Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

Mazzone, Peter J.; Gould, Michael K.; Arenberg, Douglas A.; Chen, Alexander C.; Choi, Humberto K.; Detterbeck, Frank C.; Farjah, Farhood; Fong, Kwun M.; Iaccarino, Jonathan M.; Janes, Samuel M.; Kanne, Jeffrey P.; Kazerooni, Ella A.; MacMahon, Heber; Naidich, David P.; Powell, Charles A.; Raoof, Suhail; Rivera, M. Patricia; Tanner, Nichole T.; Tanoue, Lynn K.; Tremblay, Alain; Vachani, Anil; White, Charles S.; Wiener, Renda Soylemez; Silvestri, Gerard A.

Abstract Background The 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 for lung cancer screening and lung nodule evaluation. We developed consensus statements to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic. Methods An expert panel of 24 members, including pulmonologists (17), thoracic radiologists (5), and thoracic surgeons (2) was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss then vote on statements related to 12 common clinical scenarios. A pre-defined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario. Results Twelve statements related to baseline and annual lung cancer screening (2), surveillance of a previously detected lung nodule (5), evaluation of intermediate and high risk lung nodules (4), and management of clinical stage I non-small cell lung cancer (1) were developed and modified. All 12 statements were confirmed as consensus statements by voting results. The consensus statements provide guidance about situations where it was felt to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize non-urgent interventions during the evaluation of lung nodules and stage I non-small cell lung cancer. Conclusions There was consensus that during the COVID-19 pandemic it is 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. There are multiple local, regional, and patient related factors that should be considered when applying these statements to individual patient care.