ArticleInternal medicine journal2026
Are respiratory physicians adherent to guidelines when evaluating pulmonary nodules?
Article in Internal medicine journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionAlthough fewer than 1% of pulmonary nodules are malignant, appropriate evaluation is essential in optimising patient outcomes. The 2017 Fleischner Society Guidelines provide recommendations on management of incidentally detected nodules; however, studies to date have shown variable guideline adherence. Adherence to guidelines in Australian nodule clinics has not been reported.
methodsA retrospective analysis of medical records was conducted for new patients evaluated in a pulmonary nodule clinic between 1 July 2017 and 1 July 2020. Patient demographics, past medical history, family history of malignancy, smoking history, baseline lung function tests, reasons for referral and lung nodule characteristics were analysed. Follow-up recommendations were evaluated to determine Guideline adherence. Final diagnoses, where available, were extracted from multidisciplinary meeting (MDM) data.
resultsThree hundred sixty-one patients were included (mean age 68.2 years, female 44.3%). One hundred ten patients (30.5%) were never smokers, 106 (29.3%) current smokers, and 140 (38.8%) former smokers. Most lung nodules were identified incidentally (77.0%) with mean diameter (±SD) 12.1 ± 6.4 mm averaged from the long and short axes. Adherence to guidelines was 97.2%. Ninety-seven patients (26.9%) were diagnosed with malignancy. Among patients diagnosed with lung cancer, former smokers had a higher risk (48.1%, relative risk (RR) 1.8; 95% confidence interval (CI) 1.08-3.1; P = 0.02) of lung cancer than never smokers (20.3%), with current smokers being intermediate in risk (31.6%, RR 1.6; 95% CI 0.96-2.84; P = 0.07).
conclusionOur findings from this first-in-Australia study demonstrate appropriate lung nodule follow-up in accordance with Fleischner Society Guidelines in a dedicated respiratory physician-led nodule clinic.
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