부산대학교 도서관

Introduction: Pulmonary nodules (PN) are frequently detected incidentally during coronary computed tomography angiography (CTA).Hypothesis: We evaluated whether the 2017 Fleischner Society Guidelines may result in a decrease of follow-up testing of incidental PN versus prior guidelines in patients undergoing coronary CTA.Methods: We conducted a retrospective study on a registry of emergency department patients who underwent coronary CTA for acute coronary syndrome (ACS) assessment between 2012 and 2017. Per guidelines, patients <35 years or history of cancer were excluded. Patients aged > 60 years, history of smoking, irregular/spiculated PN morphology, or PN size >20mm were classified as high risk for lung cancer. Radiological characteristics of incidental PN were identified (quantity, size, morphology) through review of radiology reports. Recommendations for PN follow-up were classified according to the newly revised comprehensive 2017 Fleischner Society Guidelines, as well as previous relevant guidelines for solid (2005) and subsolid (2013) PN. Coronary artery disease (CAD) severity was recorded. Data was analyzed with Student’s t-test.Results: The registry included 2,066 patients (female 45.1%, 52.9±11.0 years); 578 (28.0%) had incidental PN. 1771 (85.7%) had no or non-obstructive CAD. 438 (21.2%) had guideline-applicable PN findings, of whom 205 (46.8%) were classified high risk for lung cancer. Application of the 2017 guidelines decreased overall follow-up recommendations by 64.5% (p<0.001) from 12.8% (264 of 2,066) to 4.5% (94) and the minimal number of follow-up chest CTs by 55.8% from 430 to 190 (p<0.001). In 1,771 patients without obstructive CAD, follow-up decreased by 63.5% from 241 patients to 88 per 2017 guidelines (p<0.001).Conclusions: Application of the 2017 Fleischner Society guidelines resulted in a significant decrease of follow-up testing for incidental PN in patients undergoing coronary CTA for suspected ACS.