Blagev Denitza P, Lloyd James F, Conner Karen, Dickerson Justin, Adams Daniel, Stevens Scott M, Woller Scott C, Evans R Scott, Elliott C Gregory
Department of Medicine, Intermountain Medical Center, Murray, Utah; Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Intermountain Health Care Medical Informatics, Salt Lake City, Utah.
J Am Coll Radiol. 2014 Apr;11(4):378-83. doi: 10.1016/j.jacr.2013.08.003. Epub 2013 Dec 6.
Incidental pulmonary nodules that require follow-up are often noted on chest CT. Evidence-based guidelines regarding appropriate follow-up have been published, but the rate of adherence to guideline recommendations is unknown. Furthermore, it is unknown whether the radiology report affects the nodule follow-up rate.
A review of 1,000 CT pulmonary angiographic studies ordered in the emergency department was performed to determine the presence of an incidental pulmonary nodule. Fleischner Society guidelines were applied to ascertain if follow-up was recommended. Radiology reports were classified on the basis of whether nodules were listed in the findings section only, were noted in the impression section, or had explicit recommendations for follow-up. Whether the rate of nodule follow-up was affected by the radiology report was determined according to these 3 groups.
Incidental pulmonary nodules that required follow-up were noted on 9.9% (95% confidence interval, 8%-12%) of CT pulmonary angiographic studies. Follow-up for nodules was poor overall (29% [28 of 96]; 95% confidence interval, 20%-38%) and decreased significantly when the nodules were mentioned in the findings section only (0% [0 of 12]). Specific instructions to follow up nodules in radiology reports still resulted in a low follow-up rate of 29% (19 of 65; 95% confidence interval, 18%-40%).
Incidental pulmonary nodules detected on CT pulmonary angiography are common and are frequently not followed up appropriately. Although the inclusion of a pulmonary nodule in the impression section of a radiology report is helpful, it does not ensure follow-up. Better systems for appropriate identification and follow-up of incidental findings are needed.
胸部CT检查时经常会发现需要随访的偶然发现的肺结节。关于适当随访的循证指南已经发布，但对指南建议的遵循率尚不清楚。此外，放射学报告是否会影响结节的随访率也不清楚。
对急诊科进行的1000例CT肺血管造影研究进行回顾，以确定偶然发现的肺结节的存在情况。应用弗莱施纳学会指南来确定是否建议进行随访。放射学报告根据结节是否仅在检查结果部分列出、在印象部分被提及或有明确的随访建议进行分类。根据这三组情况确定放射学报告是否会影响结节的随访率。
在9.9%（95%置信区间，8%-12%）的CT肺血管造影研究中发现了需要随访的偶然发现的肺结节。总体而言，结节的随访情况较差（29%[96例中的28例]；95%置信区间，20%-38%），当结节仅在检查结果部分被提及的时候，随访率显著降低（0%[12例中的0例]）。放射学报告中对结节随访的具体指示仍然导致较低的随访率，为29%（65例中的19例；95%置信区间，18%-40%）。
CT肺血管造影检查中发现的偶然发现的肺结节很常见，且经常未得到适当随访。虽然在放射学报告的印象部分纳入肺结节是有帮助的，但并不能确保进行随访。需要更好的系统来适当识别和随访偶然发现的病变。
