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Incidentally Detected Lung Nodules: Clinical Predictors of Adherence to Fleischner Society Surveillance Guidelines

Ridge, Carole A. FFRRCSI; Hobbs, Brian D. MD; Bukoye, Bolanle A. MS; Aronson, Mark D. MD; Boiselle, Phillip M. MD; Leffler, Daniel A. MD; Sternberg, Scot B. MS; Roberts, David H. MD

Journal of Computer Assisted Tomography: January/February 2014 - Volume 38 - Issue 1 - p 89–95
doi: 10.1097/RCT.0b013e3182a939a5
Thoracic Imaging

Objective The objective of this study was to determine adherence to incidentally detected lung nodule computed tomographic (CT) surveillance recommendations and identify demographic and clinical factors that increase the likelihood of CT surveillance.

Materials and Methods A total of 419 patients with incidentally detected lung nodules were included. Recorded data included patient demographic, radiologic, and clinical characteristics and outcomes at a 4-year follow-up. Multivariate logistic regression models determined the factors associated with likelihood of recommended CT surveillance.

Results At least 1 recommended surveillance chest CT was performed on 48% of the patients (148/310). Computed tomographic result communication to the patient (odds ratio [OR], 2.2; P = 0.006; confidence interval [CI], 1.3–4.0) or to the referring physician (OR, 2.8; P = 0.001; CI, 1.7–4.5) and recommendation of a specific surveillance time interval (OR, 1.7; P = 0.023; CI, 1.08–2.72) increased the likelihood of surveillance. Other demographic, radiologic, and clinical factors did not influence surveillance.

Conclusions Documented physician and patient result communication as well as the recommendation of a specific surveillance time interval increased the likelihood of CT surveillance of incidentally detected lung nodules.

From the *Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland; †Divisions of Pulmonary, Critical Care, and Sleep Medicine, ‡Department of Surgical Services, Boston Children’s Hospital; §Department of Medicine, ∥Section of Thoracic Imaging, and ¶Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA.

Received for publication April 23, 2013; accepted August 14, 2013.

Reprints: Carole A. Ridge, FFRRCSI, Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland (e-mail:

B.A.B. received a research assistant funding from the Overholt Thoracic Foundation and Controlled Risk Insurance Company.

The other authors report no conflicts of interest.

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