Monitorization of pulmonary nodules in Turkey (Monitur)

Objective: In our multicenter study, it was aimed to reveal how pulmonary nodules are followed in Turkey and to evaluate compliance with guidelines in pulmonary nodule follow-ups. Materials and Methods: Our study was designed as a multicenter, retrospective study in Turkey. 1316 patients over 18 years of age, who were followed-up for pulmonary nodules between 01.01.2014 and 31.12.2019, had at least two thoracic tomography scans or had a single thoracic tomography and had a histopathological diagnosis were included. Demographic information of patients with pulmonary nodules, symptoms at the beginning of follow-up, comorbidities, smoking exposure, family history of lung and non-lung cancer, thoracic tomography follow-up intervals, number of tomography scans, nodule diameters, nodule characteristics and localizations, non-nodule radiological findings in tomography, additional imaging and diagnostic procedure needs, whether there was nodular and non-nodule pathological FDG uptake in cases with PET/CT evaluation, laboratory tests requested in the follow-up, and pathological results were recorded. Patients with both single and multiple nodules were included in the study. For nodule diameters, the longest diameter measured in the transverse section in thorax tomography, and the largest nodule diameter and/or the most suspicious appearance in terms of malignancy in patients with multiple pulmonary nodules were taken into consideration. Age, gender, cigarette consumption, follow-up time and nodule diameter were compared between malignant and benign nodules. The conformity of the data to the normal distribution according to the groups was examined with the Kolmogorov Smirnov test. Kruskal Wallis and Mann Whitney U tests were used to compare data that did not show normal distribution. Pearson chi-square, Yates correction and Fisher exact test were used to evaluate categorical data. ROC analysis was used to determine the malignancy for the CT diameter. Analysis results were presented as mean ± s. deviation, median (min-max) for quantitative data, and frequency (percent) for categorical data. Significance level was taken as p<0.05. Findings: Of the 1316 patients, %39.9 were female and %60.1 were male, mean age was 57.63 years. The mean follow-up period was 20.21 months, and the median number of physician visits was 4. During the follow-up, it was observed that CT scans were performed at most 11 times. When the values obtained at 11 different times were examined, the mean diameter value varied between 8.6 and 14 mm. The mean time between the first CT scan and the last CT scan was 606.3 days, while the minimum elapsed time was 2 days and the maximum elapsed time was 2101 days. When the mean difference between two consecutive CT scans in patients followed up for coincidental pulmonary nodules was examined in general, it was 283.8 days, while the median value was 195 days. In addition, the intervals between two consecutive CTs ranged from 2 to 2042 days. The most common localization of pulmonary nodules was the right lung, and the second most common was peripheral localization. It was determined that PET/CT examination was requested in %30.9 (407) of the patients. The rate of cases with pathological FDG uptake in pulmonary nodules in 407 cases for which PET/CT was requested was %51.1 (208). Among the patients whose latest status data were determined; The rate of those who were followed up without treatment was %41.3, the rate of those who were excluded from the follow-up was %32.8 and the rate of the patients who were given treatment was %11.8. Advanced age, male gender, and smoking were associated with malignancy. Irregular, lobulated, spicular margin and cavitary features were detected at a higher rate in malignant nodules. While the follow-up period was 24 months in benign nodules, it was 5.3 months in malignant nodules. There was a difference between the median follow-up times according to the malignancy status (p<0.001). CT diameter is a risk factor for malignancy (p<0.001). When the cut-off value for the first CT diameter is taken as 10 mm, the sensitivity is 88.2%, the specificity is 76.08%, the PPV is 55.04%, and the NPV value is 95.1%. Results: It is thought that this study, which provides large-scale data on patients with pulmonary nodules, can help create a national guideline. We plan our study to provide information about guideline compliance in the management of incidental pulmonary nodules. Key words: Pulmonary Nodule, Lung Cancer, Fleischner