Are respiratory physicians adherent to guidelines when evaluating pulmonary nodules?

Area of Science:

• Pulmonology
• Oncology
• Radiology

Background:

• Pulmonary nodules require appropriate evaluation to optimize patient outcomes, despite a low malignancy rate (<1%).
• The 2017 Fleischner Society Guidelines offer management recommendations for incidentally detected nodules.
• Variable adherence to these guidelines has been observed in previous studies, with no data reported for Australian nodule clinics.

Purpose of the Study:

• To assess adherence to the 2017 Fleischner Society Guidelines in an Australian pulmonary nodule clinic.
• To analyze patient demographics, nodule characteristics, and diagnostic outcomes.
• To evaluate the risk of lung cancer based on smoking history.

Main Methods:

• Retrospective analysis of medical records for new patients in a pulmonary nodule clinic (July 2017 - July 2020).
• Analysis of patient demographics, medical history, smoking status, and lung nodule characteristics.
• Evaluation of follow-up recommendations for guideline adherence and extraction of final diagnoses from multidisciplinary meeting data.

Main Results:

• High guideline adherence (97.2%) was observed in 361 patients.
• Malignancy was diagnosed in 26.9% of patients.
• Former smokers showed a significantly higher risk of lung cancer (48.1%) compared to never smokers (20.3%).

Conclusions:

• This study demonstrates excellent adherence to Fleischner Society Guidelines in an Australian physician-led pulmonary nodule clinic.
• The findings support the effectiveness of dedicated nodule clinics in managing lung nodules appropriately.
• Smoking history is a significant factor in lung cancer risk among patients with pulmonary nodules.