Management of patients with small pulmonary nodules: A survey of radiologists, pulmonologists, and thoracic surgeons

OBJECTIVE. The objective of our study was to survey recommendations for the management of small pulmonary nodules found on helical CT from radiologists, pulmonologists, and thoracic surgeons. MATERIALS AND METHODS. We surveyed 774 radiologists, 623 pulmonologists, and 101 thoracic surgeons. All are members of an associated Austrian scientific society and were asked for their recommendations in 13 hypothetical cases. Statistical analysis was focused on possible differences between medical specialities, residents and fellows, and male and female doctors and on a possible influence of the number of years in training or in medical practice. RESULTS. Complete surveys were returned from 91 radiologists, 74 pulmonologists, and 12 thoracic surgeons. The most frequent recommendation from radiologists was follow-up, whereas the most frequent recommendation from pulmonologists and surgeons was biopsy. The most frequently advised CT follow-up period was 3 months. Whereas thoracic surgeons preferred video-assisted thoracoscopy, radiologists and pulmonologists recommended less invasive procedures (bronchoscopy, CT-guided biopsy) to gain a specific diagnosis. CONCLUSION. There are significant differences in the management of small pulmonary nodules among radiologists, pulmonologists, and thoracic surgeons. Whereas radiologists tend to recommend short-term follow-up, pulmonologists and thoracic surgeons prefer a more aggressive approach, especially in patients with a higher likelihood of malignancy.