PMID- 31373897
OWN - NLM
STAT- MEDLINE
DCOM- 20200406
LR  - 20221005
IS  - 2194-802X (Electronic)
IS  - 2194-8011 (Print)
IS  - 2194-802X (Linking)
VI  - 6
IP  - 4
DP  - 2019 Nov 26
TI  - Follow-up of incidental pulmonary nodules and association with mortality in a 
      safety-net cohort.
PG  - 351-359
LID - 10.1515/dx-2019-0008 [doi]
AB  - Background Though incidental pulmonary nodules are common, rates of 
      guideline-recommended surveillance and associations between surveillance and 
      mortality are unclear. In this study, we describe adherence (categorized as 
      complete, partial, late and none) to guideline-recommended surveillance among 
      patients with incidental 5-8 mm pulmonary nodules and assess associations between 
      adherence and mortality. Methods This was a retrospective cohort study of 551 
      patients (>/=35 years) with incidental pulmonary nodules conducted from September 
      1, 2008 to December 31, 2016, in an integrated safety-net health network. Results 
      Of the 551 patients, 156 (28%) had complete, 87 (16%) had partial, 93 (17%) had 
      late and 215 (39%) had no documented surveillance. Patients were followed for a 
      median of 5.2 years [interquartile range (IQR), 3.6-6.7 years] and 82 (15%) died 
      during follow-up. Adjusted all-cause mortality rates ranged from 2.24 [95% 
      confidence interval (CI), 1.24-3.25] deaths per 100 person-years for complete 
      follow-up to 3.30 (95% CI, 2.36-4.23) for no follow-up. In multivariable models, 
      there were no statistically significant associations between the levels of 
      surveillance and mortality (p > 0.16 for each comparison with complete 
      surveillance). Compared with complete surveillance, adjusted mortality rates were 
      non-significantly increased by 0.45 deaths per 100 person-years (95% CI, -1.10 to 
      2.01) for partial, 0.55 (95% CI, -1.08 to 2.17) for late and 1.05 (95% CI, -0.35 
      to 2.45) for no surveillance. Conclusions Although guideline-recommended 
      surveillance of small incidental pulmonary nodules was incomplete or absent in 
      most patients, gaps in surveillance were not associated with statistically 
      significant increases in mortality in a safety-net population.
FAU - Lee, Jonathan S
AU  - Lee JS
AD  - Division of General Internal Medicine, University of California, San Francisco, 
      CA 94143-0320, USA.
FAU - Lisker, Sarah
AU  - Lisker S
AD  - Center for Vulnerable Populations, University of California, San Francisco, CA 
      94143-0320, USA.
FAU - Vittinghoff, Eric
AU  - Vittinghoff E
AD  - Department of Epidemiology and Biostatistics, University of California, San 
      Francisco, CA 94143-0320, USA.
FAU - Cherian, Roy
AU  - Cherian R
AD  - Center for Vulnerable Populations, University of California, San Francisco, CA 
      94143-0320, USA.
FAU - McCoy, David B
AU  - McCoy DB
AD  - Department of Radiology and Biomedical Imaging, University of California, San 
      Francisco, CA 94143-0320, USA.
FAU - Rybkin, Alex
AU  - Rybkin A
AD  - Department of Radiology and Biomedical Imaging, University of California, San 
      Francisco, CA 94143-0320, USA.
FAU - Su, George
AU  - Su G
AD  - Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of 
      California, San Francisco, CA 94143-0320, USA.
FAU - Sarkar, Urmimala
AU  - Sarkar U
AD  - Center for Vulnerable Populations, University of California, San Francisco, CA 
      94143-0320, USA.
LA  - eng
GR  - K24 CA212294/CA/NCI NIH HHS/United States
GR  - P30 HS023558/HS/AHRQ HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - Germany
TA  - Diagnosis (Berl)
JT  - Diagnosis (Berlin, Germany)
JID - 101654734
SB  - IM
MH  - Aged
MH  - Ethnicity
MH  - Female
MH  - Follow-Up Studies
MH  - Guideline Adherence/*standards/statistics & numerical data
MH  - Humans
MH  - Incidental Findings
MH  - Lung Neoplasms/*diagnostic imaging/epidemiology/mortality/pathology
MH  - Male
MH  - Middle Aged
MH  - Mortality/trends
MH  - Multiple Pulmonary Nodules/*diagnostic imaging/epidemiology/mortality/pathology
MH  - Patient Care Management/statistics & numerical data/trends
MH  - Retrospective Studies
MH  - Safety-net Providers/*methods
MH  - Tomography, X-Ray Computed/methods
PMC - PMC7757426
MID - NIHMS1652458
OTO - NOTNLM
OT  - adherence
OT  - ambulatory care
OT  - care management
OT  - diagnosis
OT  - guidelines
OT  - underserved populations
COIS- Competing interests: The funding organization(s) played no role in the study 
      design; in the collection, analysis, and interpretation of data; in the writing 
      of the report; or in the decision to submit the report for publication.
EDAT- 2019/08/03 06:00
MHDA- 2020/04/09 06:00
PMCR- 2020/12/23
CRDT- 2019/08/03 06:00
PHST- 2019/02/12 00:00 [received]
PHST- 2019/04/13 00:00 [accepted]
PHST- 2019/08/03 06:00 [pubmed]
PHST- 2020/04/09 06:00 [medline]
PHST- 2019/08/03 06:00 [entrez]
PHST- 2020/12/23 00:00 [pmc-release]
AID - dx-2019-0008 [pii]
AID - 10.1515/dx-2019-0008 [doi]
PST - ppublish
SO  - Diagnosis (Berl). 2019 Nov 26;6(4):351-359. doi: 10.1515/dx-2019-0008.