Duke Health recently launched a dedicated Lung Nodule Clinic, which leverages advanced imaging capabilities and a dedicated team to identify and treat early-stage lung malignancies. “We don’t want any patient to get lost between identifying a lung nodule and appropriate follow-up to assess for cancer risk,” says Jared Christensen, MD, MBA, imaging director of the Duke Health Lung Cancer Screening Program. 
 
Pulmonary nodules are a common incidental finding on adult chest X-rays and CT scans, appearing on 50% of adult thoracic imaging. While 95% of pulmonary nodules are benign, a small yet significant percentage of nodules require further diagnostic testing or monitoring. 
 
“We’re aligning the structure of the clinic to the latest research. For example, the DELUGE study showed that following incidentally-detected indeterminate pulmonary nodules may expand access to early detection of lung cancer when paired with traditional low-dose CT scan lung cancer screening because they capture different populations,” says Christensen.
 
The clinic will therefore support patients who may not qualify for lung cancer screening — to detect cancers in the earliest stage.

Not all patients with lung nodules qualify for a referral to the Lung Nodule Clinic. 
 
“Lung nodules can occur for many reasons outside of cancer, including in the setting of infection and inflammation," says Christensen. “We want to rule out benign pulmonary nodules so patients can avoid unnecessary appointments.” 
 
To qualify for a referral to the Lung Nodule Clinic, patients must meet the following criteria:

• incidental lung nodule detected on imaging and reported by the interpreting radiologist
• lung nodule > 6 mm in size
• lung nodule does not appear to be related to infectious or inflammatory causes
• patient is not under the current or ongoing care of an oncology provider 

“Most patients referred to the clinic are diagnosed with a pulmonary nodule during a routine work-up of another condition,” says Christensen. Referring providers now have a trusted resource to manage these incidental findings. 

After the initial appointment, patients will typically follow one of three paths:

• longitudinal surveillance in the Lung Nodule Clinic
• escalation to a higher level of service or treatment
• referral back to the referring provider for ongoing management

“Primary care providers are very busy managing multiple patient needs. The Lung Nodule Clinic reduces the burden on PCPs by taking care of imaging, follow-up, and delivering appropriate care to patients with pulmonary nodules that meet criteria,” says Christensen.
 
The clinic also has prioritized patient convenience and experience. A majority of initial patient consultations occur via telemedicine. For in-clinic visits, providers are available at locations in Raleigh and Durham. 
 
“It’s important to expedite the process for patients and make our care accessible,” says Christensen. 
 
The team has a new patient scheduler, advanced practice providers with extensive experience in caring for patients with indeterminate lung nodules, and a designated clinical workflow to assess patients, administer further diagnostic testing, and route patients to the thoracic oncology team when indicated. 
 
It’s important to note that the Lung Nodule Clinic adds an additional level of specialized care for patients with lung nodules. Other DCI services such as lung cancer screenings and the Cancer Diagnostic Clinic continue to support patients meeting criteria for a referral into those programs.