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J Cardiovasc Comput Tomogr. 2018 Jan - Feb;12(1):28-33. doi: 10.1016/j.jcct.2017.11.005. Epub 2017 Nov 14.

Incidental pulmonary nodules in emergent coronary CT angiography for suspected acute coronary syndrome: Impact of revised 2017 Fleischner Society Guidelines.

Author information

1
Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114-2750, USA; Department for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann-Wolfgang-Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany. Electronic address: janerikscholtz@gmail.com.
2
Cardiac MR PET CT Program, Department of Radiology (Cardiovascular Imaging) and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA 02114-2750, USA.
3
Department for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann-Wolfgang-Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
4
Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114-2750, USA.

Abstract

BACKGROUND:

Pulmonary nodules (PN) are frequently detected incidentally during coronary computed tomography angiography (CTA). We evaluated whether the 2017 Fleischner Society guidelines may result in a decrease of follow-up testing of incidental PN as compared to prior guidelines in patients undergoing coronary CTA.

METHODS:

We conducted a retrospective study of a registry of emergency department patients who underwent coronary CTA for acute coronary syndrome assessment between 2012 and 2017. Based on guidelines, patients <35 years, history of cancer, or prior exams showing stability of PN were excluded. Patients >60 years, history of smoking, irregular/spiculated PN morphology, or PN size >20 mm were classified as high-risk for lung cancer. Radiological findings pertaining to PN were identified (PN size, morphology, quantity) through review of radiology reports. PN follow-up recommendations were established using 2017 Fleischner Society Guidelines and compared with prior guidelines for solid (2005) and subsolid (2013) PN. Data were analyzed with Student's t-test.

RESULTS:

The registry included 2066 patients (female 45.1%, 52.9 ± 11.0 years), of which 578 (28.0%) reported PN. 438 of those (21.2%) were eligible for guideline-based follow-up evaluation. 205 (4 6.8%) were classified as high-risk for lung cancer. 2017 guidelines reduced the number of individuals requiring follow-up by 64.5%, from 264 (12.8%) to 94 patients (4.5%) when compared to prior guidelines (p < 0.001). The minimum number of follow-up chest CTs decreased by 55.8% from 430 to 190 (p < 0.001).

CONCLUSION:

Application of the 2017 Fleischner Society Guidelines resulted in a significant decrease of follow-up testing for incidental PN in patients undergoing coronary CTA for suspected acute coronary syndrome.

KEYWORDS:

Acute coronary syndrome; Coronary computed tomography angiography; Fleischner Society Guidelines; Follow-up CT; Incidental findings; Lung nodule; Management of incidental lung nodules; Pulmonary nodule

PMID:
29195841
PMCID:
PMC5903561
DOI:
10.1016/j.jcct.2017.11.005
[Indexed for MEDLINE]
Free PMC Article

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