P1.03-050 Outcomes after the Decision to Biopsy: Results from a Nurse Practitioner Run Multidisciplinary Lung Cancer Screening Program Topic: Screening

Publication Title

Journal of Thoracic Oncology

Document Type

Conference Proceeding

Publication Date

1-2017

Keywords

washington; swedish; swedish thoracic surgery

Abstract

Background

Lung cancer screening programs are increasing in popularity after results from the National Lung Screening Trial demonstrated improvement in mortality after screening with low dose computed tomography. Current guidelines recommend the availability of multidisciplinary care and evaluation; however, reported outcomes from multidisciplinary team decision making to proceed with diagnostic sampling in lung cancer screening remains sparse.

Methods

A retrospective review of patients enrolled in the Swedish Cancer Institute Lung Cancer Screening Program from January 2013 to March 2016 was performed. The program is run by an independently practicing nurse practitioner, with a multidisciplinary team consisting of radiologists, interventional pulmonologists, and thoracic surgeons. Positive screening results (nodules >6mm) with the potential need to pursue diagnostic sampling were reviewed in a multidisciplinary fashion. Basic demographics and procedural outcomes after the decision to biopsy were obtained.

Results

A total of 516 patients were enrolled within the lung cancer screening program from 2013 – 2016. Nodule(s) >6mm were identified in 164 (31.8%) patients. Subsequently, 25 (4.8%) patients underwent some form of invasive testing. The mean age of this population was 66.2 (SD-6.7) years with 56% (14/25) being female and mean pack years of 50.8 (SD-19.5). Percutaneous needle aspiration (n=11), endoscopic sampling (n=10), and surgical biopsy/resection (n=4) were performed as the first invasive diagnostic procedure. The outcomes of this initial sampling were cancer (n=15), non-diagnostic (n=7), benign (n=2), and infection (n=1). Three patients without an initial diagnosis underwent additional non-surgical biopsy attempts. Overall, surgical resection was performed in twelve patients (6 after previous diagnostic procedure, 2 after previous non-diagnostic procedure, and 4 as initial procedure). Final outcomes were cancer (n=16), non-diagnostic procedure (n=4), non-caseating granulomatous inflammation (n=2), benign diagnosis after wedge resection (n=2), and infection (n=1).

Conclusion

Within a nurse practitioner led, multidisciplinary, lung cancer screening program, a small proportion of patients undergo invasive diagnostic testing, despite a rather high prevalence of potentially actionable nodules. Within the NLST population receiving computed tomography, 6.1% underwent invasive testing with 43% undergoing testing that ultimately did not result in a cancer diagnosis. Within our multidisciplinary program, 4.8% underwent invasive testing with 36% undergoing testing not ultimately resulting in a cancer diagnosis. The utilization of multidisciplinary teams during the biopsy decision-making process may help decrease the number of non-diagnostic procedures. Further research is needed to help identify tools that improve patient selection for invasive testing in lung cancer screening programs.

Keywords

lung cancer screening, Multidisciplinary team, Diagnostic sampling, lung cancer

Clinical Institute

Cancer

Specialty

Pulmonary Medicine

Specialty

Oncology

Specialty

Nursing

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