Adherence to guidelines for incidental pulmonary nodules: insights from a Nordic survey

BACKGROUND AND PURPOSE: There is limited data on the real-world management of incidental pulmonary nodules (IPN). In this article, we review current practices and adherence to international guidelines in the Nordic countries.

MATERIALS AND METHODS: This non-interventional, observational survey study based on an online survey consisting of 13 questions. In total, 32 hospitals responded to the survey, with 11 from Denmark, 10 from Sweden, 7 from Norway, and 4 from Finland, resulting in an overall response rate of 86% (32/37). These institutions reported following a median of 20 new lung nodules monthly (5-400 IPN cases per month).

RESULTS: In Denmark and Sweden, 100% of respondents indicated the presence of national guidelines. In Norway, this rate was 86%, and in Finland 80%. Among the primary guidelines followed, 70% of respondents reported using national guidelines, 20% used international guidelines, and only 10% reported relying on local/institutional guidelines as their first choice. Most sites used a combination of international and national guidelines (75%, 24/32). Available international guidelines were equally represented, with 35% using the Fleischner Criteria, 30% using British Thoracic Society guidelines, and 35% using others (e.g. European Society for Medical Oncology, National Comprehensive Cancer Network). There was variation in which department held primary responsibility for IPN follow-up. The article also demonstrated differences in suggested follow-up cases from the survey.

INTERPRETATION: The study reveals strong adherence to guidelines among Nordic hospitals, with a notable preference for hybrid approaches that combine different guidelines. We need continued efforts to harmonize and update guidelines.