Chunxue Bai1, Chang-Min Choi2, Chung Ming Chu3, Devanand Anantham4, James Chung-Man Ho5, Ali Zamir Khan6, Jang-Ming Lee7, Shi Yue Li8, Sawang Saenghirunvattana9, Anthony Yim10. 1. Pulmonary Medicine Department, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, China. Electronic address: bai.chunxue@zs-hospital.sh.cn. 2. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea. 3. Respiratory Medicine, United Christian Hospital, Kwun Tong, Hong Kong SAR, China. 4. Respiratory Medicine and Critical Care Medicine, Singapore General Hospital, Singapore. 5. Respiratory Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China. 6. Minimally Invasive and Robotic Thoracic Surgery, Medanta The Medicity, Gurgaon, India. 7. Thoracic Surgery, National Taiwan University Hospital, Taipei, Taiwan. 8. Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. 9. Respiratory Medicine, Bangkok Hospital Medical Center, Bangkok Hospital Group, Bangkok, Thailand. 10. Minimally Invasive Thoracic Surgery Centre, Hong Kong SAR, China.
Abstract
BACKGROUND: American College of Chest Physicians (CHEST) clinical practice guidelines on the evaluation of pulmonary nodules may have low adoption among clinicians in Asian countries. Unique patient characteristics of Asian patients affect the diagnostic evaluation of pulmonary nodules. The objective of these clinical practice guidelines was to adapt those of CHEST to provide consensus-based recommendations relevant to practitioners in Asia. METHODS: A modified ADAPTE process was used by a multidisciplinary group of pulmonologists and thoracic surgeons in Asia. An initial panel meeting analyzed all CHEST recommendations to achieve consensus on recommendations and identify areas that required further investigation before consensus could be achieved. Revised recommendations were circulated to panel members for iterative review and redrafting to develop the final guidelines. RESULTS: Evaluation of pulmonary nodules in Asia broadly follows those of the CHEST guidelines with important caveats. Practitioners should be aware of the risk of lung cancer caused by high levels of indoor and outdoor air pollution, as well as the high incidence of adenocarcinoma in female nonsmokers. Furthermore, the high prevalence of granulomatous disease and other infectious causes of pulmonary nodules need to be considered. Therefore, diagnostic risk calculators developed in non-Asian patients may not be applicable. Overall, longer surveillance of nodules than those recommended by CHEST should be considered. CONCLUSIONS: TB in Asia favors lesser reliance on PET scanning and greater use of nonsurgical biopsy over surgical diagnosis or surveillance. Practitioners in Asia are encouraged to use these adapted consensus guidelines to facilitate consistent evaluation of pulmonary nodules.
BACKGROUND: American College of Chest Physicians (CHEST) clinical practice guidelines on the evaluation of pulmonary nodules may have low adoption among clinicians in Asian countries. Unique patient characteristics of Asian patients affect the diagnostic evaluation of pulmonary nodules. The objective of these clinical practice guidelines was to adapt those of CHEST to provide consensus-based recommendations relevant to practitioners in Asia. METHODS: A modified ADAPTE process was used by a multidisciplinary group of pulmonologists and thoracic surgeons in Asia. An initial panel meeting analyzed all CHEST recommendations to achieve consensus on recommendations and identify areas that required further investigation before consensus could be achieved. Revised recommendations were circulated to panel members for iterative review and redrafting to develop the final guidelines. RESULTS: Evaluation of pulmonary nodules in Asia broadly follows those of the CHEST guidelines with important caveats. Practitioners should be aware of the risk of lung cancer caused by high levels of indoor and outdoor air pollution, as well as the high incidence of adenocarcinoma in female nonsmokers. Furthermore, the high prevalence of granulomatous disease and other infectious causes of pulmonary nodules need to be considered. Therefore, diagnostic risk calculators developed in non-Asian patients may not be applicable. Overall, longer surveillance of nodules than those recommended by CHEST should be considered. CONCLUSIONS: TB in Asia favors lesser reliance on PET scanning and greater use of nonsurgical biopsy over surgical diagnosis or surveillance. Practitioners in Asia are encouraged to use these adapted consensus guidelines to facilitate consistent evaluation of pulmonary nodules.
Authors: Charlene Jin Yee Liew; Lester Chee Hao Leong; Lynette Li San Teo; Ching Ching Ong; Foong Koon Cheah; Wei Ping Tham; Haja Mohamed Mohideen Salahudeen; Chau Hung Lee; Gregory Jon Leng Kaw; Augustine Kim Huat Tee; Ian Yu Yan Tsou; Kiang Hiong Tay; Raymond Quah; Bien Peng Tan; Hong Chou; Daniel Tan; Angeline Choo Choo Poh; Andrew Gee Seng Tan Journal: Singapore Med J Date: 2019-11 Impact factor: 1.858