COVID-19 大流行期间肺结节和肺癌筛查的管理：CHEST 专家小组报告。
Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report.
机构信息
Respiratory Institute (Dr Mazzone) and Department of Medicine (Dr Choi), Cleveland Clinic, Cleveland, OH; Department of Research and Evaluation (Dr Gould), Kaiser Permanente Research, Pasadena, CA; Division of Pulmonary and Critical Care Medicine (Dr Arenberg) and Department of Radiology (Dr Kazerooni), University of Michigan, Ann Arbor, MI; Division of Pulmonary and Critical Care Medicine (Dr Chen), Washington University School of Medicine, St. Louis, MO; Section of Thoracic Surgery (Dr Detterbeck), Department of Surgery, Yale University, New Haven, CT; Department of Surgery (Dr Farjah), University of Washington, Seattle, WA; Department of Thoracic Medicine (Dr Fong), The Prince Charles Hospital, Chermside, Australia; The Pulmonary Center (Dr Iaccarino), Boston University Medical Campus, Boston, MA; Lungs for Living Research Centre (Dr Janes), University College London, London, England; Department of Radiology (Dr Kanne), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Radiology (Dr MacMahon), University of Chicago, Chicago, IL; Department of Radiology (Dr Naidich), New York University-Langone Medical Center, New York, NY; Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Powell), Icahn School of Medicine at Mt. Sinai, New York, NY; Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Raoof), Lenox Hill Hospital, New York, NY; Division of Pulmonary and Critical Care Medicine (Dr Rivera), Department of Medicine, University of North Carolina, Chapel Hill, NC; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine (Dr Tanner), Medical University of South Carolina, Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC; Department of Internal Medicine (Dr Tanoue), Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT; Division of Respiratory Medicine (Dr Tremblay), Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Pulmonary, Allergy, and Critical Care Division (Dr Vachani), University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Radiology (Dr White), School of Medicine, University of Maryland, Baltimore, MD; The Pulmonary Center (Dr Wiener), Boston University School of Medicine, Boston, MA; Center for Healthcare Organization & Implementation Research (Dr Wiener), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; and the Division of Pulmonary and Critical Care Medicine (Dr Silvestri), Medical University of South Carolina, Charleston, SC.
出版信息
Radiol Imaging Cancer. 2020 Apr 23;2(3):e204013. doi: 10.1148/rycan.2020204013. eCollection 2020 May.
BACKGROUND
The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic.
MATERIALS AND METHODS
An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario.
RESULTS
Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer.
CONCLUSION
There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.© 2020 RSNA; The American College of Chest Physicians, published by Elsevier Inc; and The American College of Radiology, published by Elsevier Inc.
背景
新型冠状病毒病 2019（COVID-19）潜在暴露风险以及为抗击这一大流行病而进行的资源重新配置，改变了当前（COVID-19 之前）肺癌筛查和肺结节评估指南建议的利弊平衡。本共识声明旨在指导临床医生在 COVID-19 大流行期间管理肺癌筛查项目和肺结节患者。
材料与方法
成立了一个由 24 名成员组成的专家小组，包括肺科医生（n = 17）、胸部放射科医生（n = 5）和胸外科医生（n = 2）。向该小组提供了与肺癌筛查和肺结节评估相关的最新指南中总结的当前证据概述。通过视频电话会议召集小组讨论，并对与 12 个常见临床情况相关的声明进行投票。使用小组 70%的成员投票表示同意或强烈同意作为确定每个声明是否达成共识的阈值。列出可能影响决策的项目作为每个场景的注意事项。
结果
制定并修改了与基线和年度肺癌筛查（n = 2）、先前发现的肺结节监测（n = 5）、中高危肺结节评估（n = 4）和临床 I 期非小细胞肺癌管理（n = 1）相关的 12 个声明。根据投票结果，所有 12 个声明均被确认为共识声明。这些共识声明提供了有关在 COVID-19 大流行期间延迟筛查、推迟肺结节监测成像以及在评估肺结节和 I 期非小细胞肺癌时尽量减少非紧急干预的指导。
结论
专家小组认为，在 COVID-19 大流行期间，由于潜在暴露的风险增加和资源重新配置的需要，延迟肺癌筛查并修改肺结节评估是合适的。在将这些声明应用于个别患者护理时，应考虑多个局部、区域和患者相关因素。
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