Patient characteristics associated with adherence to pulmonary nodule guidelines

Iaccarino, Jonathan M.; Steiling, Katrina; Slatore, Christopher G.; Drainoni, Mari-Lynn; Wiener, Renda Soylemez

doi:10.1016/j.rmed.2020.106075

Cited by 13 publications

(8 citation statements)

References 36 publications

(40 reference statements)

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“…In this case, the boundary of GGO is blurred. 8 Other viruses, such as influenza viruses, are more manifested as GGO distributed under the pleura of bilateral lungs, rather than secondary lung lobules, and fewer nodules can be found. 9,10 As for the CT difference between unmutated COVID-19 and delta variant pneumonia, there is no literature report, and further research is needed.…”

Section: Discussionmentioning

confidence: 99%

SARS‐CoV‐2 Delta VOC pneumonia with CT follow‐ups: A case report

Tang

Zhang

et al. 2021

Journal of Medical Virology

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To the Editor, Coronavirus Disease 2019 (COVID-19) as a new type of virus broke out in China and quickly swept the world in December 2019. 1,2 The virus then mutated to Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2). 3,4 The World Health Organization (WHO) has outlined three key criteria to designate the Delta Variant of Concern (VOC): increased transmissibility, increased virulence, and decreased effectiveness of available diagnostics, vaccines, and therapeutics. 5The Delta VOC caused an epidemic and outbreak in Nanjing and then spread across several provinces and cities in China. 6 Jing Wu and Jie Tang are co-first authors of this paper, they collected the data, analyzed the data, and draft the paper for the work. Tao Zhang helped to acquire the clinical and imaging data.

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Section: Discussionmentioning

confidence: 99%

SARS‐CoV‐2 Delta VOC pneumonia with CT follow‐ups: A case report

Tang

Zhang

et al. 2021

Journal of Medical Virology

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“…whose nodule evaluation was concordant with an evidence-based approach [12,25]. Using these assumptions, we expected to have 90% power to detect a 0.12 absolute increase in our primary outcome (0.2 to 0.32) if 200 patients were included.…”

Section: Plos Onementioning

confidence: 99%

Prevalence and consequences of non-adherence to an evidence-based approach for incidental pulmonary nodules

Wayne

Prescott

2022

PLoS ONE

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Importance Distinguishing benign from malignant pulmonary nodules is challenging. Evidence-based guidelines exist, but their impact on patient-centered outcomes is unknown. Objective To understand if the evaluation of incidental pulmonary nodules that follows an evidence-based management strategy is associated with fewer invasive procedures for benign lesions and/or fewer delays in cancer diagnosis. Design Retrospective cohort study. Setting Large academic medical center. Participants Adults (≥18 years age) with an incidental pulmonary nodule discovered between January 2012 and December 2014. Patients with calcified nodules, prior nodules, prior diagnosis of cancer, high suspicion for pulmonary metastasis, or limited life expectancy were excluded. Exposure Nodule management strategy (pre-specified based on evidence-based practices). Outcome Composite of any invasive procedure for a benign nodule or delay in diagnosis in patients with cancer (>3 month delay once probability of cancer was >15%). Results Of 314 patients that met inclusion criteria, median age was 61, 46.5% were men, and 66.5% had current or former tobacco use. The mean nodule size was 10.3 mm, mean probability of cancer was 11.8%, and 14.3% of nodules were malignant. Evaluation followed an evidence-based strategy in 245 patients (78.0%), and deviated in 69 patients (22%). The composite outcome occurred in 26 (8.3%) patients. Among patients whose nodule evaluation was concordant with an evidence-based evaluation, 6.1% (15/245) experienced the composite outcome versus 15.9% (11/69) of patients with an evaluation that deviated from evidence-based recommendations (P<0.01). Conclusions and relevance At a large academic medical center, more than 1 in 5 patients with an incidental pulmonary nodule underwent evaluation that deviated from evidence-based practice recommendations. Nodule evaluation that deviated from an evidence-based strategy was associated with biopsy of benign lesions and delays in cancer diagnosis, suggesting a need to improve guideline uptake.

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“…A history of COPD and being seen by a pulmonologist were also associated with guideline concordance. 30 In Greece, patient participation in decision making regarding their health choices is notoriously low and dependent almost exclusively on physician initiative and/or personality. 31 Should a PNC be introduced as a service in the NHS, it would be critical to its endorsement, adoption and uptake to not only inform patients of its existence, but also to encourage and empower them to participate in the choices around the management of their health, including through requesting a potential referral to the PNC.…”

mentioning

confidence: 99%

Establishing a Pulmonary Nodule Clinic Service for Early Diagnosis of Lung Cancer – Review of International Options and Considerations for Greece

Souliotis¹,

Golna²

2023

RMHP

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Early diagnosis of lung cancer in pulmonary nodules identified by computed tomography (CT) may be critical in reducing the epidemiological burden of the disease, particularly in countries where such a burden is considerably high and risk factors for lung cancer very prevalent. The establishment and operation of pulmonary nodule clinics (PNCs), ie, multidisciplinary services that watch and evaluate nodules found through deliberate screening efforts or as incidental findings, is increasingly becoming a key tool to implement such earlyintervention, cancer-risk management policies elsewhere in the world. This review aims to research and present in a structured manner findings from published sources on options and considerations for setting up a PNC in a country such as Greece. These refer to the type of services a PNC would provide to optimize diagnosis of suspect pulmonary nodules, its structure and organization, including processes, human resources and technology infrastructure, its target audience, ie, who would be eligible to use its services, and the expected outcomes of its operation, in terms of a set of key performance indicators. Our review also revealed critical key success factors that should be considered when designing the introduction of a PNC in a health care setting, including optimal referral pathways, aligned clinical decision making and patient preferences and participation/empowerment. Our findings may inform health care systems with a high lung cancer burden and no available PNC service on options and considerations before introducing such a service in their respective settings.

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Patient characteristics associated with adherence to pulmonary nodule guidelines

Cited by 13 publications

References 36 publications

SARS‐CoV‐2 Delta VOC pneumonia with CT follow‐ups: A case report

SARS‐CoV‐2 Delta VOC pneumonia with CT follow‐ups: A case report

Prevalence and consequences of non-adherence to an evidence-based approach for incidental pulmonary nodules

Establishing a Pulmonary Nodule Clinic Service for Early Diagnosis of Lung Cancer – Review of International Options and Considerations for Greece

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