Carr Laurie L, Dyer Debra S, Zelarney Pearlanne T, Kern Elizabeth O
Division of Oncology, Department of Medicine, National Jewish Health, Denver, Colorado.
Department of Radiology, National Jewish Health, Denver, Colorado.
JTO Clin Res Rep. 2022 Feb 16;3(3):100297. doi: 10.1016/j.jtocrr.2022.100297. eCollection 2022 Mar.
Given that an incidental pulmonary nodule (IPN) on chest computed tomography (CT) may represent nascent lung cancer, timely follow-up imaging is critical to assess nodule growth and the need for tissue sampling. We previously reported our institution's systematic process to identify and track patients with an IPN associated with improved CT on follow-up. We hypothesized that this improvement may have led to a higher frequency of early-stage lung cancer. To evaluate this, we performed a study to determine whether cases of early-stage lung cancer were more likely to have had our tracking system applied to suspicious findings.
An observational study was performed by identifying cases of lung cancer that were detected as IPNs on chest CT scans performed at our institution, from 2006 to 2016. A total of 314 cases were dichotomized into early-stage (stage 1) or late-stage (stages II to IV) disease. A multivariant regression analysis with modeling was used to determine factors associated with a diagnosis of early-stage disease. Factors included the use of the tracking system and nodule registry.
The following factors were independently associated with early-stage lung cancer: index nodule diameter, (OR = 0.971, confidence interval [CI]: 0.948-0.995], = 0.016), adenocarcinoma histology (OR = 2.930 [CI: 1.695-5.064], = 0.0001) and use of tracker phrases on CT reports (OR = 1.939 [CI: 1.126-3.339], = 0.016).
The application of a patient tracking system and computerized lung nodule registry lead to an increased frequency in the diagnosis of stage 1 NSCLC from IPNs. This is a meaningful outcome for patients and should be adapted for IPN management.
鉴于胸部计算机断层扫描（CT）上的偶然肺结节（IPN）可能代表早期肺癌，及时的随访成像对于评估结节生长情况以及是否需要进行组织采样至关重要。我们之前报告了我们机构识别和跟踪IPN患者的系统流程，这些患者在随访时CT表现有所改善。我们推测这种改善可能导致早期肺癌的检出率更高。为了评估这一点，我们进行了一项研究，以确定早期肺癌病例是否更有可能将我们的跟踪系统应用于可疑发现。
通过识别2006年至2016年在我们机构进行的胸部CT扫描中被检测为IPN的肺癌病例进行了一项观察性研究。总共314例病例被分为早期（1期）或晚期（II至IV期）疾病。采用多变量回归分析和建模来确定与早期疾病诊断相关的因素。因素包括跟踪系统和结节登记册的使用情况。
以下因素与早期肺癌独立相关：索引结节直径（OR = 0.971，置信区间[CI]：0.948 - 0.995，P = 0.016）、腺癌组织学（OR = 2.930 [CI：1.695 - 5.064]，P = 0.0001）以及CT报告中使用跟踪短语（OR = 1.939 [CI：1.126 - 3.339]，P = 0.016）。
患者跟踪系统和计算机化肺结节登记册的应用导致IPN诊断出1期非小细胞肺癌的频率增加。这对患者来说是一个有意义的结果，应适用于IPN的管理。
