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European Radiology
Published in: European Radiology 11/2016

Open Access 01-11-2016 | Chest

Fleischner recommendations for the management of subsolid pulmonary nodules: high awareness but limited conformance – a survey study

Authors: Onno M. Mets, Pim A. de Jong, Kaman Chung, Jan-Willem J. Lammers, Bram van Ginneken, Cornelia M. Schaefer-Prokop

Published in: European Radiology | Issue 11/2016

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Abstract

Objectives

The aim of this study was to assess awareness and conformance to the Fleischner society recommendations for the management of subsolid pulmonary nodules (SSN) in clinical practice.

Methods

An online questionnaire with four imaging cases was sent to 1579 associates from the European Respiratory Society and 757 from the European Society of Thoracic Imaging. Each respondent was asked to choose from several options which one they thought was the indicated management for the nodule presented. Awareness and conformance to the Fleischner recommendations (FR) were assessed and correlated to respondents characteristics.

Results

In total, 119 radiologists (response rate 16.0 %) and 243 pulmonologists (response rate 16.5 %) were included. Awareness of the FR was higher in radiologists than in pulmonologists (93 % vs. 70 %, p < 0.001), as was implementation in daily practice (66 % vs. 47 %, p < 0.001). Radiologists conformed to FR in rates of 31, 69, 68, and 82 %, and pulmonologists in 12, 43, 70, and 75 % for cases 1 to 4, respectively. Overmanagement was common. Conformance in SSN management was associated with awareness, working in an academic practice, larger practice size, teaching residents, and higher SSN exposure.

Conclusions

Although awareness of the Fleischner recommendations for SSN management is widespread, management choices in clinical practice show large heterogeneity.

Key points

• Guideline awareness among clinicians is widespread, but conformance shows large heterogeneity.
• Awareness and conformance is significantly higher among radiologists than pulmonologists.
• Overmanagement is common, which may lead to avoidable financial and physical burden.
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Metadata
Title
Fleischner recommendations for the management of subsolid pulmonary nodules: high awareness but limited conformance – a survey study
Authors
Onno M. Mets
Pim A. de Jong
Kaman Chung
Jan-Willem J. Lammers
Bram van Ginneken
Cornelia M. Schaefer-Prokop
Publication date
01-11-2016
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4249-y

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