The High-Risk Lung Assessment Program

(top) In this CT scan, the white area indicates a lesion with irregularly shaped borders partially attached to the pleura (outer lining of the lung) in a patient with emphysema. This is likely a malignant cancer. (bottom) The lesion in this scan is small.The High-Risk Lung Assessment Program uses an algorithm-driven approach to provide comprehensive, thorough care to two groups of patients. The first group, the "well at risk," includes those at risk for pulmonary disease due to family history or environmental exposures. The program helps to define the risk each patient faces, mitigates risk factors (for example by referring smokers to innovative smoking cessation programs), conducts further screening through lung function tests, or orders additional CT scans or imaging tests as required. This group of "well at risk" patients includes many New York firefighters who responded to the attack on 9/11, as well as people who have been exposed to chemicals, paint, or other toxic substances.

The second group targeted by the program includes people who have begun a screening protocol, or who have been found to have an abnormality on a CT scan. For these patients, the program uses the best available evidence to manage the results of screenings and to provide comprehensive follow-up care.

For low-risk nodules, the Lung Assessment Program typically recommends follow-up imaging at algorithm-specified intervals. For intermediate lesions, the team uses other tools to try to refine the probability of malignancy. One is to follow the lesion over time, because malignant nodules tend to grow, whereas benign ones do not. Sequential CT scans at three-month intervals may be recommended to monitor for signs of change. Another strategy is to use PET/CT scanning to determine whether a nodule may be metabolically active, because malignant lesions tend to be metabolically active while benign nodules do not.

If a lesion is highly likely to be cancerous, the program may recommend biopsy or removal of the lesion. In most cases, the program uses minimally invasive surgical methods. A new device called opto-electronic plethysmography (OEP) now allows the program to very easily and noninvasively evaluate lung function in each portion of the lung. In addition, the program includes thoracic oncology evaluation for consideration of chemotherapy when appropriate.

Patients may be referred by a primary care physician or pulmonologist, or they may seek evaluation on their own.