Robertson James, Nicholls Sandra, Bardin Philip, Ptasznik Ronnie, Steinfort Daniel, Miller Alistair
Monash Lung and Sleep, Monash Health, Melbourne, Vic, Australia.
Monash Imaging, Monash Health, Melbourne, Vic, Australia.
Heart Lung Circ. 2019 Feb;28(2):295-301. doi: 10.1016/j.hlc.2017.11.004. Epub 2017 Dec 5.
Computed tomography (CT) coronary angiogram (CTCA) is commonly used for diagnostic evaluation of low-moderate risk patients due to its excellent performance and cost-effectiveness. However, previous cost analyses have not factored in the burden of management of pulmonary nodules, which are a common occurrence. We sought to describe the frequency and characteristics of lung nodules on CTCA in an Australian tertiary hospital, and to assess cost impacts.
Consecutive CTCAs performed in the calendar year 2012 were retrospectively identified from the imaging department database. Subjects were excluded if they were under the age of 35, had known malignancy or findings identified prior to CTCA. Patients were stratified on smoking history and nodule size.
Of the 2479 CTCAs included, full-field imaging revealed nodules in 358 patients (13.9%). The nodules were generally small (73% <6mm), multiple (63%) and in the lower lobe (83.4%). There was no significant difference when stratified for smoking, with 60% of nodules detected in never-smokers. A minimum of 445 subsequent scans was required for nodule surveillance, resulting in an additional overall cost of $63.62 per CTCA. Limited-Field-of-View (L-FOV) would have identified only 22 nodules, with a cost of $6.14 for every CTCA performed, a cost saving of $57 per patient.
Indeterminate pulmonary nodules are a common incidental finding on CTCA and prevalence appears to be independent of smoking status. There is a consequent significant cost burden that has not previously been recognised. Use of L-FOV reduces the number of nodules identified, with a significant cost benefit, but this has to be balanced against the ethical and medico-legal issues inherent in not reconstructing the irradiated lung.
计算机断层扫描（CT）冠状动脉造影（CTCA）因其出色的性能和成本效益，常用于低 - 中度风险患者的诊断评估。然而，以往的成本分析未考虑到肺结节管理的负担，而肺结节很常见。我们旨在描述澳大利亚一家三级医院CTCA上肺结节的频率和特征，并评估成本影响。
从影像科数据库中回顾性识别出2012年历年进行的连续CTCA。如果受试者年龄在35岁以下、已知患有恶性肿瘤或在CTCA之前已发现病变，则将其排除。患者根据吸烟史和结节大小进行分层。
在纳入的2479例CTCA中，全视野成像显示358例患者（13.9%）有结节。结节一般较小（73%<6mm）、多发（63%）且位于下叶（83.4%）。按吸烟情况分层时无显著差异，从不吸烟者中检测到60%的结节。结节监测至少需要445次后续扫描，导致每次CTCA的额外总成本为63.62美元。有限视野（L - FOV）仅能识别22个结节，每次进行CTCA的成本为6.14美元，每位患者节省成本57美元。
不确定的肺结节是CTCA上常见的偶然发现，患病率似乎与吸烟状态无关。随之而来的是此前未被认识到的重大成本负担。使用L - FOV可减少识别出的结节数量，具有显著的成本效益，但这必须与未重建受照射肺部所固有的伦理和医疗法律问题相权衡。
