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Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report
Peter J Mazzone1, Michael K Gould1, Douglas A Arenberg1
1Respiratory Institute (Dr Mazzone) and Department of Medicine (Dr Choi), Cleveland Clinic, Cleveland, OH; Department of Research and Evaluation (Dr Gould), Kaiser Permanente Research, Pasadena, CA; Division of Pulmonary and Critical Care Medicine (Dr Arenberg) and Department of Radiology (Dr Kazerooni), University of Michigan, Ann Arbor, MI; Division of Pulmonary and Critical Care Medicine (Dr Chen), Washington University School of Medicine, St. Louis, MO; Section of Thoracic Surgery (Dr Detterbeck), Department of Surgery, Yale University, New Haven, CT; Department of Surgery (Dr Farjah), University of Washington, Seattle, WA; Department of Thoracic Medicine (Dr Fong), The Prince Charles Hospital, Chermside, Australia; The Pulmonary Center (Dr Iaccarino), Boston University Medical Campus, Boston, MA; Lungs for Living Research Centre (Dr Janes), University College London, London, England; Department of Radiology (Dr Kanne), University of Wisconsin School of Medicine and Public Health, Madison, WI; Department of Radiology (Dr MacMahon), University of Chicago, Chicago, IL; Department of Radiology (Dr Naidich), New York University-Langone Medical Center, New York, NY; Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Powell), Icahn School of Medicine at Mt. Sinai, New York, NY; Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Raoof), Lenox Hill Hospital, New York, NY; Division of Pulmonary and Critical Care Medicine (Dr Rivera), Department of Medicine, University of North Carolina, Chapel Hill, NC; Division of Pulmonary, Critical Care, Allergy and Sleep Medicine (Dr Tanner), Medical University of South Carolina, Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC; Department of Internal Medicine (Dr Tanoue), Section of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT; Division of Respiratory Medicine (Dr Tremblay), Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Pulmonary, Allergy, and Critical Care Division (Dr Vachani), University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Radiology (Dr White), School of Medicine, University of Maryland, Baltimore, MD; The Pulmonary Center (Dr Wiener), Boston University School of Medicine, Boston, MA; Center for Healthcare Organization & Implementation Research (Dr Wiener), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; and the Division of Pulmonary and Critical Care Medicine (Dr Silvestri), Medical University of South Carolina, Charleston, SC.
Background:
The risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic.
Materials And Methods:
An expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario.
Results:
Twelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non-small cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer.
Conclusion:
There was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.© 2020 RSNA; The American College of Chest Physicians, published by Elsevier Inc; and The American College of Radiology, published by Elsevier Inc.
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