Multidisciplinary Team-Based Management of Incidentally Detected Lung Nodules

Chest. 2020 Apr;157(4):985-993. doi: 10.1016/j.chest.2019.11.032. Epub 2019 Dec 17.


Background: Each year, > 1.5 million Americans are diagnosed with an incidentally detected lung nodule. Practice guidelines attempt to balance the benefit of early detection of lung cancer with the risks of diagnostic testing, but adherence to guidelines is low. The goal of this study was to determine guideline adherence rates in the setting of a multidisciplinary nodule clinic and describe reasons for nonadherence as well as associated outcomes.

Methods: This cohort study included 3 years of follow-up of patients aged ≥ 35 years with an incidentally detected lung nodule evaluated in a multidisciplinary clinic that used the 2005 Fleischner Society Guidelines.

Results: Among 113 patients, 67% (95% CI, 58-76) were recommended a guideline-concordant nodule evaluation; 7.1% (95% CI, 3.1-13) and 26% (95% CI, 18-25) were recommended less or more intense evaluation, respectively. In contrast, 58% (95% CI, 48-67), 22% (95% CI, 18-25), and 23% (95% CI, 16-32) received a guideline-concordant, less intense, or more intense evaluation. The most common reason for recommending guideline-discordant care was concern for two different diagnoses that would each benefit from early detection and treatment. A majority of lung cancer diagnoses (88%) occurred in patients who received guideline-concordant care. There were no lung cancer cases in those who received less intense nodule care.

Conclusions: A multidisciplinary nodule clinic may serve as a system-level intervention to promote guideline-concordant care, while also providing a multidisciplinary basis by which to deviate from guidelines to address the needs of a heterogeneous patient population.

Keywords: clinical decision-making; guidelines; lung neoplasm; lung nodule.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Cohort Studies
  • Early Detection of Cancer* / methods
  • Early Detection of Cancer* / statistics & numerical data
  • Early Medical Intervention / statistics & numerical data
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Health Services Needs and Demand
  • Humans
  • Incidental Findings
  • Lung Neoplasms / diagnosis*
  • Male
  • Middle Aged
  • Patient Care Team
  • Practice Guidelines as Topic
  • Risk Assessment
  • Solitary Pulmonary Nodule* / diagnosis
  • Solitary Pulmonary Nodule* / epidemiology
  • United States / epidemiology