Initial surgical experience following implementation of lung cancer screening at an urban safety net hospital
Initial surgical experience following implementation of lung cancer screening at an urban safety net hospital
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DOI：
10.1016/j.jtcvs.2017.12.135
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发表时间：
2018-06-01
影响因子：
6
通讯作者：
Litle, Virginia R.
中科院分区：
文献类型：
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作者：
Munoz-Largacha, Juan A.;Steiling, Katrina A.;Litle, Virginia R.
背景：安全网医院主要为低收入、未参保和脆弱人群提供护理，在这些人群中，癌症筛查的延迟是既定的障碍。社会经济障碍可能会对安全网医院肺癌筛查计划的成功构成重大挑战。我们的目标是确定肺部CT筛查报告和数据系统(RONG-RADS 4)分类为4类的患者的筛查依从性、诊断和治疗程序率以及癌症诊断率。方法：我们对2015年3月至2016年7月期间登记参加我们的多学科肺癌筛查计划的所有患者进行了回顾。收集人口统计学数据、吸烟状况、肺RADS评分、诊断和治疗干预次数以及癌症诊断。结果：在16个月的时间里，共筛查了554名患者。患者平均年龄63岁(范围47-85岁)，其中60%为男性。大多数患者(92%；512/554)为肺RADS 1~3级，8%(42/554)为4级。在4级肺RADS患者中，98%(41/42)完成了推荐的随访，29%(12/42)接受了诊断程序，总体诊断干预率为2%(12/554)。这12名患者中有11名患有癌症，1名患者患有结节病。手术切除率为0.9%(5/554)，非肿瘤诊断诊断性干预率为0.1%(1/554)。结论：在安全网医院实施多学科肺癌筛查是可行的。尽管预期的社会挑战，肺部RADS4患者对随访和干预建议的依从性仍然很高。在我们最初的经验中，非癌症诊断的总体诊断性和手术切除率以及干预措施都很低。
Background: Safety net hospitals provide care mostly to low-income, uninsured, and vulnerable populations, in whom delays in cancer screening are established barriers. Socioeconomic barriers might pose important challenges to the success of a lung cancer screening program at a safety net hospital. We aimed to determine screening follow-up compliance, rates of diagnostic and treatment procedures, and the rate of cancer diagnosis in patients classified as category 4 by the Lung CT Screening Reporting and Data System (Lung-RADS 4).Methods: We conducted a retrospective review of all patients enrolled in our multidisciplinary lung cancer screening program between March 2015 and July 2016. Demographics, smoking status, Lung-RADS score, and number of diagnostic and therapeutic interventions and cancer diagnoses were captured.Results: A total of 554 patients were screened over a 16-month period. The mean patient age was 63 years (range, 47-85 years), and 60% were male. The majority (92%; 512 of 554) were classified as Lung-RADS 1 to 3, and 8% (42 of 554) were classified as Lung-RADS 4. Among the Lung-RADS 4 patients, 98% (41 of 42) completed their recommended follow-up; 29% (12 of 42) underwent a diagnostic procedure, for an overall diagnostic intervention rate of 2% (12 of 554). Eleven of these 12 patients had cancer, and 1 patient had sarcoidosis. The overall rate of surgical resection was 0.9% (5 of 554), and the rate of diagnostic intervention for noncancer diagnosis was 0.1% (1 of 554).Conclusions: Implementation of a multidisciplinary lung cancer screening program at a safety net hospital is feasible. Compliance with follow-up and interventional recommendations in Lung-RADS 4 patients was high despite anticipated social challenges. Overall diagnostic and surgical resection rates and interventions for noncancer diagnosis were low in our initial experience.