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

Importance 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. Retrospective cohort study. Large academic medical center. Adults ([g...

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Bibliographic Details
Published in:PloS one 2022-09, Vol.17 (9), p.e0274107-e0274107
Main Authors: Wayne, Max T, Prescott, Hallie C, Arenberg, Douglas A
Format: Article
Language:English
Subjects:
Algorithms
Benign
Biology and Life Sciences
Biopsy
Cancer
Codes
Cohort analysis
Diagnosis
Electronic health records
Evaluation
Health aspects
Health care facilities
Invasiveness
Lesions
Life expectancy
Life span
Lung cancer
Lung nodules
Medical diagnosis
Medical referrals
Medicine and Health Sciences
Metastases
Nodules
Observational studies
Patient compliance
Patients
Research and Analysis Methods
Skin cancer
Smoking
Thoracic surgery
Tobacco
Tomography
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Summary:Importance 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. Retrospective cohort study. Large academic medical center. Adults ([greater than or equal to]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. 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
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0274107