Abstract
BackgroundThe process of diagnosis and management of solitary pulmonary nodules (SPNs) between 1 and 3 cm is not standardized. This multicentre study investigated how diagnosis of newly discovered SPNs is managed in routine practice.MethodsWe examined 11,515 radiology reports of patients undergoing chest computed tomography (CT) at all 76 radiology centres in 18 French administrative districts covering 8,220,000 people. Information on diagnostic procedures and treatment administered from discovery to definitive diagnosis of SPN was collected prospectively.ResultsWe identified 152 cases of newly diagnosed SPNs. Follow-up was complete for 112 patients. The median number of diagnostic tests was 4 and the mean time to diagnosis was 41.4 days. Marked variability was observed in the sequence of diagnostic tests, and 8 diagnostic pathways were identified. Patients' characteristics and radiological features of SPNs influenced the number of tests performed. Referral by specialist, history of smoking and spiculated SPN predicted the performance of at least one invasive procedure (P < 0.01). Definitive diagnosis was a malignant disease in 30 patients (26%).ConclusionThe diagnosis of SPN is a complex process that physicians approach in markedly different ways. Implementing practice guidelines for managing the diagnosis of SPN requires clarification.
Highlights
The process of diagnosis and management of solitary pulmonary nodules (SPNs) between 1 and 3 cm is not standardized
We considered the radiologic definition described by a committee of the Fleischner Society on computed tomography (CT) nomenclature: "coin lesion" or Solitary pulmonary nodule (SPN) defined as a "single round opacity, at least moderately well marginated and no greater than 3 cm in maximum diameter"
The present paper describes the diagnostic process in a representative sample of patients with newly diagnosed SPN identified from 11,515 radiology reports of chest CT at all radiology centres in northeastern France
Summary
The process of diagnosis and management of solitary pulmonary nodules (SPNs) between 1 and 3 cm is not standardized. Because SPN is the initial radiographic finding in 10% to 20% of patients with lung cancer [4], the aim of evaluation and management is to promptly identify and bring to surgery all patients with operable malignant nodules, while avoiding unnecessary thoracotomy in those with benign nodules [5]. Concern about malignancy may lead physicians to adopt a surgical approach, but many radiographically detected lesions initially suspected to be cancerous are later proven not. Malignant disease is estimated to occur in 20% of patients with SPNs in the population and in 40% of those in surgical series [3,7,8]
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