Factors Associated With Radiologists' Adherence to Fleischner Society Guidelines for Management of Pulmonary Nodules
Factors Associated With Radiologists' Adherence to Fleischner Society Guidelines for Management of Pulmonary Nodules
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DOI：
10.1016/j.jacr.2012.03.009
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发表时间：
2012-07-01
影响因子：
4.5
通讯作者：
Khorasani, Ramin
中科院分区：
文献类型：
--
作者：
Lacson, Ronilda;Prevedello, Luciano M.;Khorasani, Ramin
目的：2005年，Fleischner学会发布了处理CT扫描发现的肺结节的指南（FSG）。本研究的目的是评估对FSG的依从性，调整可能有助于依从性的人口统计学和临床变量。方法：随机获取2010年1月至6月在某三级医院急诊科和门诊进行的1100例胸部和腹部CT扫描的影像学报告。使用自然语言处理的自动文档检索系统从数据集中识别肺结节患者。从使用自然语言处理检索的报告中，通过人工审查提取与评价FSG坚持变化相关的特征，包括年龄、性别、种族、结节大小、扫描部位（如急诊科）和类型。所有变量均输入逻辑回归模型。结果：315例确诊为肺结节，其中75例为并发恶性肿瘤或年龄< 35岁的患者。在剩下的240份报告中，34%的肺结节推荐方案遵循了FSG。结节大小与指南依从性相关，4-mm至6 mm的>结节组的依从性最高（P = 0.04），较小和较大的结节的依从性逐渐降低。结论：肺结节是胸部和腹部CT扫描的常见表现。尽管大多数放射科医生建议对这些发现进行随访成像，但在34%的放射学报告中，对肺结节的建议与FSG一致。在调整关键变量后，结节大小显示与指南依从性相关。
Purpose: In 2005, the Fleischner Society guidelines (FSG) for managing pulmonary nodules detected on CT scans were published. The aim of this study was to evaluate adherence to the FSG, adjusting for demographic and clinical variables that may contribute to adherence.Methods: Radiology reports were randomly obtained for 1,100 chest and abdominal CT scans performed between January and June 2010 in a tertiary hospital's emergency department and outpatient clinics. An automated document retrieval system using natural language processing was used to identify patients with pulmonary nodules from the data set. Features relevant to evaluating variation in adherence to the FSG, including age, sex, race, nodule size, and scan site (eg, the emergency department) and type, were extracted by manual review from reports retrieved using natural language processing. All variables were entered into a logistic regression model.Results: Three hundred fifteen reports were identified to have pulmonary nodules, 75 of which were for patients with concurrent malignancies or aged < 35 years. Of the remaining 240 reports, 34% of recommendations for pulmonary nodules were adherent to the FSG. Nodule size demonstrated an association with guideline adherence, with adherence highest in the >4-mm to 6-mm nodule group (P = .04) and progressively diminishing for smaller and bigger nodules.Conclusions: Pulmonary nodules are prevalent findings on chest and abdominal CT scans. Although most radiologists recommend follow-up imaging for these findings, recommendations for pulmonary nodules were consistent with the FSG in 34% of radiology reports. Nodule size demonstrated an association with guideline adherence, after adjusting for key variables.