BACKGROUND Each year, over 1.5 million Americans are diagnosed with an incidentally-detected lung nodule. Practice guidelines attempt to balance the benefit of early detection of lung cancer with the risks of diagnostic testing, but adherence to guidelines is low. We sought to determine guideline-adherence rates in the setting of a multidisciplinary nodule clinic and describe reasons for non-adherence as well as associated outcomes. METHODS We performed a cohort study with 3 years of follow-up on patients ≥35 years of age with an incidentally-detected lung nodule evaluated in a multidisciplinary clinic that used the 2005 Fleischner Society Guidelines. RESULTS Among 113 patients, 67% (95% confidence interval [CI] 58-76%) were recommended a guideline-concordant nodule evaluation whereas 7.1% (95% CI 3.1-13%) and 26% (95% CI 18-25) were recommended less or more intense evaluation, respectively. In contrast, 58% (95% CI 48-67%), 22% (95% CI 18-25%), and 23% (95% CI 16-32%) received a guideline-concordant, less intense, or more intense evaluation, respectively. The most common reason for recommending guideline-discordant care was concern for two different diagnoses that would each benefit from early detection and treatment. A majority of lung cancer diagnoses (88%) occurred in patients who received guideline-concordant care. There were no lung cancer cases in those who received less intense nodule care. CONCLUSIONS A multidisciplinary nodule clinic may serve as a system-level intervention to promote guideline-concordant care, while also providing a multidisciplinary basis by which to deviate from guidelines in order to address the needs of a heterogeneous patient population.

中文翻译：

---

偶然发现的肺结节的多学科团队管理

背景 每年，超过 150 万美国人被诊断出患有偶然检测到的肺结节。实践指南试图平衡早期发现肺癌的好处和诊断测试的风险，但对指南的依从性很低。我们试图确定多学科结节诊所的指南遵守率，并描述不遵守的原因以及相关结果。方法 我们对在使用 2005 年弗莱施纳学会指南的多学科诊所中偶然发现的肺结节的≥35 岁患者进行了一项队列研究，随访 3 年。结果 在 113 名患者中，67%（95% 置信区间 [CI] 58-76%）被推荐进行符合指南的结节评估，而 7.1%（95% CI 3. 1-13%) 和 26% (95% CI 18-25) 分别被推荐为更少或更高强度的评估。相比之下，58% (95% CI 48-67%)、22% (95% CI 18-25%) 和 23% (95% CI 16-32%) 接受了与指南一致、强度较低或更高的强烈评价，分别。推荐与指南不一致的护理的最常见原因是担心两种不同的诊断，每种诊断都会受益于早期检测和治疗。大多数肺癌诊断 (88%) 发生在接受指南一致护理的患者中。在那些接受不太强烈的结节护理的人中没有肺癌病例。结论 多学科结节诊所可作为系统级干预，以促进与指南一致的护理，