The Reading Hospital and Medical Center, West Reading, PA, USA.
J Am Coll Radiol. 2012 May;9(5):336-9. doi: 10.1016/j.jacr.2011.12.026.
Solitary pulmonary nodules are a common incidental finding on CT and unnecessary follow-up affects cost, radiation exposure, and patient anxiety. The aim of this study was to evaluate the adherence of one institution's radiologists with published criteria in their follow-up recommendations.
A data set of 3,000 CT scans with the word nodule used in the report history or conclusion from 2008 to 2010 was generated. This pool was increased as each study was traced back to the examination when the pulmonary nodule was first identified. The follow-up recommendation of the radiologist was then classified as "adherent," "incomplete/no recommendation," "earlier than recommended by the criteria," "later than recommended," or a "wider follow-up time frame than recommended."
After the implementation of exclusion criteria, 1,432 examinations were satisfactory for classification. The adherence rates of radiologists for nodules followed in up to 4 consecutive examinations were 57%, 48%, 70%, and 79%, respectively. Overmanagement was the most common deviation from the Fleischner criteria, ranging from 15% to 28% of evaluated reports.
Radiologists at the authors' hospital do not always adhere to the Fleischner criteria, most often recommending closer follow-up. The possibility of missing a malignancy while it is still treatable, medicolegal concerns, and lack of familiarity with the Fleischner criteria are all potential factors in nonadherence.
孤立性肺结节是 CT 上常见的偶然发现，如果进行不必要的随访，会增加成本、辐射暴露和患者焦虑。本研究旨在评估一家机构的放射科医生在随访建议中遵循已发表标准的情况。
从 2008 年至 2010 年的报告病史或结论中使用“结节”一词生成了 3000 例 CT 扫描数据集。随着每一项研究追溯到首次发现肺结节的检查，该数据集不断增加。然后将放射科医生的随访建议分类为“遵循”、“不完整/无建议”、“早于标准推荐”、“晚于标准推荐”或“随访时间范围宽于标准推荐”。
在实施排除标准后，有 1432 项检查可进行分类。在最多连续 4 次检查中对结节进行随访的放射科医生的遵循率分别为 57%、48%、70%和 79%。过度管理是最常见的不符合 Fleischner 标准的情况，在所评估的报告中占 15%至 28%。
作者医院的放射科医生并不总是遵循 Fleischner 标准，最常建议更密切的随访。在可治疗的情况下错过恶性肿瘤的可能性、医疗法律问题以及对 Fleischner 标准的不熟悉都是不遵循的潜在因素。
