AI Article Synopsis
- Pulmonary nodules (PNs) often found during coronary CT angiography raise questions about the effectiveness of follow-up care for these incidental findings.
- A study involving 3,665 patients revealed that 16% had PNs needing follow-up, predominantly affecting older, male patients with smoking histories, while most deaths were from coronary artery disease rather than lung cancer.
- Following up on these PNs slightly reduced lung cancer mortality but resulted in increased testing and high costs per quality-adjusted life-year, particularly in nonsmokers, indicating a lack of efficiency in current follow-up practices.
Article Abstract
Background: Pulmonary nodules (PNs) are often detected incidentally during coronary computed tomographic (CT) angiography, which is increasingly being used to evaluate patients with chest pain symptoms. However, the efficiency of following up on incidentally detected PN is unknown.
Methods And Results: We determined demographic and clinical characteristics of stable symptomatic patients referred for coronary CT angiography in whom incidentally detected PNs warranted follow-up. A validated lung cancer simulation model was populated with data from these patients, and clinical and economic consequences of follow-up per Fleischner guidelines versus no follow-up were simulated. Of the 3665 patients referred for coronary CT angiography, 591 (16%) had PNs requiring follow-up. The mean age of patients with PNs was 59±10 years; 66% were male; 67% had ever smoked; and 21% had obstructive coronary artery disease. The projected overall lung cancer incidence was 5.8% in these patients, but the majority died of coronary artery disease (38%) and other causes (57%). Follow-up of PNs was associated with a 4.6% relative reduction in cumulative lung cancer mortality (absolute mortality: follow-up, 4.33% versus non-follow-up, 4.54%), more downstream testing (follow-up, 2.34 CTs per patient versus non-follow-up, 1.01 CTs per patient), and an average increase in quality-adjusted life of 7 days. Costs per quality-adjusted life-year gained were $154 700 to follow up the entire cohort and $129 800 per quality-adjusted life-year when only smokers were included.
Conclusions: Follow-up of PNs incidentally detected in patients undergoing coronary CT angiography for chest pain evaluation is associated with a small reduction in lung cancer mortality. However, significant downstream testing contributes to limited efficiency, as demonstrated by a high cost per quality-adjusted life-year, especially in nonsmokers.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4139449 | PMC |
| http://dx.doi.org/10.1161/CIRCULATIONAHA.113.007306 | DOI Listing |
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