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James Finigan
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P1.11 - Screening and Early Detection (ID 177)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
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P1.11-17 - Osteoporosis, Coronary Artery Calcification, and COPD in a Lung Cancer Screening Cohort (ID 2780)
09:45 - 18:00 | Presenting Author(s): James Finigan
- Abstract
Background
The US Preventative Services Task Force recommends annual lung cancer screening with low-dose CT scans in adults aged 55-80 who are current smokers (or have quit within the past 15 years) with a >30 pack-years history. The advent of lung cancer screening programs provides an opportunity to assess the resultant CT scans for signs of smoking-related diseases other than lung-cancer. We aimed assess the prevalence of Chronic Obstructive Pulmonary Disease (COPD), coronary artery calcification, and osteoporosis within a lung cancer screening cohort.
Method
We recruited subjects from the National Jewish Health Lung Cancer Screening (LCS) Program. In addition to the LCS CT-scan, participants completed a DXA scan, spirometry, a sit-to-stand test, and reported their medical history. Participants were classified by GOLD (Global Initiative for Chronic Obstructive Lung Disease) spirometry grade to correlate lung function, and co-morbid disease.
Result
One hundred and thirty-five subjects participated in the study (68 males, 67 females). Mean age was 64.0 (5.8) years, and 32.6% were current smokers. 51% of the cohort had moderate to severe COPD (GOLD 2 or greater). While those who were GOLD 3 or 4 had all been previously diagnosed with COPD, 34% of those classified as GOLD 2 and 85% of GOLD 1 participants had not been previously diagnosed. Undiagnosed coronary artery disease (CAD) was common in the population. Eighty-three percent of those with CAC scores over 1000 did not report a prior diagnosis of CAD.
Osteoporosis, or its precursor osteopenia, is present in a large proportion of the LCS cohort. The prevalence of osteoporotic disease increases with increasing COPD severity. Thirty-seven percent of GOLD 3 participants, and 44% of GOLD 4 participants have a Z-score of less than -2.5 (osteoporosis). Osteopenia (Z-score<-1.0) is more common, seen in 100% of GOLD 4 participants, 68% of GOLD 3 participants, 56% of GOLD 2 participants, 27% of GOLD 1, 65% of normal spirometry (GOLD 0), and 32% of PRISm participants. Increasing spirometric disease was associated with reduced physical function as measured by the sit-to-stand test and the SF-36 physical score.
Conclusion
Patients enrolled in LCS programs often have disease other than lung cancer that may be detected using a low-dose chest CT scan. Clinicians should consider using these CT scans to screen for osteoporosis and coronary artery disease. Given the prevalence of undiagnosed COPD in LCS patients, further research should investigate a potential benefit of screening these patients for COPD using spirometry.
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P2.11 - Screening and Early Detection (ID 178)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Screening and Early Detection
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.11-38 - Creating a Successful Multidisciplinary Conference for Review of Suspicious Lung Nodules (ID 2436)
10:15 - 18:15 | Author(s): James Finigan
- Abstract
Background
National Jewish Health established a weekly Multidisciplinary Conference for review of suspicious lung nodules in December 2016. The conference provides a forum to guide prompt work-up and provide management recommendations to providers. Experience with the conference and lessons learned are described.
Method
A Lung Nodule Registry with a tracking system for the management of incidental lung nodules was implemented in 2011. Nodule follow-up recommendations are based on Fleischner Society guidelines, with an additional category, Track Dx, created within the tracking system for radiologists to flag reports with highly suspicious lung nodules. A local Lung Cancer Screening Registry was created in 2015 based on LungRADS. Radiologists provide a Tracker phrase or a LungRADS classification at the bottom of their reports. The Lung Nodule Registry and the Lung Cancer Screening Registry are data-mined weekly to create a report of patients who have received a Screen 4A, 4B, 4X or Track Dx recommendation in their imaging reports. These entries populate a list of cases for the upcoming Nodule Conference and ordering providers for the patients are invited to attend. Ideally the ordering provider attends the conference to review the patient history and engage in the discussion of recommended next steps. The radiologist prepares cases for review. The conference occurs immediately following Thoracic Tumor Board and is attended by thoracic radiology, pulmonology, thoracic surgery, oncology and interventional pulmonary. After the conference the lung nodule navigator and radiologist send an email summarizing the recommendations to the ordering provider. Cases are entered into a REDCap database for long term follow-up to ascertain outcomes.
Result
From December 2016 – March 2019, 681 suspicious nodule cases were identified and reviewed at Nodule Conference. Of these, 155 were screening CTs classified as 4A, 4B or 4X. 371 were Track Dx cases. 133 additional cases were reviewed at the request of the ordering providers.
Successful components and lessons learned from the conference are:
Timely review of cases on a weekly basis is important to promote prompt work-up and evaluation.
It is beneficial to schedule the Nodule Conference immediately after the regular Thoracic Tumor Board since the key people are already gathered.
While LungRADS 3 cases are considered “positive,” there is usually little debate about the recommendation for a 6 month follow-up CT. We initially included the LungRADS 3 cases in our Nodule Conference but soon discovered this was unnecessary and subsequently included only the LungRADS 4 cases.
The radiologist covering the conference adds an addendum to the original radiology report outlining the recommendations from Nodule Conference so this is documented in the EHR.
The radiologists add the LungRADS 4 and Track Dx notations to the radiology reports for PET-CT and outside exam interpretations so these can be data-mined and tracked.
Conclusion
The conference has been well received by the ordering providers. The conference has resulted in a cultural change in our clinical staff with increased provider awareness of the need for timely nodule management and multiple requests for assistance with nodule cases.
