title: Managing Incidental Lung Nodules in Patients With a History of Oncologic Disease: A Survey of Thoracic Radiologists.
abstract: OBJECTIVE
  The aim of this study was to analyze the impact that a clinical history of an oncologic disease may have on the management decisions for incidentally detected lung nodules on chest computed tomographic (CT) examinations.
  
  
  METHODS
  An electronic survey was sent to all 796 members of the Society of Thoracic Radiology regarding criteria for the management of incidentally detected lung nodules in oncologic patients, as well as recommendations for nodule follow-up. Nodule characteristics and clinical parameters used by respondents were analyzed. Differences between variables were examined using the χ test.
  
  
  RESULTS
  Of the 796 Society of Thoracic Radiology members, 178 (22.36%) replied. Most respondents were subspecialized in cardiothoracic imaging (92.70%) and practiced in an "academic or teaching hospital setting" (75.28%) with a "dedicated oncology center" (94.03%). "History of oncologic disease" was the most important factor (98.87%) for management decisions. In patients with such a history, respondents most commonly used "experience and common sense" (56.74%) and reported "all incidentally found lung nodules" (65.73%, P<0.0001). "Size" and "shape" were the 2 most important nodule characteristics (33.61% and 27.05%, respectively) used to consider a nodule "clinically relevant," and "size" (44.07%) was also the most important nodule characteristic prompting recommendation for short-term CT follow-up. Follow-up CT examinations in oncologic patients were recommended by 75.84% of respondents.
  
  
  CONCLUSIONS
  In patients with a history of oncologic disease, radiologists tend to report every detected nodule and to routinely recommend follow-up CT examinations. Although most radiologists rely on "experience and common sense" in managing these nodules, greater standardization of lung nodule management in oncologic patients is needed, ideally through guidelines tailored to this patient population.
authors.affiliation: *Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA †Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy ‡Department of Radiology, Eberhard-Karls-University Tuebingen, Tuebingen, Germany §Department of Radiology, Houston Methodist Hospital and Research Institute, Houston, TX.
authors.forename: Mariaelena
authors.initials: M
authors.lastname: Occhipinti
authors.forename: Benedikt H
authors.initials: BH
authors.lastname: Heidinger
authors.forename: Christina
authors.initials: C
authors.lastname: Pfannenberg
authors.forename: Reginald F
authors.initials: RF
authors.lastname: Munden
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Eisenberg
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Bankier
mesh_terms: D019538:Health Care Surveys / Q000379:methods; D006801:Humans; D033162:Incidental Findings; D008168:Lung / Q000000981:diagnostic imaging; D055613:Multiple Pulmonary Nodules / Q000150:complications / Q000000981:diagnostic imaging*; D009369:Neoplasms / Q000150:complications*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D000072177:Radiologists / Q000706:statistics & numerical data*; D003074:Solitary Pulmonary Nodule / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed