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. 2018 Apr 16;5(1):e000273. doi: 10.1136/bmjresp-2017-000273
Quality statement 3
Rationale
PET-CT examinations undertaken for assessment of solid pulmonary nodules are reported using qualitative assessment with an ordinal scale to define FDG uptake as absent, faint, moderate or intense, in relation to background lung tissue and mediastinal blood pool, to facilitate use of the Herder risk prediction model.
The Herder risk prediction model is the most accurate at predicting malignancy in solid pulmonary nodules and has been validated in a UK population. It uses clinical and radiological factors in conjunction with FDG uptake within the pulmonary nodule to determine the risk of malignancy. The incorporation of FDG uptake has a synergistic effect on the predictive accuracy of clinicoradiological prediction models but is dependent on the accurate classification of FDG uptake within solid pulmonary nodules using qualitative assessment with an ordinal scale. The standardisation of reporting of FDG uptake within solid pulmonary nodules on PET-CT facilitates reliable reproducibility of the Herder risk prediction model in clinical practice.
Quality measure Structure:
  • Evidence that PET-CT reports for characterisation of solid pulmonary nodules are reported using qualitative assessment with an ordinal scale to define FDG uptake with nodules.

Process:
  • Proportion of patients undergoing PET-CT for characterisation of solid pulmonary nodules with FDG uptake within nodules categorised using qualitative assessment with an ordinal scale.

  • Numerator: number of patients undergoing PET-CTs performed for characterisation of solid pulmonary nodules with FDG uptake within the nodules categorised using qualitative assessment with an ordinal scale.

  • Denominator: number of patients undergoing PET-CTs performed for characterisation of solid pulmonary nodules.

Description of what the quality statement means for each audience Service providers:
  • Ensure that patients have timely access to PET-CT for characterisation of solid pulmonary nodules.

Healthcare professionals who report PET-CT
  • Ensure standardisation of reporting of FDG uptake within solid pulmonary nodules on PET-CT using qualitative assessment with an ordinal scale.

Commissioners:
  • Commission PET-CT for the characterisation of solid pulmonary nodules.

People having PET-CT undertaken for assessment of solid pulmonary nodules
  • Have their scans reported to facilitate the use of the Herder risk prediction model, one of the most accurate models in predicting malignancy in solid pulmonary nodules.

Relevant existing indicators Local MDT minutes/database/audit
National data sources National Lung Cancer Audit, Society for Cardiothoracic Surgery Thoracic Registry
Source references BTS Guidelines for the Investigation and Management of Pulmonary Nodules, 20153; NICE Lung Cancer: Diagnosis and Management Guideline, 20114; RCP/RCR Evidence-based indications for the use of PET-CT in the United Kingdom, 20165
Other information
Definitions BTS qualitative ordinal scale for classification of solid pulmonary nodules with FDG PET-CT
Absent: uptake indiscernible from background lung tissue.
Faint: uptake less than or equal to mediastinal blood pool.
Moderate: uptake greater than mediastinal blood pool.
Intense: uptake markedly greater than mediastinal blood pool.