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Nodule net: A centralized prospective lung nodule tracking and safety-net program.

Authors:
Harpreet Singh Megan Koster Chinmay Jani Arashdeep Rupal Alexander Walker Joseph Khoory Arti Tewari Marcel Casasola Lynsie R Ranker Carey Thomson

Respir Med 2022 02 13;192:106737. Epub 2022 Jan 13.

Department of Pulmonary and Critical Care, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA; Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA; Harvard Medical School, Boston, MA, USA.

Background: Inadequate follow-up of suspicious lung nodules can result in diagnostic delays and potential progression to advanced lung cancer. In 2015, a multidisciplinary lung nodule management program, Nodule Net, was implemented to increase the timely follow-up rate. In this study, we sought to evaluate the effectiveness of the program.

Methods: 2398 chest CT reports were reviewed for the presence of a lung nodule. Baseline demographics, nodule characteristics, and follow-up recommendations were collected. For reports that did not include structured recommendations, Fleischner Society guidelines were applied if appropriate. The rate of follow-up imaging was recorded and compared with historical rates.

Results: Lung nodules were reported on 1367 (57%) of scans. Of the 632 participants with recommendations for follow-up, the Nodule Net nurse navigator was notified on 523 (83%). Of these, 408 (78%) completed follow-up, compared to 57/109 (52%) in those who were not reported to Nodule Net tracking system (risk ratio: 1.49, 95% CI: 1.24-1.79, p-value < 0.05). Out of these 408, nodule net outreach was required to prompt the follow-up in 116 (28%). Of these, a lung malignancy was diagnosed in 4 (4%).

Conclusions: Management of lung nodules is a complex process. Implementation of a lung nodule tracking program led to a significant increase in the completion of recommended follow-up imaging compared with usual care. Developing a comprehensive lung nodule program using an automated software system rather than manual processes to refer and track incidental findings may further reduce barriers to completion of follow-up.

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http://dx.doi.org/10.1016/j.rmed.2022.106737DOI Listing
February 2022

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