A group of leading experts has developed consensus recommendations on computed tomography (CT) lung cancer screening in an effort to improve patient safety and optimize outcomes. “The Society of Thoracic Surgeons (STS) Expert Consensus Document on Interventions for Screen-Detected Lung Nodules” was published The Annals of Thoracic Surgery.
The STS convened a multidisciplinary panel of specialists, including surgeons, radiologists and pulmonologists, who employed the PICO (population, intervention, comparisons, outcome) framework to review comprehensive literature.
The panel underwent three Delphi rounds to develop 23 consensus statements focused on improving consistency and quality of patient care. The statements, which required minimum of 75% agreement, addressed:
- Preoperative biopsy and diagnostic surgical procedures
- Adequate rates of diagnostic and therapeutic procedure complications
- Interventional timing of suspicious lung cancer screening (LCS) findings
“This STS consensus defines perioperative quality standards for CT LCS programs, supporting shared decision-making, multidisciplinary care and quality improvement,” the authors wrote.
Highlights of the consensus document include:
- Careful, coordinated decision-making: Immediate surgery may be required for patients at high risk of cancer, even without biopsy, but less invasive procedures are strongly encouraged. The consensus does not recommend major procedures without confirmed diagnoses.
- Procedural safety standards: The consensus outlines acceptable benchmarks of specific procedural complications, such as less than 5% for pneumothorax (lung collapse) and less than 2% for hemoptysis (severe bleeding) and less than 1% for mortality.
- Treatment timing: The panel agreed patients who have unclear or skeptical diagnostic results should receive definitive treatment within 12 weeks.
- Overall treatment approach: Panelists recommended preliminary treatments, such as smoking cessation and pulmonary rehabilitation, prior to surgery to optimize outcomes.
The expert panel also recommended a system to track the frequency that surgeries conclude noncancerous conditions to minimize the amount of unnecessary procedures.
“Collectively, these consensus statements underscore that maintaining rigorous quality metrics, data tracking and multidisciplinary collaboration are essential to ensure that the life-saving potential of LCS is realized through safe, efficient and patient-centered care,” the authors wrote.
Patient resources, including the American Lung Association’s low-dose CT lung cancer screening and eligibility test and the Centers for Medicaid and Medicare Services’ current screening decision, are recommended to maintain transparency and shared decision-making.
