There are a number of different manifestations of pulmonary aspergillosis. This study aims to review the radiology, presentation, and histological features of lung nodules caused by Aspergillus spp.Patients were identified from a cohort attending our specialist Chronic Pulmonary Aspergillosis clinic. Patients with cavitating lung lesions, with or without fibrosis and those with aspergillomas or a diagnosis of invasive aspergillosis were excluded. Demographic, laboratory, and clinical data and radiologic findings were recorded.Thirty-three patients with pulmonary nodules and diagnostic features of aspergillosis (histology and/or laboratory findings) were identified. Eighteen (54.5 %) were male, mean age 58 years (range 27-80 years). 19 (57.6 %) were former or current smokers. The median Charleston co-morbidity index was 3 (range 0-7). All complained of a least one of; dyspnoea, cough, haemoptysis, or weight loss. None reported fever. Ten patients (31 %) did not have an elevated Aspergillus IgG, and only 4 patients had elevated Aspergillus precipitins. Twelve patients (36 %) had a single nodule, six patients (18 %) had between 2 and 5 nodules, 2 (6 %) between 6 and 10 nodules and 13 (39 %) had more than 10 nodules. The mean size of the nodules was 21 mm, with a maximum size ranging between 5-50 mm. No nodules had cavitation radiographically. The upper lobes were most commonly involved. Histology was available for 18 patients and showed evidence of granulation tissue, fibrosis, and visualisation of fungal hyphae.Pulmonary nodules are a less common manifestation of aspergillosis in immunocompetent patients. Distinguishing these nodules from other lung pathology may be difficult on CT findings alone.
Patients with suspected lung cancer require computed tomography (CT), specialist interpretation of the CT and a consultation with a specialist. Significant time savings could be made with rapid access to these components in the front end of the lung cancer pathway.
Methods
The RAPID programme was launched at Manchester9s Wythenshawe Hospital in April 2016. This pathway offers next working day CT for patients with suspected lung cancer, immediate 'hot' reporting of CT images and a same day consultation with a diagnostic specialist.
Results
From April 2016 to January 2019, 1,027 patients were referred to the RAPID programme. The median time from referral to CT was 3 days. The CT was hot reported in 94% of patients. The median time from CT to triage and consultation with a diagnostic specialist was 0 days. Overall 56% and 90% of patients had completed a CT and consultation within 3 and 7 days of referral, respectively (0% and 24% prior to implementation).
Conclusion
Through simple reorganisation of workload, we have significantly reduced the pathway for patients with suspected lung cancer to meet a specialist with a reported CT, something we firmly believe is replicable across all hospitals.
Objective: This study aimed to establish a reproducible method for selecting AI-detected chest X-ray (CXR) abnormalities prioritised for urgent reporting to support faster lung cancer diagnosis. By selecting findings informed by cancer prevalence and clinical significance, we sought to maximise detection while maintaining a high negative predictive value (NPV). Materials and Methods: Two cohorts of CXRs were evaluated: (1) a retrospective cohort of patients with confirmed lung cancer and abnormal CXRs, and (2) a prospective cohort of primary care referred CXRs from seven Greater Manchester trusts, with the AI system in shadow mode. The AI triage system (Annalise Enterprise CXR) evaluated the relative prevalence of 124 abnormalities, and prioritisation strategies were assessed using sensitivity, specificity, positive predictive value (PPV), and NPV. Results: A total of 1,282 lung cancer patients were included in cohort 1. In cohort 2, the AI system processed 13,802 CXRs. Sensitivity was 95.87% (94.77%-96.97%) in cohort 1, and specificity was 79.11% (78.43%-79.79%) in cohort 2, with an NPV of 99.95%. Conclusion: This study presents a systematic, reproducible method for prioritising AI-detected CXR abnormalities, balancing high sensitivity and NPV while minimising low-risk prioritisation. This approach provides a data-driven alternative to traditional methods relying solely on clinical judgement.
In Salford, annual 2WW referrals rose from 235 in 2010/11 to 248 (2011/12) and 281 (2012/13) but fell to 249 in 2013/14 as the result of a 5 month pilot1 of our CATCH protocol (Community Access To CT Chest) allowing abnormal “low risk” CXR reports to trigger a GP request for a fast track CT scan. This audit reviews the performance of CATCH for a whole year of activity from 1st May 2014 to 30th April 2015.
Methods
The CATCH d-base and electronic patient record were used to identify the patients and dates of CXR and CT examinations in addition to CXR/CT scan reports and final diagnoses. The number of 2WW referrals was determined for the same time period using the cancer waiting times d-base.
Results
A total of 117 patients entered the CATCH protocol of which the majority of CXRs demonstrated the presence of a well-defined (47%) or ill-defined opacity (14%) and a further 18% revealed abnormality at the hilum. The remaining CXRs (21%) raised concerns about fat pads, atelectasis or pleural abnormality. For the 115 patients having a CT scan, the findings confirmed cancer in 9%, solitary pulmonary nodule (25%), infection/inflammation (15%), atelectasis (10%), pleural plaque (10%), fat pad (5%) and in 11% the CT scan was normal. Following CATCH CT scan, 53 (46%) patients required no follow up, 33 (29%) generated urgent referral, 16 (14%) non-urgent referral to the chest clinic, 11 (10%) required follow up surveillance imaging. Timelines for CATCH management are detailed in Table 1. Mean time from CT report to cancer diagnosis was 61.1 days (range 23 to 187) and total number of 2WW referrals for 2014/15 was 234.
Conclusions
Following the introduction of CATCH to the Salford Lung Cancer Service, 2WW referrals have fallen further to manageable numbers. The pick-up rate for cancer is only small and reflects the low risk abnormality detected on CXR. The relatively long diagnostic times for cancer reflect the processing of small nodules detected within this select group of patients.
Reference
1 Moorcroft CS, Kamalatharen G, Elliot S, et al. CATCH - community access to CT chest. Thorax 2014;69:A115 doi:10.1136/thoraxjnl-2014-206260.231
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