Pulmonology Expert Panel Offers Guidance During the COVID-19 Pandemic
Posted: Thursday, May 28, 2020
Management of lung cancer screening and lung nodule evaluation may need to be altered in many scenarios due to coronavirus 2019 (COVID-19). Specifically, “risks from potential exposure to COVID-19, and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre–COVID-19) guideline recommendations,” according to an expert panel consisting of Peter J. Mazzone, MD, MPH, of Cleveland Clinic, Ohio, and 23 colleagues—pulmonologists, thoracic radiologists, and thoracic surgeons. The panel developed consensus statements related to 12 common clinical scenarios to guide fellow physicians at this unprecedented time, and they were published in Radiology: Imaging Cancer.
The scenarios relate to potential delays in baseline and annual lung cancer screening, deferring surveillance of a previously detected lung nodule, minimizing nonurgent interventions in the evaluation of intermediate- and high-risk lung nodules, and managing clinical stage I non–small cell lung cancer. For instance, for a patient due for surveillance CT of the chest for an incidentally detected small solid nodule (< 8 mm in average diameter), the consensus for now is consistent with guidance from the Centers for Disease Control and Prevention (CDC) to defer nonurgent care; the scan could be delayed for about 3 to 6 months. In another clinical situation, “a patient who presents for evaluation of an incidentally detected larger solid nodule, the consensus again for now is consistent with CDC guidance: “It is acceptable to evaluate…with a PET scan and/or nonsurgical biopsy to insure there is [an actual] need to proceed to treatment (surgical resection or stereotactic radiotherapy).”
Consensus was reached that during the COVID-19 pandemic, it is generally “appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation,” noted the panel experts.
Disclosure: The study authors reported no conflicts of interest.
