Panel: CT lung screening can be delayed during COVID-19

2018 12 20 00 39 5654 Lung 3 D 400

CT screening for lung cancer can be postponed during the current COVID-19 crisis as a means of conserving scarce healthcare resources and preventing the spread of infection, according to a new statement from an international group. The group also provided guidance on other screening-related issues.

The guidelines cover how to handle CT lung cancer screening and management of patients with lung nodules during the COVID-19 crisis. The guideline was published simultaneously April 24 in CHEST, the Journal of the American College of Radiology, and Radiology: Imaging Cancer.

The guideline should help clinicians better manage patient care in these unprecedented times, wrote a group led by Dr. Peter Mazzone of the Respiratory Institute at the Cleveland Clinic.

"The purpose of this consensus statement is to provide expert opinion to clinicians regarding the performance of lung cancer screening and the management of patients with pulmonary nodules ... in a manner that is consistent with current [U.S. Centers for Disease Prevention and Control] COVID-19 guidance," the group wrote.

The 24-member panel included 17 pulmonologists, five thoracic radiologists, and two thoracic surgeons. It developed 12 statements related to the following:

  • Baseline and annual lung cancer screening
  • Surveillance of a previously identified lung nodule
  • Evaluation of intermediate- and high-risk lung nodules
  • Management of clinical stage I non-small cell lung cancer

Consensus was determined by 70% or higher agreement among panel members.

Overall, the team concluded that during the COVID-19 crisis 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," but local, regional, and patient factors should be taken into consideration.

The group applied this conclusion to the following 12 scenarios:

Panel consensus for lung screening/nodule tracking in time of COVID-19 crisis
Scenario Percentage of panel members who "agree" or "strongly agree"
Delay start of screening 100%
Delay annual screening 100%
Consider delay in treatment of stage I non-small-cell lung carcinoma 100%
Delay surveillance of ground glass nodule 100%
Delay surveillance of solid nodule < 8 mm 96%
Delay surveillance of Lung-RADS category 3 nodule 96%
Delay surveillance of part-solid 6 mm to 8 mm nodule 96%
Delay surveillance of solid nodule ≥ 8 mm, pCA < 10% 88%
Avoid further diagnostic testing of solid nodule ≥ 8 mm, pCA > 85% 87%
Monitor part-solid nodule ≥ 8 mm in 3 to 6 months 83%
Evaluate solid nodule ≥ 8 mm, pCA 65% to 85% 79%
Monitor solid nodule ≥ 8 mm, pCA 10% to 25%, in 3 to 6 months 75%
pCA = probability of malignancy

The consensus statement is consistent with CDC guidance, but the COVID-19 situation remains unpredictable, and best medical practice must continue to be evaluated, according to the panel.

"The situation is fluid, and it is not possible at this time to determine when it will be advisable to return to usual care practices," the group concluded. "That said, we suspect that the statements will remain valid in most countries for at least the next three to six months."

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