Proportion and characteristics of transient nodules in a retrospective analysis of pulmonary nodules (original) (raw)

The follow-up of solitary pulmonary nodules at Mater Dei Hospital

2019

Background: Solitary pulmonary nodules (SPNs) are a common incidental radiological finding, occurring in 28% of smokers, 20% of ex-smokers and 36% of non-smokers.1 These nodules represent a diagnostic challenge. Under-evaluation may delay the diagnosis of early lung cancer whilst over-evaluation may increase expenditure, radiation and also patient concern.2 The aim of this audit was to evaluate whether the Fleischner Society Guidelines 3 are adhered to in the follow-up of SPNs locally. Methodology: This retrospective study includes all SPNs diagnosed incidentally on Computed Tomography (CT) between January 2013 and December 2014, excluding patients with a history of malignancy. The follow-up of the nodules was compared with Fleischner Society Recommendations (FSR) as the gold standard. Standard Use: FSR 2005, which stratify nodules based on size and smoking history. Results: From a cohort of 100 patients, guideline-concordant care was found in 29%. SPNs were under-evaluated in 36% ...

Follow-up of Incidental Pulmonary Nodules and the Radiology Report

Journal of the American College of Radiology, 2014

Incidental pulmonary nodules that require follow-up are often noted on chest CT. Evidence-based guidelines regarding appropriate follow-up have been published, but the rate of adherence to guideline recommendations is unknown. Furthermore, it is unknown whether the radiology report affects the nodule follow-up rate. Methods: A review of 1,000 CT pulmonary angiographic studies ordered in the emergency department was performed to determine the presence of an incidental pulmonary nodule. Fleischner Society guidelines were applied to ascertain if follow-up was recommended. Radiology reports were classified on the basis of whether nodules were listed in the findings section only, were noted in the impression section, or had explicit recommendations for follow-up. Whether the rate of nodule follow-up was affected by the radiology report was determined according to these 3 groups. Results: Incidental pulmonary nodules that required follow-up were noted on 9.9% (95% confidence interval, 8%e12%) of CT pulmonary angiographic studies. Follow-up for nodules was poor overall (29% [28 of 96]; 95% confidence interval, 20%e38%) and decreased significantly when the nodules were mentioned in the findings section only (0% [0 of 12]). Specific instructions to follow up nodules in radiology reports still resulted in a low follow-up rate of 29% (19 of 65; 95% confidence interval, 18%e40%). Conclusions: Incidental pulmonary nodules detected on CT pulmonary angiography are common and are frequently not followed up appropriately. Although the inclusion of a pulmonary nodule in the impression section of a radiology report is helpful, it does not ensure follow-up. Better systems for appropriate identification and follow-up of incidental findings are needed.

Incidentally Detected Lung Nodules

Journal of Computer Assisted Tomography, 2014

Objective: The objective of this study was to determine adherence to incidentally detected lung nodule computed tomographic (CT) surveillance recommendations and identify demographic and clinical factors that increase the likelihood of CT surveillance.

Evaluation of Patients With Pulmonary Nodules: When Is It Lung Cancer?

Chest, 2007

Background: Pulmonary nodules are spherical radiographic opacities that measure up to 30 mm in diameter. Nodules are extremely common in clinical practice and challenging to manage, especially small, "subcentimeter" nodules. Identification of malignant nodules is important because they represent a potentially curable form of lung cancer. Methods: We developed evidence-based clinical practice guidelines based on a systematic literature review and discussion with a large, multidisciplinary group of clinical experts and other stakeholders. Results: We generated a list of 29 recommendations for managing the solitary pulmonary nodule (SPN) that measures at least 8 to 10 mm in diameter; small, subcentimeter nodules that measure < 8 mm to 10 mm in diameter; and multiple nodules when they are detected incidentally during evaluation of the SPN. Recommendations stress the value of risk factor assessment, the utility of imaging tests (especially old films), the need to weigh the risks and benefits of various management strategies (biopsy, surgery, and observation with serial imaging tests), and the importance of eliciting patient preferences. Conclusion: Patients with pulmonary nodules should be evaluated by estimation of the probability of malignancy, performance of imaging tests to characterize the lesion(s) better, evaluation of the risks associated with various management alternatives, and elicitation of patient preferences for treatment.

Evaluation of pulmonary nodules: clinical practice consensus guidelines for Asia

Chest, 2016

American College of Chest Physicians (ACCP) clinical practice guidelines on the evaluation of pulmonary nodules may have low adoption among clinicians in Asian countries. Unique patient characteristics of Asian patients affect the diagnostic evaluation of pulmonary nodules. The objective of these clinical practice guidelines is to adapt those of the ACCP to provide consensus-based recommendations relevant to practitioners in Asia. A modified ADAPTE process was used by a multidisciplinary group of pulmonologists and thoracic surgeons in Asia. An initial panel meeting analysed all ACCP recommendations to achieve consensus on recommendations and identify areas that required further investigation before consensus could be achieved. Revised recommendations were circulated to panel members for iterative review and redrafting to develop the final guidelines. Evaluation of pulmonary nodules in Asia broadly follows those of the ACCP guidelines with important caveats. Practitioners should be ...

Natural History of Pulmonary Subsolid Nodules: A Prospective Multicenter Study

Journal of Thoracic Oncology, 2016

Introduction: The purpose of this study was to evaluate the natural course of the progression of pulmonary subsolid nodules (SSNs). Materials and Methods: Eight facilities participated in this study. A total of 795 patients with 1229 SSNs were assessed for the frequency of invasive adenocarcinomas. SSNs were classified into three categories: pure ground-glass nodules (PGGNs), heterogeneous GGNs (HGGNs) (solid component detected only in lung windows), and part-solid nodules. Results: The mean prospective follow-up period was 4.3 ± 2.5 years. SSNs were classified at baseline as follows: 1046 PGGNs, 81 HGGNs, and 102 part-solid nodules. Among the 1046 PGGNs, 13 (1.2%) developed into HGGNs and 56 (5.4%) developed into part-solid nodules. Among the 81 HGGNs, 16 (19.8%) developed into part-solid nodules. Thus, the SSNs at the final follow-up were classified as follows: