Lung nodule size predicts adherence to guidelines for managing them
Patient Safety and Quality
When evaluating pulmonary nodules on computerized tomography (CT) scans, radiologists can benefit from several guidelines for recommending management of these nodules to facilitate early detection of malignancies. The most notable of these were developed by the Fleischner Society in 2005. Only 34 percent of radiologists at an academic tertiary hospital adhered to the guidelines from the Fleischner Society, according to a new study. What's more, over half of the cases that adhered to the guidelines did not mention the Fleischner guidelines in the report.
The setting for this study was a 752-bed adult urban tertiary academic medical center with 7 outpatient imaging locations. A total of 653 chest and 432 abdominal CT scans were randomly selected from the emergency department and outpatient clinics during a 6-month period. Two researchers performed independent manual reviews of the radiology reports with findings of pulmonary nodules. Recommendations in each report were reviewed to determine adherence to the Fleischner guidelines.
The researchers identified 331 reports with confirmed pulmonary nodules (277 for chest CT and 38 for abdominal CT). Sixteen of these were false-positives, 62 were from patients with coexisting malignancies, and 13 were in patients under age 35. These were all excluded from the final analysis of 240 reports with pulmonary nodules.
The average nodule size was 6.6-mm for chest CT and 6.7-mm for abdominal CT. Only 34 percent of recommendations for followup of pulmonary nodules were adherent to the Fleischner guidelines. Nodule size was significantly associated with adherence. The odds of adherence to the guidelines doubled when the nodule was greater than 4-mm to 6-mm in size compared to when the nodule size was 4-mm or less. Of the 240 reports, only 34 actually mentioned the term Fleischner.
The researchers recommend more efforts to monitor and improve adherence to the guidelines. The study was supported in part by AHRQ (HS19635).
See "Factors associated with radiologists' adherence to Fleischner Society guidelines for management of pulmonary nodules," by Ronilda Lacson, M.D., Ph.D., Luciano M. Prevedello, M.D., Katherine P. Andriole, Ph.D., and others in the July 2012 Journal of the American College of Radiology 9(7), pp. 468-473.