Clinical research study
Incidental Pulmonary Nodules on Cardiac Computed Tomography: Prognosis and Use

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Abstract

Background

Small asymptomatic lung nodules are found frequently in the course of cardiac computed tomography (CT) scanning. However, the utility of assessing and reporting incidental findings in healthy, asymptomatic subjects is unknown.

Methods

The sample comprised 1023 60- to 69-year-old subjects free of clinical cardiovascular disease and cancer who participated in the Atherosclerotic Disease, VAscular functioN and genetiC Epidemiology Study. All subjects underwent cardiac CT for determination of coronary calcium between 2001 and 2004, and the first 459 subjects were assessed for incidental pulmonary findings. We used health plan clinical databases to ascertain 24-month health care use and clinical outcomes.

Results

Noncalcified pulmonary nodules were reported in 81 of 459 subjects (18%). Chest CT was performed on 78% of participants in the 24 months after notification, compared with 2.5% in the previous 24 months. Chest x-ray use increased from 28% to 49%. The mean number of chest CT scans per subject was 1.3 (range, 0-5). Although no malignant lesions were diagnosed in the group who had pulmonary findings read, 1 lung cancer case was diagnosed in the group who did not have lung findings read. Among the 63 participants followed up by CT, the original lesion was not identified in 22 participants (35%), the lesion had decreased or remained stable in 39 participants (62%), and there was interval growth in 2 participants (3%).

Conclusion

Reporting noncalcified pulmonary nodules resulted in substantial rescanning that overwhelmingly revealed resolution or stability of pulmonary nodules, arguing for benign processes.

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)

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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.

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