Resources Utilization for the Investigation of Pulmonary Nodules in a University Hospital Center in Quebec, Canada


      Lung cancer is the leading cause of death among cancer patients; therefore, the detection of a pulmonary nodule cannot be ignored. With the increasing prevalence of lung nodule detection, the investigation requires a large number of health care resources. The objective of this study was to measure the health care resources used for the investigation of pulmonary nodules.


      A retrospective medical chart review was conducted at the CHUM-Hotel-Dieu in Montreal, Canada. Eligible patients were selected consecutively using the electronic appointment book of the pulmonary clinic, from January 1st 2011 to May 23rd 2012. Inclusion criteria were: 40 year-old and over, presenting a pulmonary nodule ranging from 0.8 to 3.0 cm with no prior history of cancer in the last 5 years and no history of lung cancer. Patient’s demographics, nodule characteristics, medical information and resources utilization were extracted for each eligible patient.


      A total of 47 patients (23 women and 24 men, mean age = 64) were included in the analysis. The mean nodule size was 1.8 cm. Thirteen patients (28%) had a benign nodule and 34 (72%) had a malignant nodule. The most frequent non-invasive procedures were Thorax CT-Scan, PET-Scan and Chest X-ray performed at least once in respectively 96%, 85% and 77% of patients. The minimally invasive procedures (bronchoscopy and transthoracic needle biopsy) and the invasive procedures (thoracoscopy and thoracotomy) were mostly performed in patients who were eventually diagnosed with a lung cancer. On average, patients with a benign nodule underwent 0.77 minimally invasive or invasive procedures vs. 1.94 for patients with a malignant nodule (p=0.028).


      A significant amount of health care resources are deployed for the investigation of pulmonary nodules. This study tends to demonstrate that minimally invasive and invasive procedures are mostly deployed for the diagnosis of malignant nodules.