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Laurie Carr



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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): Laurie Carr

      • 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.