Introduction and objectives Pulmonary nodules detected on computed tomography (CT) scanning should be followed-up appropriately, particularly to ensure cases of malignancy are not missed. Direction for this comes through British Thoracic Society (BTS)1 and Fleischner Society guidelines.2 We sought to assess whether appropriate advice was provided for follow-up of lung nodules identified on CT images.
Methods All CT scans undertaken at Wexham Park and Heatherwood Hospitals between July and October of 2015 were searched for the term ‘lung nodule’. This search yielded 152 matches. Scans were subsequently excluded if they were reported as showing ‘no lung nodule(s)’, a nodule in the context of known or metastatic malignancy, and nodules reported as calcified granulomas. The remaining 42 scans were assessed to determine whether advice on follow-up was provided in the radiological report, and whether this was in keeping with existing guidance.
Results Of the 42 reports included, only fourteen of these (33%) provided any guidance on follow-up. Of these, nine (21% of reports) complied with BTS or Fleischner Society recommendations. The reasons for non-compliance with guidelines when advice was provided were no timescales or follow-up modalities suggested (four of five) and incorrect follow-up time (one of five). Results are summarised in Figure 1.
Conclusions From our results it is evident that no or incorrect follow-up advice is being given, based on radiological appearances, for the majority (79%) of pulmonary nodules seen on CT imaging. Clearly the potential consequences of this may include malignancy not being detected and managed in a timely fashion. It is therefore fundamental that each unit has a system, based on existing guidelines, to ensure correct advice is provided based on radiological findings.
Callister MEJ, Baldwin DR, Akram AR, et al. British thoracic society guidelines for the investigation and management of pulmonary nodules. Thorax 2015;70(Suppl 2):ii1–ii54.
Macmahon H, Austin JH, Gamsu G, et al. Guidelines for the management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 2005;237(2):395–400.