A thoracic surgery clinic dedicated to indeterminate pulmonary nodules: Too many scans and too little pathology?

Nirmal K. Veeramachaneni, Traves D. Crabtree, Daniel Kreisel, Jennifer B. Zoole, Joanne F. Musick, Nicole G. Taylor, Alexander S. Krupnick, David S. Gierada, G. Alexander Patterson, Bryan F. Meyers

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Objective: Widespread application of computed tomographic scans has increased detection of asymptomatic pulmonary nodules. A dedicated clinic was established to encourage referral and manage large numbers of patients with such nodules. Methods: Patients were evaluated periodically by a nurse practitioner with surgeon oversight, and follow-up imaging was centralized. Patients were rescanned at intervals on the basis of radiologist recommendation. Results: A total of 414 patients, 189 male and 225 female with a median age of 60.2 years (20.7-84.1 years), were evaluated since April 2000. Median follow-up was 1.51 years (0-6.65 years). Thirty-seven percent (153/414) were older than 60 years with at least 10 pack-years of tobacco use, whereas 30% (123/414) had never smoked. A total of 286 patients completed at least 2 years of follow-up computed tomographic evaluation. After 2 years, 24.2% (69/286) were deemed in stable condition and were discharged from further follow-up, whereas 22.4% (64/286) of patients were followed up longer than 2 years owing to the development of new nodules. Forty-five percent (127/286) of patients did not complete their recommended follow-up at our clinic. Overall, 3% (13/414) of our patients have been shown to have a malignant tumor. Only 5 patients underwent curative resection of a primary lung cancer. Conclusion: In a population of patients with indeterminate nodules in routine clinical practice, few patients required intervention and few cancers were detected. Although the benefits of a "nodule" clinic may include patient reassurance and convenience to referring physicians, a significant number of patients did not complete their follow-up in our clinic.

Original languageEnglish
Pages (from-to)30-35
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume137
Issue number1
DOIs
StatePublished - Jan 1 2009

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