Lung Nodule Evaluation Guideline Adherence Is High in Multidisciplinary Clinics

The majority of patients with an incidentally detected lung nodule are likely to receive guideline-based evaluation if they are assessed at a multidisciplinary nodule clinic, study results published in CHEST suggest.

Patients aged ≥35 years who were referred to the Seattle Cancer Care Alliance Lung Cancer Early Detection and Prevention Clinic in Washington were included in this cohort study. Researchers included only patients with an incidentally detected lung nodule evaluated in a multidisciplinary clinic, focusing attention on nodules evaluated using the 2005 Fleischner Society Guidelines (n=113). The intensity of nodule evaluation recommended by the multidisciplinary clinic was assessed relative to recommendations in the guideline. Diagnostic outcomes, imaging use, adverse events associated with invasive procedures, and 3-year overall survival were also assessed.

Approximately 67% of patients (95% CI, 58%-76%) received a nodule evaluation concordant with guidelines. Conversely, 7% (95% CI, 3.1%-13%) received a less intense evaluation vs 26% (95% CI 18%-25%) for whom a more intense evaluation was recommended. Less intense evaluation was defined as either no follow-up or a longer-than-recommended interval for reimaging. More intense evaluation was defined as a shorter-than-recommended interval for follow-up, the use of advanced imaging or invasive tests when a computed tomography scan or no follow-up is recommended, or surveillance >2 years.

Concern for 2 different diagnoses that would possibly benefit from early detection and management was the most common reason for recommending care discordant with the guideline. Approximately 88% of patients who received guideline-concordant evaluations had a lung cancer diagnosis. The percentage of patients who received a guideline-concordant, less intense, or more intense nodule evaluation was 58% (95% CI, 48%-67%), 20% (95% CI 13%-28%), and 23% (95% CI 16%-32%), respectively.

Study limitations included the lack of information describing why the clinic deviated from the guidelines and the use of the 2005 Fleischner Society Guidelines rather than the 2017 updated guidelines.

In addition to guideline adherence, the researchers suggested that multidisciplinary clinics “may be more likely to incorporate other system-level interventions believed to improve nodule management.”

Reference

Verdial FC, Madtes DK, Cheng G-S, et al. Multidisciplinary team based management of incidentally detected lung nodules [published online December 17, 2019]. CHEST. doi:10.1016/j.chest.2019.11.032