Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic CHEST Expert Panel Report
Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic CHEST Expert Panel Report
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DOI：
10.1016/j.chest.2020.04.020
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发表时间：
2020-07-01
期刊：
影响因子：
9.6
通讯作者：
Silvestri, Gerard A.
中科院分区：
文献类型：
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作者：
Mazzone, Peter J.;Gould, Michael K.;Silvestri, Gerard A.
背景：潜在暴露于 2019 年冠状病毒病 (COVID-19) 的风险，以及为抗击这一流行病而进行的资源重新分配，改变了利弊之间的平衡，从而改变了当前（COVID-19 之前）肺癌筛查和肺结节评估指南建议。制定共识声明是为了指导临床医生在 COVID-19 大流行期间管理肺癌筛查项目和肺结节患者。方法：成立了一个由 24 名成员组成的专家小组，其中包括肺科医师 (n = 17)、胸部放射科医生 (n = 5) 和胸外科医生 (n = 2)。专家组概述了当前的证据，并根据最近的肺癌筛查和肺结节评估相关指南进行了总结。该小组通过视频电话会议召开，讨论并就与 12 种常见临床情况相关的声明进行投票。 70% 的小组成员投票同意或强烈同意的预定阈值用于确定每项声明是否达成共识。可能影响决策的项目被列为每种情况下需要考虑的注释。 结果：制定并修改了与基线和年度肺癌筛查 (n = 2)、先前检测到的肺结节的监测 (n = 5)、中危和高风险肺结节的评估 (n = 4) 以及临床 I 期非小细胞肺癌 (n = 1) 的管理相关的 12 条陈述。根据投票结果，12条声明均被确认为共识声明。共识声明就在肺结节和 I 期非小细胞肺癌评估过程中推迟筛查、推迟肺结节监测成像以及尽量减少非紧急干预的情况提供了指导。结论：一致认为，在 COVID-19 大流行期间，由于潜在暴露增加的风险和资源重新分配的需要，推迟肺癌筛查的入组并修改肺结节的评估是适当的。将这些陈述应用于个体患者护理时，应考虑多种当地、区域和患者相关因素。
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.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.CONCLUSIONS: 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.