Incidental Pulmonary Nodule Detection and Factors Influencing Follow-Up: A Retrospective Study in an Academic Medical Center

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Incidental pulmonary nodules (IPNs) are commonly identified on computerized tomography (CT) scans. Their follow-up in concordance to guidelines is important. Non-concordant (NC) follow-up of IPNs could represent a missed opportunity for early lung cancer detection. What is the real-world adherence to Fleischner 2017 guidelines in patients with IPNs and what are the factors that influence guideline concordant follow up? We conducted a single center retrospective cohort study at a tertiary care hospital in Central Ohio, on patients with IPN, 6 mm or more in size, detected on CT of chest, neck or abdomen between January 1 and December 31, 2018. Our primary outcome was NC follow-up, defined as lack of adherence to Fleischner 2017 guidelines. We estimated the odds of NC follow-up by patient demographics, disease characteristics and follow-up patterns associated with NC follow-up. We identified 696 patients with IPNs meeting our inclusion criteria. 395(56.8%) patients had NC follow-up. The odds of NC follow-up were significantly higher for IPN identified on CT abdomen (OR 1.98, p=0.001) or CT neck (OR 2.61, p=0.016). Nodules with size more than 8mm (OR 0.33, p<0.001), multiplicity (OR 0.55, p=0.010), spiculation (OR 0.25, p<0.001), upper lobe location (OR 0.70, p=0.018), radiographic emphysema (OR 0.71, p=0.040), family history of lung cancer (OR 0.57, p=0.011) and high-risk (Mayo Clinic model score) (OR 0.21, p<0.001) were less likely to have NC follow-up. Including the recommended follow-up of IPN in the "impression" of the CT report reduced the odds of NC follow-up by 45% (p=0.004). The rate of NC follow-up for IPNs in this study is high at 56.8%. We identified critical modifiable factors linked to NC follow-up.

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