title: Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts.
abstract: BACKGROUND
  The process of diagnosis and management of solitary pulmonary nodules (SPNs) between 1 and 3 cm is not standardized. This multicentre study investigated how diagnosis of newly discovered SPNs is managed in routine practice.
  
  
  METHODS
  We examined 11,515 radiology reports of patients undergoing chest computed tomography (CT) at all 76 radiology centres in 18 French administrative districts covering 8,220,000 people. Information on diagnostic procedures and treatment administered from discovery to definitive diagnosis of SPN was collected prospectively.
  
  
  RESULTS
  We identified 152 cases of newly diagnosed SPNs. Follow-up was complete for 112 patients. The median number of diagnostic tests was 4 and the mean time to diagnosis was 41.4 days. Marked variability was observed in the sequence of diagnostic tests, and 8 diagnostic pathways were identified. Patients' characteristics and radiological features of SPNs influenced the number of tests performed. Referral by specialist, history of smoking and spiculated SPN predicted the performance of at least one invasive procedure (P < 0.01). Definitive diagnosis was a malignant disease in 30 patients (26%).
  
  
  CONCLUSIONS
  The diagnosis of SPN is a complex process that physicians approach in markedly different ways. Implementing practice guidelines for managing the diagnosis of SPN requires clarification.
authors.affiliation: EA 4003, Nancy-University, Faculté de médecine, 9 avenue de la Forêt de Haye B,P, 184, 54500 Vandoeuvre lès Nancy, France. k.alzahouri@chu-nancy.fr
authors.forename: Kazem
authors.initials: K
authors.lastname: Alzahouri
authors.forename: Michel
authors.initials: M
authors.lastname: Velten
authors.forename: Patrick
authors.initials: P
authors.lastname: Arveux
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Woronoff-Lemsi
authors.forename: Damien
authors.initials: D
authors.lastname: Jolly
authors.forename: Francis
authors.initials: F
authors.lastname: Guillemin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019091:Critical Pathways / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D003948:Diagnostic Techniques, Respiratory System; D005260:Female; D005602:France; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed