ERS5741. Radiology-Driven Pulmonary Nodule Clinic Referrals: Workflow, Cost of Clinical Implementation, and TNM Staging
Authors * Denotes Presenting Author
  1. Murad Aldoghmi *; University of California Irvine
  2. Chang Shu; University of California Irvine
  3. Kayla Nakashima; University of California Irvine
  4. Monica Gerges; University of California Irvine
  5. Erwin Ho; University of California Irvine
  6. Ryan Sabour; University of California Irvine
  7. Roozbeh Houshyar; University of California Irvine
Lung cancer is the leading cause of cancer-related death in adults with an estimated prevalence of 234,000 cases and more than 154,000 deaths annually in the United States. With current clinical and diagnostic advancements, improvements in clinical outcome is directly related to the time of diagnosis and appropriate follow-ups. As of today, estimates of five-year survival rates average 18 percent in all lung cancer patients. Multidisciplinary pulmonary nodule clinics have emerged as promising solutions for optimizing the efficiency of time to diagnosis. In this abstract, we aim to showcase how a lung nodule referral program was implemented at a single institution and its associated costs, and tumor, node and metastasis (TNM) staging. We hypothesize that tumors detected after the program were caught at an earlier stage in the disease course, potentially reducing patient mortality risk with a shorter time interval from diagnosis to treatment.

Materials and Methods:
The program employs mPower, an algorithm designed to scan radiology reports for various items to index and identify follow-up recommendations and compile a list of patients that meet the inclusion criteria. Annually, the referral program gross total cost is $4,541 considering ancillary costs of mPower software and nursing salary. Inclusion criteria include lung nodule(s) = 7mm, corresponding to a Lung CT Screening Reporting & Data System (Lung-RADS) score of 3 or 4, and were referred to the pulmonology clinic for follow-up between October 2020 and April 2023. Subsequently, an interventional pulmonologist employed Fleischner criteria to risk-stratify patients for management. From the lung biopsies conducted, cancer subtypes were determined. Furthermore, the cost-effectiveness was established by comparing implantation of the noninvasive > 7mm tumor size biomarker to United States Preventive Services Task Force (USPSTF) guidelines of a diagnostic biomarker of at least 90% specificity and medium sensitivity that costs $250 or less. The TNM staging of each primary lung cancer was also determined through chart review.

In total, 285 of 2096 referred patients (14%) underwent nodule biopsy. Among those biopsied, 98 of 285 (34%) had metastasis (non-primary), 86 of 285 (30%) had non-small cell carcinoma, 86 of 285 (30%) were benign, 14 of 285 (5%) had infectious nodules, and 1 of 285 (0.4%) had small cell carcinoma. Implementing the diagnostic biomarker of > 7mm criteria for referral indicates a cost-effective screening program per USPSTF. The average primary lung cancer stage was 3A, with 3B being the most frequent. The most often managing department is Hematology-oncology, followed by Pulmonology. Biopsy most frequently done by Interventional Pulmonology and Interventional Radiology, with treatment subsequently managed under Hematology-oncology, Radiation Oncology, or Surgery.

The establishment of a lung nodule referral program can contribute to the development of similar referral programs in other healthcare settings by offering insights into patient selection criteria, referral processes, and cost considerations.