The follow-up of solitary pulmonary nodules at Mater Dei Hospital

Abstract

Background: Solitary pulmonary nodules (SPNs) are a common incidental radiological finding, occurring in 28% of smokers, 20% of ex-smokers and 36% of non-smokers. These nodules represent a diagnostic challenge. Under-evaluation may delay the diagnosis of early lung cancer whilst over-evaluation may increase expenditure, radiation and also patient concern. The aim of this audit was to evaluate whether the Fleischner Society Guidelines are adhered to in the follow-up of SPNs locally. Methodology: This retrospective study includes all SPNs diagnosed incidentally on Computed Tomography (CT) between January 2013 and December 2014, excluding patients with a history of malignancy. The follow-up of the nodules was compared with Fleischner Society Recommendations (FSR) as the gold standard. Standard Use: FSR 2005, which stratify nodules based on size and smoking history. Results: From a cohort of 100 patients, guideline-concordant care was found in 29%. SPNs were under-evaluated in 36% of cases, while over-evaluation occurred in 12%. Twenty-two SPNs had insufficient description for further evaluation. From the total cohort, lung malignancy was diagnosed in 47% and the risk of malignancy increased with increasing nodule size (10.6% in ≤4mm, 19% in 5-8mm, and 61.7% in >8mm). Key Messages and Recommendations: It is the responsibility of the ordering physician to give appropriate smoking history information on request. The reporting radiologist should then be clearly documenting the size and nodule characteristics, followed by timely follow-up according to FSR criteria. Appropriate specific booking request information and standardised medical imaging reporting systems should be implemented to ensure adequate follow-up of SPNs according to international recommendations.