Research article

Management of SPN in France. Pathways for definitive diagnosis of solitary pulmonary nodule: a multicentre study in 18 French districts

Kazem Alzahouri^1,2, Michel Velten³, Patrick Arveux⁴, Marie-Christine Woronoff-Lemsi⁵, Damien Jolly⁶ and Francis Guillemin^1,2*

• * Corresponding author: Francis Guillemin francis.guillemin@chu-nancy.fr

Author Affiliations

¹ EA 4003, Nancy-University, Faculté de médecine, 9 avenue de la Forêt de Haye B.P. 184, 54500 Vandoeuvre lès Nancy, France

² Clinical Epidemiology Centre Inserm CIE6, Service d'Epidémiologie et Evaluation Cliniques, CHU de Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54000 Nancy, France

³ Département d'Information Médicale, Centre Paul Strauss, Strasbourg, France

⁴ Département d'Information Médicale, Centre Georges-François Leclerc, Dijon, France

⁵ Service Pharmacie, Unité Evaluation Médico-économique, CHU de Besançon, France

⁶ Département d'Informations Médicales, CHU de Reims, France

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BMC Cancer 2008, 8:93 doi:10.1186/1471-2407-8-93

Published: 10 April 2008

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%).

Conclusion

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.