Observational studyChest2017
Physician Assessment of Pretest Probability of Malignancy and Adherence With Guidelines for Pulmonary Nodule Evaluation.
Observational study in Chest, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 68 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
68 citing papers in PubMed, 1 synthesis or guideline pooled it, 113 citations in OpenAlex.
- EarlyCDT Lung blood test for risk classification of solid pulmonary nodules: systematic review and economic evaluation.Health technology assessment (Winchester, England) · 2022Pooled it
- Are respiratory physicians adherent to guidelines when evaluating pulmonary nodules?Internal medicine journal · 2026Article
- Improving lung cancer screening diagnostic efficiency.Current opinion in pulmonary medicine · 2026Review
- Is This Calculator Broken?: Comparative Performance of Lung Nodule Risk Assessment Calculators in a High-Prevalence Cohort.CHEST pulmonary · 2026Article
- Use of the TREAT 2.0 Model to Create a Web-Based Lung Nodule Calculator for High-Risk Patients.Annals of thoracic surgery short reports · 2026Article
- Evaluation of Lung Cancer Probability Models and Guideline Recommendations in Settings With a High Prevalence of Cancer.CHEST pulmonary · 2026Article
- Improved reachability during bronchoscopy with a novel multisection robotic bronchoscope.JTCVS techniques · 2026Article
- Predicting pulmonary nodule growth from a single time point: a fusion model of radiomics and deep learning to optimize follow-up strategies.Journal of thoracic disease · 2026Article
- Clinicians' cancer risk assessment among patients with pulmonary nodules: a qualitative study.Annals of the American Thoracic Society · 2026Article
- Validation of a blood-based autoantibody test to assess lung cancer risk in 4-30 mm pulmonary nodules: a retrospective pooled analysis of four cohort studies.Future oncology (London, England) · 2026Article
- Cost-effectiveness analysis of artificial intelligence-assisted risk stratification of indeterminate pulmonary nodules.PloS one · 2026Article
- Comparison of three commercial AI tools for detection and malignancy assessment of incidental lung nodules.Frontiers in medicine · 2026Article
- Performance comparison of four published lung cancer prediction models applied to a cohort from the National Lung Screening Trial.Translational lung cancer research · 2025Article
- Management and Outcomes of Pulmonary Nodules in a Real-World Setting.Diagnostics (Basel, Switzerland) · 2025Article
- Validation of a High-Specificity Blood Autoantibody Test to Detect Lung Cancer in Pulmonary Nodules.CHEST pulmonary · 2025Article
- Analysis of the morbidity characteristics and related factors of pulmonary nodules in patients with type 2 diabetes mellitus: a retrospective study.BMC endocrine disorders · 2025Article
- Accurate puncture of targets in the lower lung lobes with respiratory motion using a teleoperated robotic system and low-dose computed tomography fluoroscopy: an experimental animal study.Quantitative imaging in medicine and surgery · 2025Article
- Global burden of pulmonary sarcoidosis from 1990 to 2021: a comprehensive analysis based on the GBD 2021 study.Frontiers in medicine · 2025Article
- Biomarkers in lung cancer diagnosis and bronchoscopy: Current landscape and future directions.Cancer biomarkers : section A of Disease markers · 2025Review
- Radiomics and artificial intelligence for risk stratification of pulmonary nodules: Ready for primetime?Cancer biomarkers : section A of Disease markers · 2025Review
8 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundThe annual incidence of pulmonary nodules is estimated at 1.57 million. Guidelines recommend using an initial assessment of nodule probability of malignancy (pCA). A previous study found that despite this recommendation, physicians did not follow guidelines.
methodsPhysician assessments (N = 337) and two previously validated risk model assessments of pretest probability of cancer were evaluated for performance in 337 patients with pulmonary nodules based on final diagnosis and compared. Physician-assessed pCA was categorized into low, intermediate, and high risk, and the next test ordered was evaluated.
resultsThe prevalence of malignancy was 47% (n = 158) at 1 year. Physician-assessed pCA performed better than nodule prediction calculators (area under the curve, 0.85 vs 0.75; P < .001 and .78; P = .0001). Physicians did not follow indicated guidelines when selecting the next test in 61% of cases (n = 205). Despite recommendations for serial CT imaging in those with low pCA, 52% (n = 13) were managed more aggressively with PET imaging or biopsy; 12% (n = 3) underwent biopsy procedures for benign disease. Alternatively, in the high-risk category, the majority (n = 103 [75%]) were managed more conservatively. Stratified by diagnosis, 92% (n = 22) with benign disease underwent more conservative management with CT imaging (20%), PET scanning (15%), or biopsy (8%), although three had surgery (8%).
conclusionsPhysician assessment as a means for predicting malignancy in pulmonary nodules is more accurate than previously validated nodule prediction calculators. Despite the accuracy of clinical intuition, physicians did not follow guideline-based recommendations when selecting the next diagnostic test. To provide optimal patient care, focus in the areas of guideline refinement, implementation, and dissemination is needed.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.