Outcome of Patients with Incidental Pulmonary Nodules in Veterans Population

Background: Lung cancer is the leading cause of cancer death.Chest computed tomography (CT) has resulted in increased detection of incidental pulmonary nodules requiring close monitoring.Fleischner Society guidelines have been applied in the management of those pulmonary nodules.However, it is unclear whether the guidelines are sufficient in the management of veterans with high lung cancer risks.Objectives: To assess whether shorter interval of monitoring is required in veterans with incidental detection of pulmonary nodules.We hypothesize that shorter interval of monitoring is needed to detect progression of lung nodules in high-risk veterans than recommended by the Fleischner Society. Method:In this retrospective study, all Chest CTs labeled Code 1-Tumor between 2012 and 2014 at single Veterans Affairs Medical Center were reviewed.A team of Pulmonary and Radiology physicians made decisions for a diagnostic procedure and/or follow up using the Fleischner Society guidelines.Clinical data were collected including reasons for imaging, tobacco use, premorbid conditions, type, and number of nodules, change in size, and duration of follow up.Results: All nodules less than 8 mm were benign.At initial detection, the average size of malignant nodules was significantly greater than that of the benign nodules.The rate of lung cancer in veterans with incidental lung nodules was higher (7.7%) than in general population (5.5 %) with average follow up of 5.6 months. Conclusion:The rate of malignancy of incidentally detected pulmonary nodules in veterans is relatively high, and the Fleischner Society guidelines are sufficient to monitoring those nodules.