A study of two New York City hospitals found that only 41.3% of patients with incidentally detected lung nodules received recommended follow-up imaging, with racial minorities, uninsured patients, and those with Medicaid experiencing significantly lower surveillance completion rates, highlighting critical healthcare disparities that could delay early lung cancer detection.
- Only 41.3% of patients completed follow-up imaging for incidental lung nodules at two NYC teaching hospitals.
- Black and Other racial groups had persistently lower odds of completing recommended surveillance compared to white patients.
- Uninsured individuals were significantly less likely to complete follow-up (odds ratio: 0.461) compared to insured patients.
- Imaging obtained in emergency departments or during inpatient admission independently reduced follow-up odds by 55-56%.
- 5.7% of patients who completed follow-up were diagnosed with lung cancer, underscoring the importance of adherence to surveillance protocols.
Less than half of patients with CT-detected incidental lung nodules received recommended follow-up imaging at two large New York City hospitals, according to a recent study.
A group from Mount Sinai Morningside and Mount Sinai West hospitals analyzed surveillance adherence for incidentally detected lung nodules in a racially and socioeconomically diverse urban population, with findings suggesting that structural factors and patient demographics drive follow-up gaps, according to the authors.
"Addressing these gaps is critical to reducing lung cancer-related morbidity and mortality," noted lead author Hong Yu Wang, MD, of the Icahn School of Medicine at Mount Sinai, and colleagues. The study was published October 28 in BMC Pulmonary Medicine.
Incidental lung nodules (ILNs) are frequently detected during routine imaging, with approximately 1.6 million new cases identified annually in the U.S., the authors explained. Although the majority are benign, up to 6% may represent early-stage lung cancer. Despite established follow-up protocols, adherence remains suboptimal, with over 60% of ILNs not receiving appropriate surveillance, they noted.
To identify factors influencing adherence, including demographic, socioeconomic, and clinical variables, the researchers conducted a retrospective study using natural language processing software to flag radiology reports from two urban teaching hospitals in New York City from January to June 2022. The primary outcome was adherence to follow-up recommendations within guideline-specified timeframes. Of 3,925 flagged reports, 1,266 patients met inclusion criteria, with chest CT accounting for 84.1% of exams.
According to the analysis, the overall follow-up adherence rate was 41.3%. Of those who completed follow-up, 5.7% were diagnosed with lung cancer. In the fully adjusted integrated model, Black and Other patients demonstrated persistently lower odds of completing follow-up (Black: adjusted odds ratio [aOR] 0.774; Other: aOR 0.779).
Compared to patients with any other insurance, uninsured individuals also had significantly lower odds of follow-up (OR: 0.461), as did patients with Medicaid (OR: 0.718. Imaging obtained in the emergency department (aOR 0.451) or during inpatient admission (aOR 0.531) independently lowered follow-up odds, while imaging during standard working hours and documented emphysema were associated with higher odds, the researchers reported.
"Given the potential for early lung cancer detection, targeted interventions – such as structured tracking systems, patient navigation programs, and standardized reporting protocols – are needed to improve follow-up rates and mitigate healthcare disparities," the authors wrote.
The findings of the study provide actionable, real-world evidence to guide the design and targeting of such interventions, the authors concluded.
The full study is available here.
