1
|
Glandorf J, Vogel-Claussen J. Incidental pulmonary nodules - current guidelines and management. ROFO-FORTSCHR RONTG 2024; 196:582-590. [PMID: 38065544 DOI: 10.1055/a-2185-8714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND Due to the greater use of high-resolution cross-sectional imaging, the number of incidental pulmonary nodules detected each year is increasing. Although the vast majority of incidental pulmonary nodules are benign, many early lung carcinomas could be diagnosed with consistent follow-up. However, for a variety of reasons, the existing recommendations are often not implemented correctly. Therefore, potential for improvement with respect to competence, communication, structure, and process is described. METHODS This article presents the recommendations for incidental pulmonary nodules from the current S3 guideline for lung cancer (July 2023). The internationally established recommendations (BTS guidelines and Fleischner criteria) are compared and further studies on optimized management were included after a systematic literature search in PubMed. RESULTS AND CONCLUSION In particular, AI-based software solutions are promising, as they can be used in a support capacity on several levels at once and can lead to simpler and more automated management. However, to be applicable in routine clinical practice, software must fit well into the radiology workflow and be integrated. In addition, "Lung Nodule Management" programs or clinics that follow a high-quality procedure for patients with incidental lung nodules or nodules detected by screening have been established in the USA. Similar structures might also be implemented in Germany in a future screening program in which patients with incidental pulmonary nodules could be included. KEY POINTS · Incidental pulmonary nodules are common but are often not adequately managed. · The updated S3 guideline for lung cancer now includes recommendations for incidental pulmonary nodules. · Competence, communication, structure, and process levels offer significant potential for improvement. CITATION FORMAT · Glandorf J, Vogel-Claussen J, . Incidental pulmonary nodules - current guidelines and management. Fortschr Röntgenstr 2024; 196: 582 - 590.
Collapse
Affiliation(s)
- Julian Glandorf
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Vogel-Claussen
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| |
Collapse
|
2
|
Mortani Barbosa EJ, Kelly K. Statistical modeling can determine what factors are predictive of appropriate follow-up in patients presenting with incidental pulmonary nodules on CT. Eur J Radiol 2020; 128:109062. [PMID: 32422551 DOI: 10.1016/j.ejrad.2020.109062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess the performance of statistical modeling in predicting follow-up adherence of incidentally detected pulmonary nodules (IPN) on CT, based on patient variables (PV), radiology report related variables (RRRV) and physician-patient communication variables (PPCV). METHODS 200 patients with IPN on CT were retrospectively identified and randomly selected. PV (age, gender, smoking status, ethnicity), RRRV (nodule size, patient context, whether follow-up recommendations were provided) and PPCV (whether referring physician documented IPN and ordered follow-up on the electronic medical record) were recorded. Primary outcome was whether patients received appropriate follow-up within +/- 1 month of the recommended time frame. Statistical methods included logistic regression and machine learning (K-nearest neighbors and support vector machine). RESULTS Adherence was low, with or without recommendations provided in the radiology report (23.4 %-27.4 %). Whether the referring physician ordered follow-up was the dominant predictor of adherence in all models. The following variables were statistically significant predictors of whether referring physician ordered follow-up: recommendations provided in the radiology report, smoking status, patient context and nodule size (FDR logworth of respectively 21.18, 11.66, 2.35, 1.63, p < 0.05). Prediction accuracy varied from 72 % (PV) to 93 % (PPCV, all variables). CONCLUSION PPCV are the most important predictors of adherence. Amongst all variables, patient context, smoking status, nodule size, and whether the radiologist provided follow-up recommendations in the report were all statistically significant predictors of patient follow-up adherence, supporting the utility of statistical modeling for analytics, quality assurance and optimization of outcomes related to IPN.
Collapse
Affiliation(s)
| | - Kate Kelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| |
Collapse
|
3
|
Verdial FC, Madtes DK, Cheng GS, Pipavath S, Kim R, Hubbard JJ, Zadworny M, Wood DE, Farjah F. Multidisciplinary Team-Based Management of Incidentally Detected Lung Nodules. Chest 2019; 157:985-993. [PMID: 31862440 DOI: 10.1016/j.chest.2019.11.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/26/2019] [Accepted: 11/21/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Each year, > 1.5 million Americans are diagnosed with an incidentally detected lung nodule. Practice guidelines attempt to balance the benefit of early detection of lung cancer with the risks of diagnostic testing, but adherence to guidelines is low. The goal of this study was to determine guideline adherence rates in the setting of a multidisciplinary nodule clinic and describe reasons for nonadherence as well as associated outcomes. METHODS This cohort study included 3 years of follow-up of patients aged ≥ 35 years with an incidentally detected lung nodule evaluated in a multidisciplinary clinic that used the 2005 Fleischner Society Guidelines. RESULTS Among 113 patients, 67% (95% CI, 58-76) were recommended a guideline-concordant nodule evaluation; 7.1% (95% CI, 3.1-13) and 26% (95% CI, 18-25) were recommended less or more intense evaluation, respectively. In contrast, 58% (95% CI, 48-67), 22% (95% CI, 18-25), and 23% (95% CI, 16-32) received a guideline-concordant, less intense, or more intense evaluation. The most common reason for recommending guideline-discordant care was concern for two different diagnoses that would each benefit from early detection and treatment. A majority of lung cancer diagnoses (88%) occurred in patients who received guideline-concordant care. There were no lung cancer cases in those who received less intense nodule care. CONCLUSIONS A multidisciplinary nodule clinic may serve as a system-level intervention to promote guideline-concordant care, while also providing a multidisciplinary basis by which to deviate from guidelines to address the needs of a heterogeneous patient population.
Collapse
Affiliation(s)
- Francys C Verdial
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - David K Madtes
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Guang-Shing Cheng
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Sudhakar Pipavath
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Richard Kim
- Division of Pulmonary and Critical Care Medicine, Valley Medical Center, Renton, WA
| | - Jesse J Hubbard
- Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Megan Zadworny
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Douglas E Wood
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Farhood Farjah
- Department of Surgery, University of Washington School of Medicine, Seattle, WA.
| |
Collapse
|
4
|
Kohli M, Alkasab T, Wang K, Heilbrun ME, Flanders AE, Dreyer K, Kahn CE. Bending the Artificial Intelligence Curve for Radiology: Informatics Tools From ACR and RSNA. J Am Coll Radiol 2019; 16:1464-1470. [DOI: 10.1016/j.jacr.2019.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 01/22/2023]
|
5
|
Umscheid CA, Wilen J, Garin M, Goldstein JD, Cook TS, Liu Y, Chen Y, Myers JS. National Survey of Hospitalists' Experiences with Incidental Pulmonary Nodules. J Hosp Med 2019; 14:353-356. [PMID: 30794135 PMCID: PMC6824805 DOI: 10.12788/jhm.3115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/18/2018] [Indexed: 11/20/2022]
Abstract
Incidental pulmonary nodules (IPNs) are common and often require follow-up. The Fleischner Society guidelines were created to support IPN management. We developed a 14-item survey to examine hospitalists' exposure to and management of IPNs. The survey targeted attendees of the 2016 Society of Hospital Medicine (SHM) annual conference. We recruited 174 attendees. In total, 82% were identified as hospitalist physicians and 7% as advanced practice providers; 63% practiced for >5 years and 62% supervised trainees. All reported seeing ≥1 IPN case in the past six months, with 39% seeing three to five cases and 39% seeing six or more cases. Notwithstanding, 42% were unfamiliar with the Fleischner Society guidelines. When determining the IPN follow-up, 83% used radiology report recommendations, 64% consulted national or international guidelines, and 34% contacted radiologists; 34% agreed that determining the follow-up was challenging; only 15% reported availability of automated tracking systems. In conclusion, despite frequent IPN exposure, hospitalists are frequently unaware of the Fleischner Society guidelines and rely on radiologists' recommendations.
Collapse
Affiliation(s)
- Craig A Umscheid
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania
- Center for Healthcare Improvement and Patient Safety, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Corresponding Author: Craig A. Umscheid, MD, MSCE; E-mail: ; Telephone: 215-349-8098
| | - Jonathan Wilen
- New York Presbyterian - Columbia University Medical Center, New York, New York
| | - Matthew Garin
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Jenna D Goldstein
- Center for Quality Improvement, Society of Hospital Medicine, Philadelphia, Pennsylvania
| | - Tessa S Cook
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yulun Liu
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Yong Chen
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jennifer S Myers
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Center for Healthcare Improvement and Patient Safety, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
6
|
Bueno J, Landeras L, Chung JH. Updated Fleischner Society Guidelines for Managing Incidental Pulmonary Nodules: Common Questions and Challenging Scenarios. Radiographics 2018; 38:1337-1350. [PMID: 30207935 DOI: 10.1148/rg.2018180017] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The new guidelines for managing incidental pulmonary nodules published by the Fleischner Society in 2017 reflect an improved understanding of the risk factors and biologic features of lung cancer. Specific topics emphasized in the updated guidelines include a new threshold size for follow-up, the importance of the morphologic features of nodules, accurate nodule measurements, recognition of subsolid components, understanding interval growth or change in nodule morphology, and knowledge of patient risk factors. The updated guidelines enable greater personal flexibility in the decision-making process and encourage individualized management of pulmonary nodules. These factors may introduce new challenges for radiologists, who previously used solely nodule size to make management recommendations. The authors describe eight scenarios that illustrate the challenges potentially encountered when applying the new guidelines to pulmonary nodule management. ©RSNA, 2018.
Collapse
Affiliation(s)
- Juliana Bueno
- From the Department of Radiology and Medical Imaging, University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908 (J.B.); and Department of Radiology, University of Chicago, Chicago, Ill (L.L., J.H.C.)
| | - Luis Landeras
- From the Department of Radiology and Medical Imaging, University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908 (J.B.); and Department of Radiology, University of Chicago, Chicago, Ill (L.L., J.H.C.)
| | - Jonathan H Chung
- From the Department of Radiology and Medical Imaging, University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908 (J.B.); and Department of Radiology, University of Chicago, Chicago, Ill (L.L., J.H.C.)
| |
Collapse
|
7
|
|
8
|
Alkasab TK, Bizzo BC, Berland LL, Nair S, Pandharipande PV, Harvey HB. Creation of an Open Framework for Point-of-Care Computer-Assisted Reporting and Decision Support Tools for Radiologists. J Am Coll Radiol 2017. [DOI: 10.1016/j.jacr.2017.04.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
9
|
Motiwala H, Bansal I, Goyal P, Dorokhova O, Kumar Y, Olsavsky TD, DiMeo A, Gupta N. Do we really care about incidental lung nodules?-Review of atypical lung carcinoid and a proposal for systematic patient follow up. Transl Lung Cancer Res 2017; 6:387-392. [PMID: 28713683 DOI: 10.21037/tlcr.2017.05.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Atypical lung carcinoids are intermediate-grade neuroendocrine tumors (NETs) with malignant potential. They are often detected incidentally on imaging done for non-related causes, as the patients are frequently asymptomatic. Histopathology is required to confirm the diagnosis with immunohistochemistry (IHC). Due to their indolent nature, these are often diagnosed only in the advanced stages. Treatment options include chemoradiation for widespread disease versus surgery for local or minimally invasive disease. This article describes a nonsmoker female with enlarging solitary pulmonary nodule who was initially lost to follow up, subsequently operated and with final pathology revealing atypical lung carcinoid. This case stress on the schematic follow up of these incidentally detected pulmonary nodules. Inspired from the mandatory lay mammography report letters recommended by ACR, this article proposes sending lay letters to patients for pulmonary nodule follow up, directly from the Radiology Department to reinforce the importance of timely follow up, which will complement the information provided to the patient from their primary care physician or pulmonologist's office.
Collapse
Affiliation(s)
- Henal Motiwala
- Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Itisha Bansal
- Department of Anesthesiology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA
| | - Pradeep Goyal
- Department of Radiology, Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Olena Dorokhova
- Department of Pathology, Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Yogesh Kumar
- Department of Radiology, Yale New Haven Heath at Bridgeport Hospital, Bridgeport, CT, USA
| | - Thomas D Olsavsky
- Department of Nuclear Medicine and Thoracic Radiology, Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Albert DiMeo
- Department of Cardiovascular Surgery, St. Francis Hospital, Roslyn, NY, USA
| | - Nishant Gupta
- Department of Radiology, Saint Vincent's Medical Center, Bridgeport, CT, USA
| |
Collapse
|
10
|
Bobbin MD, Ip IK, Sahni VA, Shinagare AB, Khorasani R. Focal Cystic Pancreatic Lesion Follow-up Recommendations After Publication of ACR White Paper on Managing Incidental Findings. J Am Coll Radiol 2017; 14:757-764. [DOI: 10.1016/j.jacr.2017.01.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 12/18/2022]
|
11
|
Zufallsbefunde. Radiologe 2017; 57:302-308. [DOI: 10.1007/s00117-017-0227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
12
|
Clark TJ, Coats G. Adherence to ACR Incidental Finding Guidelines. J Am Coll Radiol 2016; 13:1530-1533. [DOI: 10.1016/j.jacr.2016.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 04/30/2016] [Accepted: 05/09/2016] [Indexed: 12/21/2022]
|
13
|
Rawson JV, Kannan A, Furman M. Use of Process Improvement Tools in Radiology. Curr Probl Diagn Radiol 2016; 45:94-100. [DOI: 10.1067/j.cpradiol.2015.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/20/2015] [Accepted: 09/22/2015] [Indexed: 11/22/2022]
|
14
|
Blagev DP, Lloyd JF, Conner K, Dickerson J, Adams D, Stevens SM, Woller SC, Evans RS, Elliott CG. Follow-up of Incidental Pulmonary Nodules and the Radiology Report. J Am Coll Radiol 2016; 13:R18-24. [DOI: 10.1016/j.jacr.2015.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
15
|
The Value of Imaging Part II: Value beyond Image Interpretation. Acad Radiol 2016; 23:23-9. [PMID: 26683509 DOI: 10.1016/j.acra.2015.09.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/09/2015] [Accepted: 09/20/2015] [Indexed: 12/21/2022]
Abstract
Although image interpretation is an essential part of radiologists' value, there are other ways in which we contribute to patient care. Part II of the value of imaging series reviews current initiatives that demonstrate value beyond the image interpretation. Standardizing processes, reducing the radiation dose of our examinations, clarifying written reports, improving communications with patients and providers, and promoting appropriate imaging through decision support are all ways we can provide safer, more consistent, and higher quality care. As payers and policy makers push to drive value, research that demonstrates the value of these endeavors, or lack thereof, will become increasingly sought after and supported.
Collapse
|
16
|
Radiologist Point-of-Care Clinical Decision Support and Adherence to Guidelines for Incidental Lung Nodules. J Am Coll Radiol 2015; 13:156-62. [PMID: 26577875 DOI: 10.1016/j.jacr.2015.09.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 09/16/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the effect of a workstation-integrated, point-of-care, clinical decision support (CDS) tool on radiologist adherence to radiology department guidelines for follow-up of incidental pulmonary nodules detected on abdominal CT. METHODS The CDS tool was developed to facilitate adherence to department guidelines for managing pulmonary nodules seen on abdominal CT. In October 2012, the tool was deployed within the radiology department of an academic medical center and could be used for a given abdominal CT at the discretion of the interpreting radiologist. We retrospectively identified consecutive patients who underwent abdominal CT (in the period from January 2012 to April 2013), had no comparison CT scans available, and were reported to have a solid, noncalcified, pulmonary nodule. Concordance between radiologist follow-up recommendation and department guidelines was compared among three groups: patients scanned before implementation of the CDS tool; and patients scanned after implementation, with versus without use of the tool. RESULTS A total of 409 patients were identified, including 268 for the control group. Overall, guideline concordance was higher after CDS tool implementation (92 of 141 [65%] versus 133 of 268 [50%], P = .003). This finding was driven by the subset of post-CDS implementation cases in which the CDS tool was used (57 of 141 [40%]). In these cases, guideline concordance was significantly higher (54 of 57 [95%]), compared with post-implementation cases in which CDS was not used (38 of 84 [45%], P < .001), and to a control group of patients from before implementation (133 of 268 [50%]; P < .001). CONCLUSIONS A point-of-care CDS tool was associated with improved adherence to guidelines for follow-up of incidental pulmonary nodules.
Collapse
|
17
|
Penn A, Ma M, Chou BB, Tseng JR, Phan P. Inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules. Acta Radiol 2015; 56:1180-6. [PMID: 25293951 DOI: 10.1177/0284185114551975] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/27/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2013, the Fleischner Society published recommendations for managing subsolid pulmonary nodules. Inter-reader variability has not yet been defined and has potential implications for the ease and reproducibility of applying the guidelines to clinical practice. PURPOSE To evaluate inter-reader variability when applying the 2013 Fleischner guidelines for potential solitary subsolid lung nodules. MATERIAL AND METHODS Potential nodules were identified through a systematic retrospective review of CT studies that reported a ground-glass lesion. Three radiologists decided whether these lesions fit criteria of a subsolid nodule and thus merit application of the Fleischner Society guidelines, determined if a solid component was present, and measured each component in two dimensions. Final management recommendations were based on these intermediate decisions. Inter-reader variability for management was calculated and Fleiss' kappa was used to determine significance. Logistic regression and Fisher's exact test determined whether management was contingent on each intermediate decision. RESULTS Forty-four nodules with mean diameter of 9.4 mm were evaluated by three radiologists. Final management recommendations were in agreement for 93 out of 132 cases (70.4%, kappa = 0.56). Inter-reader variability in management recommendation was contingent on disagreement over whether a pulmonary lesion fit criteria of a subsolid nodule for 24 cases (P < 0.01), whether there was a solid component for 10 cases (P = 0.01), and whether the measurement met the threshold of 5 mm for five cases (P = 0.12). CONCLUSION There is moderate inter-reader variability when applying the 2013 Fleischner Society management recommendations. Significant contributors of variability include whether the potential lesions fit subsolid nodule criteria and whether a solid component is present. Measurement variability does not significantly affect the final management decisions.
Collapse
Affiliation(s)
- Alex Penn
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Mingming Ma
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Benjamin B Chou
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Jeffrey R Tseng
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Peter Phan
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA, USA
| |
Collapse
|
18
|
Sharma A, Hostetter J, Morrison J, Wang K, Siegel E. Focused Decision Support: a Data Mining Tool to Query the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial Dataset and Guide Screening Management for the Individual Patient. J Digit Imaging 2015; 29:160-4. [PMID: 26385814 DOI: 10.1007/s10278-015-9826-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
The Prostate, Lung, Colorectal, and Ovarian Cancer (PLCO) Screening Trial enrolled ~155,000 participants to determine whether certain screening exams reduced mortality from prostate, lung, colorectal, and ovarian cancer. Repurposing the data provides an unparalleled resource for matching patients with the outcomes of demographically or diagnostically comparable patients. A web-based application was developed to query this subset of patient information against a given patient's demographics and risk factors. Analysis of the matched data yields outcome information which can then be used to guide management decisions and imaging software. Prognostic information is also estimated via the proportion of matched patients that progress to cancer. The US Preventative Services Task Force provides screening recommendations for cancers of the breast, colorectal tract, and lungs. There is wide variability in adherence of clinicians to these guidelines and others published by the Fleischner Society and various cancer organizations. Data mining the PLCO dataset for clinical decision support can optimize the use of limited healthcare resources, focusing screening on patients for whom the benefit to risk ratio is the greatest and most efficacious. A data driven, personalized approach to cancer screening maximizes the economic and clinical efficacy and enables early identification of patients in which the course of disease can be improved. Our dynamic decision support system utilizes a subset of the PLCO dataset as a reference model to determine imaging and testing appropriateness while offering prognostic information for various cancers.
Collapse
Affiliation(s)
- Arjun Sharma
- Department of Radiology, University of Maryland Medical Center, 22 S. Greene St, Baltimore, MD, 21201, USA.
| | | | - James Morrison
- Oregon Hospital and Science University, Portland, OR, USA
| | - Kenneth Wang
- University of Maryland Medical Center, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Eliot Siegel
- University of Maryland Medical Center, Baltimore VA Medical Center, Baltimore, MD, USA
| |
Collapse
|
19
|
Abstract
OBJECTIVE The goals of this article are to provide an overview of controversial aspects of imaging-based screening and to elucidate potential risks that may offset anticipated benefits. CONCLUSION Current controversial topics associated with imaging-based screening include false-positive results, incidental findings, overdiagnosis, radiation risks, and costs. Alongside the benefits of screening, radiologists should be prepared to discuss these additional diagnostic consequences with providers and patients to better guide shared decision making regarding imaging-based screening.
Collapse
|
20
|
Blagev DP, Lloyd JF, Conner K, Dickerson J, Adams D, Stevens SM, Woller SC, Evans RS, Elliott CG. Follow-up of Incidental Pulmonary Nodules and the Radiology Report. J Am Coll Radiol 2014; 11:378-83. [DOI: 10.1016/j.jacr.2013.08.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 08/01/2013] [Indexed: 12/21/2022]
|