A MULTIDISCIPLINARY APPROACH TO LUNG NODULE EVALUATION: A ONE-YEAR EXPERIENCE

SESSION TITLE: Education, Research, and Quality Improvement 2 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2018 01:00 pm - 02:00 pm PURPOSE: The authors conducted a one-year review of the referrals to the multidisciplinary nodule board at the William S Middleton VA Hospital in Madison, Wisconsin intending to evaluate sources of referrals and outcomes from board recommendations.Recommendations included diagnostic procedures and schedules for follow-up imaging. This quality improvement project aimed to identify process areas for improvement and assess outcomes from diagnostic procedures. METHODS: The authors conducted a one-year review of the referrals to the multidisciplinary nodule board at the William S Middleton VA Hospital in Madison, Wisconsin intending to evaluate sources of referrals and outcomes from board recommendations.Recommendations included diagnostic procedures and schedules for follow-up imaging. This quality improvement project aimed to identify process areas for improvement and assess outcomes from diagnostic procedures. RESULTS: The mean nodule size was 17mm at the time of evaluation, with a range from 2mm to 10.9cm. 39% of cases had multiple nodules. 95% of patients were male. Follow up imaging was recommended for 49 cases (43%), with 81% occurring within 3-6 months. Diagnostic procedures were recommended in 34 cases (36%). A diagnosis of malignancy was found in 21 cases (65%) as a result of these procedures. From March 2016 through October 2017, 9 patients (9.7%) had died, with 4 patients (4.3%) dying from complications of lung cancer. CONCLUSIONS: Multidisciplinary lung nodule boards coordinate the efforts of multiple medical specialties to provide timely and accurate diagnosis of pulmonary nodules concerning for malignancy. 56% of patients reviewed were referred for follow up imaging and 36% were referred for a diagnostic procedure. By providing a multidisciplinary consensus recommendation, it is possible patients were spared invasive diagnostic procedures in favor of follow up imaging. Multidisciplinary evaluation also provided opportunity for coordination amongst services to offer diagnostic procedure most likely to offer conclusive diagnostic information. CLINICAL IMPLICATIONS: Multidisciplinary lung nodule board evaluations coordinate the efforts of several services involved in the diagnosis and treatment of lung cancer. Prompt and accurate diagnostic information is important for early diagnosis of lung cancer. In the era of frequent diagnostic imaging and incidental discovery of lung nodules, multidisciplinary evaluation also offers opportunity for multiple providers to evaluate nodules for malignancy potential and offer evidence-based recommendations for further evaluation that may spare patients invasive procedures. DISCLOSURES: No relevant relationships by william bzdawka, source=Web Response No relevant relationships by Joshua Smith, source=Web Response