The Solitary Pulmonary Nodule*

Tan, Bethany B.; Flaherty, Kevin R.; Kazerooni, Ella A.; Iannettoni, Mark D.

doi:10.1378/chest.123.1_suppl.89s

Cited by 283 publications

(185 citation statements)

References 47 publications

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“…Most SPNs in adult patients discovered at chest radiography, if not shown to be stable for more than 2 years and without benign features, should be evaluated with thoracic CT (44). Thoracic CT is used to characterize the nodule and generate an assessment of the likelihood of malignancy using the morphological features described previously.…”

Section: Management Strategies For the Spnmentioning

confidence: 99%

“…In such patients, even negative non-invasive evaluations, such as negative FDG-PET and CT nodule enhancement studies, cannot lower the probability of malignancy to a low enough level to allow an observational strategy (44). Similarly, transthoracic biopsy is not recommended in such patients because positive results…”

Section: Notesmentioning

confidence: 99%

“…will not change management and negative results are insufficiently reliable to exclude malignancy (44). Nevertheless, in practice, FDG-PET and a pre-operative tissue diagnosis are often obtained in such patients, often to justify to the patient the risks of and need for surgical treatment of an SPN.…”

Section: Notesmentioning

confidence: 99%

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Imaging Evaluation of the Solitary Pulmonary Nodule

Tassel

Gotway

et al. 2011

Clinical Pulmonary Medicine

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Section: Management Strategies For the Spnmentioning

confidence: 99%

Section: Notesmentioning

confidence: 99%

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Imaging Evaluation of the Solitary Pulmonary Nodule

Tassel

Gotway

et al. 2011

Clinical Pulmonary Medicine

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“…Genellikle başka nedenlerden dolayı yapılan radyolojik incelemelerde tesadüfen saptanırlar. Soliter pulmoner nodüllerin göğüs grafilerinde görülme oranı % 0.1-2 arasında bildirilmektedir [2,3]. Genelde benign nedenlere daha fazla rastlandığı bildirilmiştir [4].…”

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“…Benign lezyonlarda çoğunluğu infeksiyöz nedenler oluşturmak-tadır. Genel görüş, "aksi ispat edilmedikçe SPN'ler malign gibi düşünülmelidir" şeklindedir [3].…”

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The Evaluation of Preoperative Diagnostic Approach to Solitary Pulmonary Nodule with Solid Structure

Ceviker¹

2015

Ann Clin Anal Med

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Resource Use and Guideline Concordance in Evaluation of Pulmonary Nodules for Cancer

et al. 2014

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are common, and more will be found with implementation of lung cancer screening. How potentially malignant pulmonary nodules are evaluated may affect patient outcomes, health care costs, and effectiveness of lung cancer screening programs. Guidelines for evaluating pulmonary nodules for cancer exist, but little is known about how nodules are evaluated in the usual care setting.OBJECTIVE To characterize nodule evaluation and concordance with guidelines. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was conducted including detailed review of medical records from pulmonary nodule detection through evaluation completion, cancer diagnosis, or study end (December 31, 2012). The participants included 300 adults with pulmonary nodules from 15 Veterans Affairs hospitals. MAIN OUTCOMES AND MEASURESResources used for evaluation at any Veterans Affairs facility and guideline-concordant evaluation served as the main outcomes.RESULTS Twenty-seven of 300 patients (9.0%) with pulmonary nodules ultimately received a diagnosis of lung cancer: 1 of 57 (1.8%) with a nodule of 4 mm or less, 4 of 134 (3.0%) with a nodule of 5 to 8 mm, and 22 of 109 (20.2%) with a nodule larger than 8 mm. Nodule evaluation entailed 1044 imaging studies, 147 consultations, 76 biopsies, 13 resections, and 21 hospitalizations. Radiographic surveillance (n = 277) lasted a median of 13 months but ranged from less than 0.5 months to 8.5 years. Forty-six patients underwent invasive procedures (range per patient, 1-4): 41.3% (19 patients) did not have cancer and 17.4% (8) experienced complications, including 1 death. Notably, 15 of the 300 (5.0%) received no purposeful evaluation and had no obvious reason for deferral, seemingly "falling through the cracks." Among 197 patients with a nodule detected after release of the Fleischner Society guidelines, 44.7% received care inconsistent with guidelines (17.8% overevaluation, 26.9% underevaluation). In multivariable analyses, the strongest predictor of guideline-inconsistent care was inappropriate radiologist recommendations (overevaluation relative risk, 4.6 [95% CI, underevaluation,). Other systems factors associated with underevaluation included receiving care at more than 1 facility (2.0 [1.5-2.7]) and nodule detection during an inpatient or preoperative visit (1.6 [1.1-2.5]). CONCLUSIONS AND RELEVANCEPulmonary nodule evaluation is often inconsistent with guidelines, including cases with no workup and others with prolonged surveillance or unneeded procedures that may cause harm. Systems to improve quality (eg, aligning radiologist recommendations with guidelines and facilitating communication across providers) are needed before lung cancer screening is widely implemented.

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The Solitary Pulmonary Nodule*

Cited by 283 publications

References 47 publications

Imaging Evaluation of the Solitary Pulmonary Nodule

Imaging Evaluation of the Solitary Pulmonary Nodule

The Evaluation of Preoperative Diagnostic Approach to Solitary Pulmonary Nodule with Solid Structure

Resource Use and Guideline Concordance in Evaluation of Pulmonary Nodules for Cancer

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