title: Estimation of performance and sequential selection of diagnostic tests in patients with lung lesions suspicious for cancer.
abstract: BACKGROUND
  Measuring variation in clinician test ordering behavior for patients with similar indications is an important focus for quality management and cost containment.
  
  
  OBJECTIVE
  To obtain information from physicians and nonphysicians regarding their test-ordering behavior and their knowledge of test performance characteristics for diagnostic tests used to work up patients with lung lesions suspicious for cancer.
  
  
  METHODS
  A self-administered, voluntary, anonymous questionnaire was distributed to 452 multiple-specialty physicians and 500 nonphysicians in academic and private practice in Pennsylvania, Iowa, and North Carolina. Respondents indicated their estimates of test sensitivities for multiple tests used in the diagnosis of lung lesions and provided their test selection strategy for case simulations of patients with solitary lung lesions. Data were analyzed using descriptive statistics and the chi(2) test.
  
  
  RESULTS
  The response rate was 11.2%. Both physicians and nonphysicians tended to underestimate the sensitivities of all minimally invasive tests, with the greatest underestimations reported for sputum cytology and transthoracic fine-needle aspiration biopsy. There was marked variation in sequential test selection for all the case simulations and no association between respondent perception of test sensitivity and their selection of first diagnostic test. Overall, the most frequently chosen first diagnostic test was bronchoscopy.
  
  
  CONCLUSIONS
  Physicians and nonphysicians tend to underestimate the performance of diagnostic tests used to evaluate solitary lung lesions. However, their misperceptions do not appear to explain the wide variation in test-ordering behavior for patients with lung lesions suspicious for cancer.
authors.affiliation: Department of Pathology and Laboratory Medicine, Allegheny General Hospital and MCP Hahnemann University, Pittsburgh, PA 15212, USA. dgrzybic@wpahs.org
authors.forename: Dana Marie
authors.initials: DM
authors.lastname: Grzybicki
authors.forename: Thomas
authors.initials: T
authors.lastname: Gross
authors.forename: Kim R
authors.initials: KR
authors.lastname: Geisinger
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Raab
mesh_terms: D001707:Biopsy, Needle; D001999:Bronchoscopy; D003657:Decision Making; D003948:Diagnostic Techniques, Respiratory System; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D009367:Neoplasm Staging; D010823:Physician Assistants; D010818:Practice Patterns, Physicians'; D012680:Sensitivity and Specificity; D013183:Sputum / Q000166:cytology; D011795:Surveys and Questionnaires; D013906:Thoracoscopy; D013908:Thoracotomy