Journal Article

P164 Outcome of lung nodule surveillance: a brief retrospective review of a cohort of patients followed-up according to BTS guidelines

Majury, M, Perez Augusto, A, Ling, Y, Datta, S, McClure, L, Grieve, D

2021

Overview

IntroductionLung cancer continues to be the leading cause of cancer death in the UK and the 2nd most common cancer diagnosed each year. In 2015, the British Thoracic Society (BTS) published the updated guidelines on lung nodule follow-up with the aim of improving early identification of lung malignancies and improving survival. Here we aim to determine the rate of early cancer detection in patients referred to the lung nodule MDT and explore their outcomes.MethodsPatients were identified from the minutes of lung nodule MDTs celebrated during 2018 and information gathered via RIS, PACS and clinical record systems of the hospital.Results92 patients were identified using the method described above. The median age of participants was 67.5 (42–88) and there were slightly more females than males (51 to 41; 55.4 to 44.6%). The rate of compliance with guidelines was very high at 98.9%. We identified 6 lung primary malignancies of which all but 1 (83.3%) were in early stages (stage I or II), compared to 27% in lung cancers detected in the population (figure 1). Of the patients with early-stage lung cancer, 3 were judged not fit for active treatment. The other 2 underwent lobectomies and have had more than 2 disease-free years as of the time of this writing.Abstract P164 Figure 1Comparison between the stages at diagnosis in patients in surveillance programme(grey) vs those in the general population (black)ConclusionThis data shows that implementation of the BTS guidelines in lung nodule follow-up leads to higher rates of early-stage lung cancer detection and improved prognosis for these patients. However, we also note that a relatively high proportion of these detected lung cancers are found in patients with poor functional status making them ineligible for active treatment. We propose that it may be beneficial for future editions of this BTS guidelines to explore including clear entry and retainment criteria for patients which, no matter the outcome, will be unable to withstand active treatment. These could include looking at, for example, elements such as minimum functional or pulmonary status. This would avoid some patients undergoing a 2 to 4-year-long surveillance programme which will ultimately not affect their management options.

• Publisher: BMJ Publishing Group Ltd and British Thoracic Society,BMJ Publishing Group LTD
• Subject: Lung cancer / Medical prognosis / Surveillance / Topics in thoracic malignancies