is inconsistency and lack of standardization in the management of patients with IPNs in Canada. Multidisciplinary expert consensus is recommended to help overcome the communication and operational barriers to a safe and cost-effective approach to this common clinical issue.
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Affiliation(s)
- Geneviève C. Digby
- Department of Medicine, Division of Respirology, Queen’s University, Kingston, ON, Canada
| | - Jeffrey Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jyoti Sahota
- Health Economics and Market Access, Amaris Consulting, Toronto, ON, Canada
| | - Lucía Zhu
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
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Borg M, Bodtger U, Kristensen K, Alstrup G, Mamaeva T, Arshad A, Laursen CB, Hilberg O, Andersen MB, Rasmussen TR. Incidental pulmonary nodules may lead to a high proportion of early-stage lung cancer: but it requires more than a high CT volume to achieve this. Eur Clin Respir J 2024; 11:2313311. [PMID: 38379593 PMCID: PMC10878329 DOI: 10.1080/20018525.2024.2313311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
Background The management of pulmonary nodules plays a critical role in early detection of lung cancer. Computed tomography (CT) has led to a stage-shift towards early-stage lung cancer, but regional differences in survival rates have been reported in Denmark. This study aimed to evaluate whether variations in nodule management among Danish health regions contributed to these differences. Material and Methods The Danish Health Data Authority and Danish Lung Cancer Registry provided data on CT usage and lung cancer stage distribution, respectively. Auditing of lung cancer stage IA patient referrals and nodule management of stage IV lung cancer patients was conducted in seven Danish lung cancer investigation centers, covering four of the five Danish health regions. CT scans were performed up to 2 years before the patients' diagnosis from 2019 to 2021. Results CT usage has increased steadily in Denmark over the past decade, with a simultaneous increase in the proportion of early-stage lung cancers, particularly stage IA. However, one Danish health region, Region Zealand, exhibited lower rates of early-stage lung cancer and overall survival despite a CT usage roughly similar to that of the other health regions. The audit did not find significant differences in pulmonary nodule management or a higher number of missed nodules by radiologists in this region compared to others. Conclusion This study suggests that a high CT scan volume alone is not sufficient for the early detection of lung cancer. Factors beyond hospital management practices, such as patient-related delays in socioeconomically disadvantaged areas, may contribute to regional differences in survival rates. This has implications for future strategies for reducing these differences.
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Affiliation(s)
- M. Borg
- Department of Internal Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark
| | - U. Bodtger
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital Næstved & Roskilde, Næstved, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - K. Kristensen
- Department of Internal Medicine, Gødstrup Hospital, Herning, Denmark
| | - G. Alstrup
- Respiratory Research Unit PLUZ, Department of Respiratory Medicine, Zealand University Hospital Næstved & Roskilde, Næstved, Denmark
| | - T. Mamaeva
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - A. Arshad
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - CB. Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - O. Hilberg
- Department of Internal Medicine, Lillebaelt Hospital Vejle, Vejle, Denmark
- Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - M. Brun Andersen
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
- Institute of clinical medicine, Copenhagen University, Copenhagen, Denmark
| | - T Riis Rasmussen
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Vindum HH, Kristensen K, Christensen NL, Madsen HH, Rasmussen TR. Outcome of Incidental Pulmonary Nodules in a Real-World Setting. Clin Lung Cancer 2023; 24:673-681. [PMID: 37839963 DOI: 10.1016/j.cllc.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Early diagnosis of lung cancer is imperative to improve survival. Incidental pulmonary nodules (IPN) may represent early stages of lung cancer and appropriate follow-up and management of these nodules is important, but also very resource demanding. We aim to describe the results of the CT-based follow-up on a cohort of patients with IPN in terms of detected malignancies, the proportion undergoing invasive procedures, and the subsequent outcome. MATERIALS AND METHODS Retrospective cohort study of patients in a CT IPN follow-up program who underwent a needle biopsy of the lung from 2018 to 2021 at Aarhus University Hospital. RESULTS A total of 4181 patients with IPN were followed with CT control scans. Out of these 249 (6%) were diagnosed with lung cancer of which 224 (90%) were diagnosed as a result of the IPN follow-up. Seventy-five percent of the patients were diagnosed in stages I to II and curable treatment was possible in 77.9% of the patients. In the CT IPN follow-up program 449 patients underwent a CT guided needle biopsy. Out of these 190 patients underwent biopsy without the detection of malignancy, corresponding to 4.5% of the entire IPN population. CONCLUSION The cumulated incidence of lung cancer in our population in the IPN follow-up program was 6%. The probability of malignancy when undergoing an invasive procedure on an IPN was 55.7% of which lung cancer was vastly predominant. The majority of lung cancers were diagnosed in an early and potentially curable stage.
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Affiliation(s)
- Helene Hjorth Vindum
- Department of Respiratory Disease and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Katrine Kristensen
- Department of Respiratory Disease and Allergy, Aarhus University Hospital, Aarhus, Denmark.
| | - Niels Lyhne Christensen
- Department of Respiratory Disease and Allergy, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Torben Riis Rasmussen
- Department of Respiratory Disease and Allergy, Aarhus University Hospital, Aarhus, Denmark; Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Fernandes M, Milla C, Gubran A, Barrazueta S, Altonen B, DiVittis A, Kuperberg S. Assessing the impact of socioeconomic status on incidental lung nodules at an urban safety net hospital. BMC Pulm Med 2023; 23:469. [PMID: 37996867 PMCID: PMC10668357 DOI: 10.1186/s12890-023-02726-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Lower socioeconomic status has been identified as an emerging risk factor for health disparities, including lung cancer outcomes. Most research investigating these outcomes includes patients from formal lung cancer screening programs. There is a paucity of studies assessing the relationship between socioeconomic status and incidental lung nodules. This study aimed to investigate the association between socioeconomic status and the size of incidental lung nodules on initial presentation at an urban safety net hospital, which did not have a formal lung cancer screening program or incidental lung nodule program. METHODS A retrospective chart review was conducted on patients with incidental lung nodules on CT chest imaging who were referred from primary care to a pulmonology clinic at a safety net hospital. Patients with incomplete nodule characteristics information were excluded. Data on demographics, comorbidities, smoking history, insurance type, immigration status, and geographical factors were collected. Less commonly studied determinants such as crime index, cost of living, and air quality index were also assessed. Logistic regression analysis was performed to assess relationships between nodule size and socioeconomic determinants. RESULTS Out of 3,490 patients with chest CT scans, 268 patients with ILNs were included in the study. 84.7% of patients represented racial or ethnic minorities, and most patients (67.8%) had federal insurance. Patients with non-commercial insurance were more likely to have larger, inherently higher-risk nodules (> 8 mm) compared to those with commercial insurance (OR 2.18, p 0.01). Patients from areas with higher unemployment rates were also less likely (OR 0.75, p 0.04) to have smaller nodules (< 6 mm). Patients representing racial or ethnic minorities were also more likely to have nodules > 8 mm (OR 1.6, p 0.24), and less likely to have nodules < 6 mm (OR 0.6, p 0.32), however, these relationships were not statistically significant. CONCLUSION This study found that lower socioeconomic status, indicated by having non-commercial insurance, was associated with larger incidental lung nodule size on initial presentation. While it is established that socioeconomic status is associated with disparities in lung cancer screening, these findings suggest that inequalities may also be present in those with incidental lung nodules. Further research is needed to understand the underlying mechanisms and develop interventions to address these disparities in incidental lung nodule evaluation and improve outcomes.
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Affiliation(s)
- Mateus Fernandes
- Pulmonary and Critical Care Medicine, Lenox Hill Hospital, Northwell Health, New York, USA
| | - Cristian Milla
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA
- Division of Nephrology, SUNY Downstate/Health Sciences Center at Brooklyn, NY, Brooklyn, USA
| | - Ahmed Gubran
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA
| | - Sandra Barrazueta
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA
| | - Brian Altonen
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA
- Research and Administration, New York City Health and Hospitals, NY, New York, USA
| | - Anthony DiVittis
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA
| | - Stephen Kuperberg
- Department of Medicine, NYC Health + Hospitals/Woodhull, New York City Health and Hospitals, 760 Broadway, Brooklyn, NY, 11206, USA.
- Pulmonary and Critical Care Medicine, New York University Grossman School of Medicine, NY, New York, USA.
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Hendrix W, Rutten M, Hendrix N, van Ginneken B, Schaefer-Prokop C, Scholten ET, Prokop M, Jacobs C. Trends in the incidence of pulmonary nodules in chest computed tomography: 10-year results from two Dutch hospitals. Eur Radiol 2023; 33:8279-8288. [PMID: 37338552 PMCID: PMC10598118 DOI: 10.1007/s00330-023-09826-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/25/2023] [Accepted: 05/19/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To study trends in the incidence of reported pulmonary nodules and stage I lung cancer in chest CT. METHODS We analyzed the trends in the incidence of detected pulmonary nodules and stage I lung cancer in chest CT scans in the period between 2008 and 2019. Imaging metadata and radiology reports from all chest CT studies were collected from two large Dutch hospitals. A natural language processing algorithm was developed to identify studies with any reported pulmonary nodule. RESULTS Between 2008 and 2019, a total of 74,803 patients underwent 166,688 chest CT examinations at both hospitals combined. During this period, the annual number of chest CT scans increased from 9955 scans in 6845 patients in 2008 to 20,476 scans in 13,286 patients in 2019. The proportion of patients in whom nodules (old or new) were reported increased from 38% (2595/6845) in 2008 to 50% (6654/13,286) in 2019. The proportion of patients in whom significant new nodules (≥ 5 mm) were reported increased from 9% (608/6954) in 2010 to 17% (1660/9883) in 2017. The number of patients with new nodules and corresponding stage I lung cancer diagnosis tripled and their proportion doubled, from 0.4% (26/6954) in 2010 to 0.8% (78/9883) in 2017. CONCLUSION The identification of incidental pulmonary nodules in chest CT has steadily increased over the past decade and has been accompanied by more stage I lung cancer diagnoses. CLINICAL RELEVANCE STATEMENT These findings stress the importance of identifying and efficiently managing incidental pulmonary nodules in routine clinical practice. KEY POINTS • The number of patients who underwent chest CT examinations substantially increased over the past decade, as did the number of patients in whom pulmonary nodules were identified. • The increased use of chest CT and more frequently identified pulmonary nodules were associated with more stage I lung cancer diagnoses.
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Affiliation(s)
- Ward Hendrix
- Radiology Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, the Netherlands.
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
| | - Matthieu Rutten
- Radiology Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, the Netherlands
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Nils Hendrix
- Radiology Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, the Netherlands
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
- Jheronimus Academy of Data Science, Sint Janssingel 92, 5211 DA, 's-Hertogenbosch, the Netherlands
| | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Cornelia Schaefer-Prokop
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
- Radiology Department, Meander Medical Center, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - Ernst T Scholten
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
- Radiology Department, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | - Colin Jacobs
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
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13
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Hendrix W, Hendrix N, Scholten ET, Mourits M, Trap-de Jong J, Schalekamp S, Korst M, van Leuken M, van Ginneken B, Prokop M, Rutten M, Jacobs C. Deep learning for the detection of benign and malignant pulmonary nodules in non-screening chest CT scans. COMMUNICATIONS MEDICINE 2023; 3:156. [PMID: 37891360 PMCID: PMC10611755 DOI: 10.1038/s43856-023-00388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Outside a screening program, early-stage lung cancer is generally diagnosed after the detection of incidental nodules in clinically ordered chest CT scans. Despite the advances in artificial intelligence (AI) systems for lung cancer detection, clinical validation of these systems is lacking in a non-screening setting. METHOD We developed a deep learning-based AI system and assessed its performance for the detection of actionable benign nodules (requiring follow-up), small lung cancers, and pulmonary metastases in CT scans acquired in two Dutch hospitals (internal and external validation). A panel of five thoracic radiologists labeled all nodules, and two additional radiologists verified the nodule malignancy status and searched for any missed cancers using data from the national Netherlands Cancer Registry. The detection performance was evaluated by measuring the sensitivity at predefined false positive rates on a free receiver operating characteristic curve and was compared with the panel of radiologists. RESULTS On the external test set (100 scans from 100 patients), the sensitivity of the AI system for detecting benign nodules, primary lung cancers, and metastases is respectively 94.3% (82/87, 95% CI: 88.1-98.8%), 96.9% (31/32, 95% CI: 91.7-100%), and 92.0% (104/113, 95% CI: 88.5-95.5%) at a clinically acceptable operating point of 1 false positive per scan (FP/s). These sensitivities are comparable to or higher than the radiologists, albeit with a slightly higher FP/s (average difference of 0.6). CONCLUSIONS The AI system reliably detects benign and malignant pulmonary nodules in clinically indicated CT scans and can potentially assist radiologists in this setting.
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Affiliation(s)
- Ward Hendrix
- Diagnostic Imaging Analysis Group, Radiology and Nuclear Medicine Department, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Radiology Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
| | - Nils Hendrix
- Diagnostic Imaging Analysis Group, Radiology and Nuclear Medicine Department, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Radiology Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
- Jheronimus Academy of Data Science, Sint Janssingel 92, 5211 DA, 's-Hertogenbosch, The Netherlands
| | - Ernst T Scholten
- Diagnostic Imaging Analysis Group, Radiology and Nuclear Medicine Department, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Mariëlle Mourits
- Radiology Department, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Joline Trap-de Jong
- Radiology Department, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Steven Schalekamp
- Diagnostic Imaging Analysis Group, Radiology and Nuclear Medicine Department, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Mike Korst
- Radiology Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
| | - Maarten van Leuken
- Radiology Department, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Bram van Ginneken
- Diagnostic Imaging Analysis Group, Radiology and Nuclear Medicine Department, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Mathias Prokop
- Diagnostic Imaging Analysis Group, Radiology and Nuclear Medicine Department, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Radiology Department, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Matthieu Rutten
- Diagnostic Imaging Analysis Group, Radiology and Nuclear Medicine Department, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Radiology Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, The Netherlands
| | - Colin Jacobs
- Diagnostic Imaging Analysis Group, Radiology and Nuclear Medicine Department, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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Gorospe L, Gómez-Bermejo MÁ, Paredes-Rodríguez P, Mirambeaux-Villalona RM, Fra-Fernández S, Muñoz-Molina GM, Benito-Berlinches A. Three synchronous Lung Cancers in the Same Lung Segment: Triple Trouble? Arch Bronconeumol 2023:S0300-2896(23)00022-4. [PMID: 36822881 DOI: 10.1016/j.arbres.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Affiliation(s)
- Luis Gorospe
- Department of Radiology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | | | | | | | - Sara Fra-Fernández
- Department of Thoracic Surgery, Hospital Universitario Ramón y Cajal, Madrid, Spain
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