Data from: Management of pulmonary nodules by community pulmonologists

BACKGROUND: Pulmonary nodules (PNs) are a common reason for referral to
pulmonologists. The majority of data for the evaluation and management of
PNs is derived from studies performed in academic medical centers. Little
is known about the prevalence and diagnosis of PNs, the use of diagnostic
testing, or the management of PNs by community pulmonologists. METHODS:
This multicenter observational record review evaluated 377 patients aged
40 to 89 years referred to 18 geographically diverse community pulmonary
practices for intermediate PNs (8-20 mm). Study measures included the
prevalence of malignancy, procedure/test use, and nodule pretest
probability of malignancy as calculated by two previously validated
models. The relationship between calculated pretest probability and
management decisions was evaluated. RESULTS: The prevalence of malignancy
was 25% (n = 94). Nearly one-half of the patients (46%, n = 175) had
surveillance alone. Biopsy was performed on 125 patients (33.2%). A total
of 77 patients (20.4%) underwent surgery, of whom 35% (n = 27) had benign
disease. PET scan was used in 141 patients (37%). The false-positive rate
for PET scan was 39% (95% CI, 27.1%-52.1%). Pretest probability of
malignancy calculations showed that 9.5% (n = 36) were at a low risk,
79.6% (n = 300) were at a moderate risk, and 10.8% (n = 41) were at a high
risk of malignancy. The rate of surgical resection was similar among the
three groups (17%, 21%, 17%, respectively; P = .69). CONCLUSIONS: A
substantial fraction of intermediate-sized nodules referred to
pulmonologists ultimately prove to be lung cancer. Despite advances in
imaging and nonsurgical biopsy techniques, invasive sampling of low-risk
nodules and surgical resection of benign nodules remain common, suggesting
a lack of adherence to guidelines for the management of PNs.