Background. Quality gaps exist in the diagnostic evaluation of lung cancer patients. The initial CT chest guides the workup of patients with suspected lung cancer. We sought to determine how frequently CT reports provided guideline-concordant recommendations with regard to additional imaging studies and/or invasive diagnostic procedures. Methods. This was a retrospective study. The records of patients referred for investigation of suspected lung cancer between January 1, 2015, and June 30, 2016, were reviewed. Patients with confirmed lung cancer, for whom CT scan images and reports were available, are included. CT reports were reviewed, with attention to additional imaging studies and/or invasive diagnostic procedures suggested. These recommendations were examined against current guidelines for lung cancer diagnosis and staging, based on suspected disease stage. Results. One hundred forty-six patients are included in the analysis. Most patients were diagnosed with non-small-cell lung cancer (NSCLC), and 63% had advanced disease (stages III and IV). Only 12% of CT reports contained guideline-concordant recommendations for additional imaging studies, with PET scan suggested in only 6% of reports. Potential invasive diagnostic procedures were suggested in one fifth of CT reports, and only 58% of these recommendations were in keeping with current guidelines. In particular, transthoracic needle aspiration (TTNA) was suggested in 26% of patients despite advanced stage disease. Conclusion. Guideline-concordant recommendations for investigation of suspected lung cancer are rarely available on CT reports. This is true with respect to both imaging studies and invasive diagnostic procedures. Incorporation of more evidence-based suggestions may reduce quality gaps in lung cancer diagnosis and staging.

中文翻译：

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CT胸部报告的审计及其对疑似肺癌患者检查的潜在影响

背景。肺癌患者的诊断评估存在质量差距。最初的胸部 CT 指导疑似肺癌患者的检查。我们试图确定 CT 报告提供与其他影像学研究和/或侵入性诊断程序相关的指南一致建议的频率。方法. 这是一项回顾性研究。回顾了2015年1月1日至2016年6月30日期间转诊进行疑似肺癌调查的患者记录。包括已确诊的肺癌患者，这些患者的 CT 扫描图像和报告是可用的。审查了 CT 报告，并注意建议的其他影像学研究和/或侵入性诊断程序。根据当前的肺癌诊断和分期指南，根据疑似疾病分期，对这些建议进行了审查。结果. 146 名患者包括在分析中。大多数患者被诊断为非小细胞肺癌 (NSCLC)，63% 患有晚期疾病（III 期和 IV 期）。只有 12% 的 CT 报告包含与指南一致的额外影像学研究建议，只有 6% 的报告建议使用 PET 扫描。五分之一的 CT 报告建议了潜在的侵入性诊断程序，而这些建议中只有 58% 符合当前的指南。特别是，尽管疾病处于晚期，仍有 26% 的患者建议进行经胸针穿刺 (TTNA)。结论. CT 报告中很少提供与指南一致的疑似肺癌调查建议。对于影像学研究和侵入性诊断程序来说都是如此。纳入更多循证建议可能会减少肺癌诊断和分期的质量差距。