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Invasive sampling remains common for pulmonary nodule management

Despite advances in non-surgical management for pulmonary nodules, researchers found that many specialists treat low-risk nodules with invasive sampling and surgical resection, according to recent research.

“One in four patients referred with a nodule to a community pulmonologist has cancer, making management decisions critical to patient outcomes. To spare patients unnecessary testing, use of a higher [pretest probability of malignancy] to define a nodule as low risk seems reasonable,” Nichole T. Tanner, MD, MSCR, of the department of medicine and division of pulmonary and critical care medicine at the Medical University of South Carolina in Charleston, and colleagues wrote. “There is a wide variation in how nodules are managed and the choice of management may be influenced by a variety of factors in addition to pretest probability. Future research should focus on what influences decision making in [pulmonary module] management so that interventions may be developed to promote proper guideline adherence and avoidance of unnecessary invasive procedures.”

Tanner and colleagues sought to measure the prevalence of malignancy, nodule pretest probability of malignancy and procedure test use for intermediate pulmonary nodules, according to the abstract. Thus, they analyzed records from 377 patients aged between 40 years and 89 years who had nodules between 8 mm and 20 mm in size.

Ninety-four patients (25%) had malignant pulmonary nodules; 175 patients (46%) underwent surveillance alone and 125 patients (33.2%) underwent biopsy. Seventy-seven patients (20.4%) underwent surgery and 27 of those patients (35%) had benign disease. The researchers noted that there was a false-positive rate of 39% (95% CI, 27.1-52.1) for the 141 patients (37%) who underwent a PET scan.

According to results from the pretest probability of malignancy, 36 patients (9.5%) had a low risk, 300 patients (79.6%) had a moderate risk and 41 patients (10.8%) had a high risk for malignancy, according to the abstract. There was a 17% rate of surgical resection in the low risk group, a 21% rate in the moderate risk group and a 17% rate in the high risk group. – by Jeff Craven

Disclosure: Tanner and other researchers report consultant fees from Integrated Diagnostics Inc. Please see the full study for a list of all other researchers’ relevant financial disclosures.