Maximizing high-risk incidental pulmonary nodule referrals using artificial intelligence

Background: Effective lung cancer screening and pulmonary nodule (PN) management programs require timely detection and robust care coordination. We report the initial outcomes of an artificial intelligence (AI) tool for obtaining referrals to pulmonary following the detection of high-risk PN findings. Methods: JPS Health Network created the Pulmonary Nodule Risk Score (PNRS) classification system using nationally accepted PN guidelines. AI-driven Natural Language Processing (NLP) enabled navigators to identify patients meeting the PNRS 4B criteria (Table 1), the highest risk PN category. PNRS 4B detection and referral rates were compared over 22 months, spanning 11 months pre- and post-NLP implementation. Statistical analysis used Fisher's Exact for categorical variables and Mann-Whitney U or t tests for continuous variables. Results: From June 1, 2023-April 25, 2024 (pre-NLP), 26,393 chest CTs were performed; 23,396 were obtained post-NLP (April 26, 2024-March 20, 2025). The pre- and post-NLP periods included 76 and 106 PNRS 4B patients, respectively. Post-NLP workflow significantly improved referral within 90 days rates from 55 (72%) to 98 (93%) (p<0.001). Appointment completion improved from 68% to 78% (p=0.17). Pre- and post-NLP comparisons demonstrated no significant differences in biopsy completion (65% vs 60%), Malignancy was noted in 28 (37%) vs 38 (37%). If pre-NLP referrals had reached 93% with the same 37% malignancy rate, an estimated 6 additional patients would have been diagnosed. Conclusion: The AI tool significantly increased referral rates and expedited malignancy detection, potentially reducing missed or delayed diagnoses in high-risk nodules. PNRS 4B Criteria and Recommended Clinical Management Pathways PNRS: Score Description: E quivalent Radiology Findings: Associated Recommendation(s): PNRS 4B Very Suspicious Solid Nodule : Single or Multiple ≥ 15 mm (≥ 1,767 mm 3 ) nodule(s) at baseline or new or; Growing ≥ 8 (≥ 268 mm 3 ) nodule. Part Solid Nodule: Solid component ≥ 8 mm (268 mm 3 ) at baseline or new or; Growing solid component ≥ 6 mm (113 mm 3 ) upon follow-up. Ground Glass Nodule (GGN) : Growing ≥ 8 mm (268 mm 3 ). Perifissural or Juxtapleural Nodule : Growing ≥ 10 mm (524 mm 3 ). Pulmonary Referral Recommended AND Follow-Up Diagnostic Chest CT AND/OR; PET/CT AND/OR; Tissue sampling / biopsy AND/OR; GGN Consider Resection