Effectiveness of a protocolized system to alert pulmonologists of lung cancer radiological suspicion

Abstract

Purpose: When lung cancer (LC) is suspected in chest radiography, an adequate interpretation and management by experts would improve the selection, the access to rapid diagnostic units, the diagnostic effectiveness and prevent the loss of patients with suspected LC. To ensure this, we planned a system for alerting pulmonologists by radiologists to radiological suspicion of LC.

Methods: This system consists of an alert from radiologists to pulmonologists through a specific email. The pulmonologists alerted has to contact the study doctor petitioner who must refer the patient for study to the Lung Cancer Rapid Diagnostic Unit (LCRDU). We have prospectively analyzed all patients studied in a 2-year period including clinical variables, time invested in the different diagnostic steps and the degree of collaboration and satisfaction among the involved professionals.

Results: Of 118 alerts received, 84 (71 %) were studied in our LCRDU. The median of days until petitioner contact, patient consulted at LCRDU and to obtain a diagnosis was 1 (IQR 0-1.5), 2 (IQR 1-5) and 13 (IQR 7.5-30), respectively. In 45 cases (53 %), the suspicion of malignancy was confirmed (LC 84.4 % and metastasic 10.1 %). After staging was complete, 33 % of non-small cell lung cancer was potentially resectable (clinical TNM stage I-II). The level of satisfaction was high so that only one of the petitioner's studies chose other diagnostic pathways.

Conclusion: This strategy for radiological suspicion of LC ensures the communication between general practitioners, radiologists and pulmonologist improving the LC diagnostic effectiveness. This system can be easily implemented in health care systems.