Incidental Pulmonary Nodules Found on Shoulder Arthroplasty Preoperative CT Scans

Abstract

With current emphasis on preoperative templating of anatomical and reverse shoulder arthroplasty (aTSA and rTSA, respectively), patients often receive thin slice (<1.0 mm) computerized tomography (CT) scans of the operative shoulder, which includes about two-thirds of the ipsilateral lung. The purpose of this study is to evaluate the prevalence and management of incidentally detected pulmonary nodules on preoperative CT scans for shoulder arthroplasty. In this single-center retrospective study, we queried records of aTSA and rTSA patients from 2015 to 2020 who received preoperative CT imaging of the shoulder. Compared to patients with negative CT findings, there were significantly more females (63.8% vs. 46.4%; P = .011), COPD (13.0% vs. 4.7%; P = .015), and asthma (18.8% vs. 6.9%; P = .003) among the patients with incidental nodules on CT. Binary logistic regression confirmed that female sex (odds ratio = 2.00; 95% CI = 1.04 to 3.88; P = .037), COPD history (OR = 3.02; 95% CI = 1.05 to 8.65; P = .040), and asthma history (OR = 3.17; 95% CI = 1.30 to 7.77; P = .011) were significantly associated with an incidental nodule finding. Incidental pulmonary nodules found on shoulder arthroplasty preoperative CT scans are often low risk in size with low risk of malignancy, and do not require further workup. This study may provide guidance to orthopedic surgeons on how to manage patients with incidental pulmonary nodules to increase chances of early cancer detection, avoid unnecessary referrals, reduce potentially harmful radiation exposure of serial CT scans, and improve cost efficiency.