Small Pulmonary Nodule Management A Survey of the Members of the Society of Thoracic Radiology With Comparison to the Fleischner Society Guidelines

Purpose: We surveyed the members of the Society of Thoracic Radiology regarding their interpretation of and management decision for small pulmonary nodules on computed tomography. We then compared their responses with the published guidelines set forth by the Fleischner Society. Materials and Methods: A survey consisting of 13 case scenarios in which small pulmonary nodules were encountered on computed tomography examination was electronically mailed to 625 members of the Society of Thoracic Radiology. Statistical analysis was performed to determine associations between responses, years of experience, location in an endemic region of granulomatous disease, and setting of practice. To assess the relationship between recommendation (defined as appropriate or not appropriate based on the Fleischner Society guidelines) and the characteristics of the radiologist, univariate analyses were first carried out. Characteristics with evidence of association with recommendation (defined as P < 0.10) were included in the multiple-variable analysis. Multiple-variable logistic regression was used to assess the simultaneous effects of reader characteristics on recommendation. A backward selection process was used applying a significance level of 0.05. This analysis was carried out for each question. Results: One hundred and eighty-one surveys were completed (29%). Overall, 27% of the participants had made the appropriate recommendation based on the Fleischner Society guidelines. There was an overall trend for over-management in the various clinical scenarios. Radiologists who had been in practice for longer periods of time were less likely to select the appropriate management, as were radiologists who practiced outside the United States. In addition, in certain scenarios, radiologists in endemic areas were less likely to over-manage than their counterparts in nonendemic regions. Conclusions: Among responding members of the Society of Thoracic Radiology, there was poor adherence to the published guidelines set forth by the Fleischner Society.