Incidental Pulmonary Nodules Are Common on CT Coronary Angiogram and Have a Significant Cost Impact

Robertson, James Louis; Nicholls, S.; Bardin, Philip G.; Ptasznik, Ronnie; Steinfort, Daniel P.; Miller, Alistair

doi:10.1016/j.hlc.2017.11.004

Cited by 19 publications

(14 citation statements)

References 33 publications

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“…16 The expansion of CTCA, as demonstrated by this study, generates a large number of incidental findings both cardiac and extra-cardiac in nature. 17 The most common incidental findings in our study were hepatic cysts and pulmonary nodules, both requiring downstream scans, and, for the lung nodules, referrals to chest medicine clinics. With the increased use of CTCA, services will need to be able to offer robust pathways for onward referral of incidental findings.…”

Section: Discussionmentioning

confidence: 65%

Computed tomography coronary angiography: Diagnostic yield and downstream testing

et al. 2020

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Background The UK National Institute for Health and Care Excellence (NICE) updated its guidelines on stable chest pain in 2016 and recommended computed tomography coronary angiography (CTCA) as fi rst line investigation for all patients with new onset symptoms. We implemented the guideline and audited downstream testing. Methods We undertook a retrospective search of the local radiology database from January 2017 to May 2018. Results Six-hundred and fifty-two patients underwent CTCA (mean age of 55 years, 330 were male). Thirty-four patients were found to have severe coronary artery disease (CAD), with 30 undergoing invasive coronary angiography (ICA) which confirmed severe CAD in 22, a yield of 73%. Fifty-eight patients were found to have moderate CAD on CTCA with 36 referred for ICA, of which, 33 attended and 18 were found to have severe CAD. Eighteen were referred for imaging stress tests and one was positive. The total yield of severe CAD at ICA was 55%. The majority of patients had normal coronary arteries. Conclusions CTCA was an effective rule-out test for most patients. In patients that went on to have ICA, the overall yield of severe CAD was relatively high. This compares well with our previous audit applying the NICE 2010 guidelines which recommended ICA for all high probability patients wherein the yield of severe CAD was 30%.

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Section: Discussionmentioning

confidence: 65%

Computed tomography coronary angiography: Diagnostic yield and downstream testing

et al. 2020

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“…Our study population of people undergoing CTCA is Patients unwilling to take part in survey: 5 considerably different to a cross-sectional study of the Busselton Shire of Western Australia and the age limit of that study was only 68 years. 19 Ninety-three (40.6%) people undergoing CTCA in our study were smokers or ex-smokers. 4,5,9,16,17 La Grutta et al found that 6886 incidental non-cardiac findings were detected in 4303 patients and only 865 (20.1%) of their patients did not have any incidental findings.…”

Section: Discussionmentioning

confidence: 78%

“…Limited FOV may be more appropriate as fewer pulmonary nodules are identified and there is a cost benefit compared to full FOV. 19 Ninety-three (40.6%) people undergoing CTCA in our study were smokers or ex-smokers. Onuma et al 5 noted that 52% of their CTCA patients were current (65/503) or exsmokers (197/503).…”

Section: Brief Communicationsmentioning

confidence: 78%

“…15 We observed the USPSTF criteria identified fewer eligible high-risk participants than PLCO m2012 criteria (6.1% vs 10.0%, P = 0.03). 19 From our cohort of people undergoing CTCA, only 23 (10%) participants were eligible for lung cancer screening with LDCT using the PLCO m2012 risk calculator. Our study population of people undergoing CTCA is Patients unwilling to take part in survey: 5 considerably different to a cross-sectional study of the Busselton Shire of Western Australia and the age limit of that study was only 68 years.…”

Section: Discussionmentioning

confidence: 99%

“…17 A recent paper has given information on the Australian population where full-FOV identified nodules in 358 patients of 2530 undergoing CTCA where, if limited FOV were utilised, only 23 (6%) nodules would be identified. 19 From our cohort of people undergoing CTCA, only 23 (10%) participants were eligible for lung cancer screening with LDCT using the PLCO m2012 risk calculator. Even though smoking is a shared risk factor for CAD and lung cancer, the population often referred for CTCA demonstrate a low prevalence of CAD.…”

Section: Brief Communicationsmentioning

confidence: 99%

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Low rates of eligibility for lung cancer screening in patients undergoing computed tomography coronary angiography

Lyne

Zaw

King

et al. 2018

Internal Medicine Journal

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Incidental findings, including pulmonary nodules, on computed tomography coronary angiography (CTCA) are common. Previous authors have suggested CTCA could allow opportunistic screening for lung cancer, though the lung cancer risk profile of this patient group has not previously been established. Smoking histories of 229 patients undergoing CTCA at two tertiary hospitals were reviewed and only 25% were current or former smokers aged 55–80 years old. Less than half of this group were eligible for screening based on the PLCOm2012 risk model. We conclude that routine screening in the form of full thoracic field imaging, of individuals undergoing CTCA is not appropriate as it would likely result in net harm.

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Benign and malignant pulmonary parenchymal findings on chest CT among adult survivors of childhood and young adult cancer with a history of chest radiotherapy

et al. 2023

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Incidental Pulmonary Nodules Are Common on CT Coronary Angiogram and Have a Significant Cost Impact

Cited by 19 publications

References 33 publications

Computed tomography coronary angiography: Diagnostic yield and downstream testing

Computed tomography coronary angiography: Diagnostic yield and downstream testing

Low rates of eligibility for lung cancer screening in patients undergoing computed tomography coronary angiography

Benign and malignant pulmonary parenchymal findings on chest CT among adult survivors of childhood and young adult cancer with a history of chest radiotherapy

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