Incidental pulmonary nodule management in Canada: exploring current state through a narrative literature review and expert interviews

Geneviève C Digby; Jeffrey Habert; Jyoti Sahota; Lucía Zhu; Daria Manos

doi:10.21037/jtd-23-1453

Incidental pulmonary nodule management in Canada: exploring current state through a narrative literature review and expert interviews

J Thorac Dis. 2024 Feb 29;16(2):1537-1551. doi: 10.21037/jtd-23-1453. Epub 2024 Feb 27.

Authors

Geneviève C Digby¹, Jeffrey Habert², Jyoti Sahota³, Lucía Zhu⁴, Daria Manos⁵

Affiliations

¹ Department of Medicine, Division of Respirology, Queen's University, Kingston, ON, Canada.
² Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
³ Health Economics and Market Access, Amaris Consulting, Toronto, ON, Canada.
⁴ Health Economics and Market Access, Amaris Consulting, Barcelona, Spain.
⁵ Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada.

Abstract

Background and objective: Incidental pulmonary nodules (IPNs) are common and increasingly detected with the overall rise of radiologic imaging. Effective IPN management is necessary to ensure lung cancer is not missed. This study aims to describe the current landscape of IPN management in Canada, understand barriers to optimal IPN management, and identify opportunities for improvement.

Methods: We performed a narrative literature review by searching biomedical electronic databases for relevant articles published between January 1, 2010, and November 22, 2023. To validate and complement the identified literature, we conducted structured interviews with multidisciplinary experts involved in the pathway of patients with IPNs across Canada. Interviews between December 2021 and May 2022 were audiovisual recorded, transcribed, and thematically analyzed.

Key content and findings: A total of 1,299 records were identified, of which 37 studies were included for analysis. Most studies were conducted in Canada and the United States and highlighted variability in radiology reporting of IPNs and patient management, and limited adherence to recommended follow-up imaging. Twenty experts were interviewed, including radiologists, respirologists, thoracic surgeons, primary care physicians, medical oncologists, and an epidemiologist. Three themes emerged from the interviews, supported by the literature, including: variability in radiology reporting of IPNs, suboptimal communication, and variability in guideline adherence and patient management.

Conclusions: Despite general awareness of guidelines, there is inconsistency and lack of standardization in the management of patients with IPNs in Canada. Multidisciplinary expert consensus is recommended to help overcome the communication and operational barriers to a safe and cost-effective approach to this common clinical issue.

Keywords: Incidental pulmonary nodule (IPN); expert interviews; literature review; patient management; radiology.

Publication types

Review