Clinical research studyIncidental Pulmonary Nodules on Cardiac Computed Tomography: Prognosis and Use
Section snippets
Materials and Methods
The study sample comprised the control subjects in the 60- to 69-year age range participating in ADVANCE, a case-control study of genetic and nongenetic determinants of coronary artery disease. Recruitment of these subjects has been described.7, 8, 9 Briefly, from a large pool of health plan members meeting inclusion criteria (n = 84,590), 1390 subjects were randomly selected and found to be eligible after a phone interview; 1063 subjects were interested in participating, and 1023 subjects (639
Results
Of the 459 subjects whose cardiac CT scan was read for incidental findings, 144 (31%) were found to have 1 or more lung incidental findings; of those, 81 (18%) had pulmonary nodules that met our study criteria for reporting to participants and their primary care physicians (Figure 1). Compared with those whose cardiac CT scan was not read, participants whose cardiac CT scan was read for incidental findings were, on average, 1 year younger, twice as likely to be female, more likely to be white
Discussion
Reporting noncalcified pulmonary nodules in our study sample resulted in substantial rescanning that appears to have almost uniformly revealed resolution or stability of pulmonary nodules, arguing for benign granulomatous or nongranulomatous infectious disease processes and against malignancy.
Responding to a need in the medical community for guidance in this area, the Fleischner Society recently published recommendations for the management of small pulmonary nodules detected on CT scans.5 As
Conclusions
Our findings support more conservative approaches for following incidental, asymptomatic pulmonary nodules, such as the one put forth by the Fleischner Society.
References (13)
- et al.
Frequency and severity of “incidentalomas” encountered during electron beam computed tomography for coronary calcium in middle-aged army personnel
Am J Cardiol
(2002) - et al.
Ethnic differences in coronary artery calcium in a healthy cohort aged 60 to 69 years
Am J Cardiol
(2007) - et al.
The solitary pulmonary nodule
Chest
(2003) - et al.
Small solid noncalcified pulmonary nodules detected by screening chest computed tomography
Respir Med
(2007) - et al.
Prevalence of significant noncardiac findings on electron-beam computed tomography coronary artery calcium screening examinations
Circulation
(2002) - et al.
Prevalence and clinical significance of accidental findings in electron-beam tomographic scans for coronary artery calcification
Eur Heart J
(2001)
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Higher agreement between readers with deep learning CAD software for reporting pulmonary nodules on CT
2022, European Journal of Radiology OpenCitation Excerpt :Some of this increased workload can be attributed to pulmonary nodules, a prevalent CT finding. One or more pulmonary nodules have been reported as an incidental finding in 14–31 % of patients undergoing chest CT imaging for any clinical indication [5–7] and in 51 % of lung cancer screening trial participants, pulmonary nodules were found at baseline [8]. Considering that more than 95 % of these findings are benign, it is crucial that pulmonary nodules are managed safely and cost-effectively to prevent unnecessary patient burden and healthcare utilization but still allow for the early detection of lung cancer or lung metastases.
Incidental Lung Nodules on Cross-sectional Imaging: Current Reporting and Management
2021, Radiologic Clinics of North AmericaStatistical modeling can determine what factors are predictive of appropriate follow-up in patients presenting with incidental pulmonary nodules on CT
2020, European Journal of RadiologyCitation Excerpt :Incidental pulmonary nodules (IPN) are a common finding, with reported frequencies ranging from 5.6% to 51% [1–7], and with the probability of malignancy ranging from 0.1 % to greater than 50 % depending on the nodule characteristics and patient risk factors [1,3,8].
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2019, Journal of the American College of CardiologyCitation Excerpt :The potential for observing incidental findings of uncertain clinical significance (e.g., incidentally observed lung nodules, requiring further testing) also exists; studies suggest that incidental findings may be observed in ≥10% of asymptomatic individuals undergoing cardiac CT imaging. These findings are overwhelmingly, but not exclusively, benign in nature but often require follow up imaging to assess their potential health impact (67,68). The costs and anxiety potentially caused by these findings can be mitigated by limiting the window of imaging/reading to just the cardiac region, or by focused follow-up.
Managing Patients With Screen-Detected Nodules: The Nodule Clinic
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This study was supported by a grant from the Kaiser Permanente Community Benefit Program; the ADVANCE Study was originally funded by the Donald W. Reynolds Foundation (Las Vegas, Nevada).
Conflicts of Interest: None.