References

1. Adherence to follow-up CT scans in patients with small pulmonary nodules, a retrospective studySofie Lock Johansson, Niels-Chr. G. HansenDepartment of Respiratory Medicine, Odense University Hospital Abstract Results Adherence to follow-up CT scans in patients with small pulmonary nodules, a retrospective study. The Danish National guidelines have since 2008 suggested serial follow-up CT scans at 3, 6, 12, and 24 months for nodules between 5 and 10 mm and at 12 and 24 months for nodules less than 5 mm in accordance with Ellis et al 1,2. As a part of our quality assurance efforts, we wanted to investigate how this follow-up proceeded - before and after the publication of the National guidelines. At our diagnostic unit we recorded 2961 cases referred for a suspected thoracic malignancy in the four year period 2006-2009. In 72 cases, 19 in 2006-2007 and 51 in 2008-2009, one or more small nodules, with diameter ≤ 10 mm, were detected on CT in patients with no known recent malignant disease. For these patients follow-up was suggested, either with CT or PET-CT. One of the 70 patients from 2008 was referred to another hospital and we have insufficient data on the follow-up. Another patient – also from 2008 -never came to the suggested first follow-up. Fifty eight patients have completed the first follow-up, while 10 are waiting for the first scheduled control CT. In twelve of the 19 patients (63 %) registered in 2006-2007 the follow-up ended after the first 3 month CT, compared to 17 of the 49 patients (33 %) in 2008-2009 (p = 0.064, Fisher’s exact test). In 28 (55 %) of all the cases registered in 2008-2009 the follow-up program was completed or on-going as planned as of February 2010. The probability for a patient to be recommended follow-up, doubled from 19/1156 (1.6%) in 2006-2007 to 53/1645 (3.2%) in 2008-2009 (p = 0.01). (Tabel 1) At the end of August 2008, 35 of the 53 subjects from 2008-2009 had an ended follow-up program. Three (16 %) of the 19 subjects in 2006-2007, and 7 (20 %), of the 35 subjects in 2008-2009, had complete regression or 2 years stability of the nodules. (p= 1.00) 16 (84%) patients in 2006-2007 and 28 (80 %) in 2008-2009 had an observation time less than 2 years (p= 1.00). (Tabel 2) By July 2010 three subjects had been diagnosed with lung cancer. Neither of these patients was diagnosed while followed with control CTs. One patient ended follow-up after 2 years stability of the nodule, one patient had complete regression at first control scan and one patient was terminated from follow-up after 2 control scans because of stability of the nodule. Table 1 :Number of patients recommended follow-up CT due to pulmonary nodules ≤10mm p=0.01 Fishers exact test Conclusions There was a significant increase in the number of patients who were recommended follow-up CT scans due to small pulmonary nodules from 2006-2007 to 2008-2009. Adherence to follow-up CT scans has not changed after implementationof guidelines in 2008. To prevent non-adherence, we will now, in our department, implement a prospective program, for monitoring the adherence to the follow-up CT scans. Table 2: Outcome of follow-up Aim In 2008 Danish Lung Cancer Group published a reference program containing guidelines in management of small pulmonary nodules1. In accordance to Ellis et al2, serial follow-up CT scans at 3, 6, 12, and 24 months for nodules between 5 and 10 mm, and at 12 and 24 months for nodules less than 5 mm, were suggested. As a part of our quality assurance efforts, we wanted to investigate how the follow-up proceeded at our diagnostic unit, before and after the publication of the National guidelines. Numbers in parenthesis represent percentage Figure 1: Outcome (percentage) References • Danish Lung Cancer Group, Referenceprogram 2008 • Ellis, S. M., J. E. Husband, et al. (2001). "Computed tomography screening for lung cancer: back to basics." Clin Radiol 56(9): 691-9. References Methods Retrospective review of medical records with identification and review of all patients, who were suggested control CT because of one or more small pulmonary nodules, at our diagnostic unit in the four-year period 2006-2009. Inclusion criteria: One or more pulmonary nodules with a diameter ≤ 10. All comparisons of frequencies were made by Fisher’s exact test, 2-sided.