{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T17:57:37Z","timestamp":1793210257488,"version":"4.5.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T00:00:00Z","timestamp":1662681600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008269","name":"Michigan Institute for Clinical and Health Research","doi-asserted-by":"publisher","award":["UL1-TR000433"],"award-info":[{"award-number":["UL1-TR000433"]}],"id":[{"id":"10.13039\/100008269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Importance<\/jats:title>\n<jats:p>Distinguishing benign from malignant pulmonary nodules is challenging. Evidence-based guidelines exist, but their impact on patient-centered outcomes is unknown.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To understand if the evaluation of incidental pulmonary nodules that follows an evidence-based management strategy is associated with fewer invasive procedures for benign lesions and\/or fewer delays in cancer diagnosis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Design<\/jats:title>\n<jats:p>Retrospective cohort study.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Setting<\/jats:title>\n<jats:p>Large academic medical center.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Participants<\/jats:title>\n<jats:p>Adults (\u226518 years age) with an incidental pulmonary nodule discovered between January 2012 and December 2014. Patients with calcified nodules, prior nodules, prior diagnosis of cancer, high suspicion for pulmonary metastasis, or limited life expectancy were excluded.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Exposure<\/jats:title>\n<jats:p>Nodule management strategy (pre-specified based on evidence-based practices).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec007\">\n<jats:title>Outcome<\/jats:title>\n<jats:p>Composite of any invasive procedure for a benign nodule or delay in diagnosis in patients with cancer (&gt;3 month delay once probability of cancer was &gt;15%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec008\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 314 patients that met inclusion criteria, median age was 61, 46.5% were men, and 66.5% had current or former tobacco use. The mean nodule size was 10.3 mm, mean probability of cancer was 11.8%, and 14.3% of nodules were malignant. Evaluation followed an evidence-based strategy in 245 patients (78.0%), and deviated in 69 patients (22%). The composite outcome occurred in 26 (8.3%) patients. Among patients whose nodule evaluation was concordant with an evidence-based evaluation, 6.1% (15\/245) experienced the composite outcome versus 15.9% (11\/69) of patients with an evaluation that deviated from evidence-based recommendations (<jats:italic>P<\/jats:italic>&lt;0.01).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec009\">\n<jats:title>Conclusions and relevance<\/jats:title>\n<jats:p>At a large academic medical center, more than 1 in 5 patients with an incidental pulmonary nodule underwent evaluation that deviated from evidence-based practice recommendations. Nodule evaluation that deviated from an evidence-based strategy was associated with biopsy of benign lesions and delays in cancer diagnosis, suggesting a need to improve guideline uptake.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0274107","type":"journal-article","created":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T20:48:47Z","timestamp":1662756527000},"page":"e0274107","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Prevalence and consequences of non-adherence to an evidence-based approach for incidental pulmonary nodules"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7751-6505","authenticated-orcid":true,"given":"Max T.","family":"Wayne","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hallie C.","family":"Prescott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas A.","family":"Arenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,9,9]]},"reference":[{"key":"pone.0274107.ref001","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1164\/rccm.201505-0990OC","article-title":"Recent trends in the identification of incidental pulmonary nodules","volume":"192","author":"MK Gould","year":"2015","journal-title":"Am J Respir Crit Care Med"},{"key":"pone.0274107.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/j.annemergmed.2011.05.020","article-title":"National trends in use of computed tomography in the emergency department","volume":"58","author":"KE Kocher","year":"2011","journal-title":"Ann Emerg Med"},{"key":"pone.0274107.ref003","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1001\/jama.2019.11456","article-title":"Trends in Use of Medical Imaging in US Health Care Systems and in Ontario, Canada, 2000\u20132016","author":"R Smith-Bindman","year":"2019","journal-title":"JAMA\u2014Journal of the American Medical Association. 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