Standardized reporting and management of suspicious findings on chest computed tomography is associated with improved lung cancer diagnosis in an observational study

Lung Cancer

Urbania TH, et al. Chest 2020.


BACKGROUND: Follow-up of chest computed tomography (CT) findings suspicious for lung cancer may be delayed because of inadequate documentation. Standardized reporting and follow-up may reduce time to diagnosis and care for lung cancer.

STUDY DESIGN AND METHODS: We implemented a reporting system that standardizes tagging of chest CT reports by classifying pulmonary findings. The system also automates referral of patients with findings suspicious for lung cancer to a multidisciplinary care team for rapid review and follow-up. The system was designed to reduce the time to diagnosis, particularly for early-stage lung cancer. We evaluated the effectiveness of this system using a quasi-experimental stepped wedge cluster design, examining 99,148 patients who underwent diagnostic (non-screening) chest CT from 2015 to 2017 who had not had a chest CT in the preceding 24 months. We evaluated the association of the intervention with incidence of diagnosis and surgical treatment of early-stage (I, II) and late-stage (III, IV) lung cancer within 120 days after chest CT.

RESULTS: 40% of patients received the intervention. Among 2,856 (2.9%) patients who were diagnosed with lung cancer, 28% had early-stage disease. In multivariable analyses, the intervention was associated with a 24% greater odds of early-stage diagnosis (OR = 1.24, 95% CI, 1.09-1.41) and no change in the odds of late-stage diagnosis (OR=1.04, 95% CI, 0.95-1.14). The intervention was not associated with the rate of surgical treatment within 120 days.

INTERPRETATION: In this large quasi-experimental community-based observational study, implementation of a system that combines standardized tagging of chest CT reports with clinical navigation was effective for increasing the diagnosis of early-stage lung cancer.