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J Thorac Cardiovasc Surg 2003;126:761-768
© 2003 The American Association for Thoracic Surgery

General thoracic surgery

Transthoracic needle biopsy in the diagnosis of solitary pulmonary nodules: a survey of canadian physicians

Yves Lacasse, MD, MSca,*, Julie Plante, MDa, Simon Martel, MDa, Bruno Raby, MD, MSca

a Centre de recherche, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval, Ste-Foy, Québec, Canada

Received for publication December 4, 2001; revisions received March 28, 2002; revisions received October 7, 2002; accepted for publication October 18, 2002.

* Address for reprints: Yves Lacasse, Hôpital Laval, Centre de Pneumologie, 2725 Chemin Ste-Foy, Ste-Foy, Québec G1V 4G5, Canada
yves.lacasse{at}med.ulaval.ca

OBJECTIVE: To describe Canadian physicians' opinions relative to the choice of diagnostic procedures in patients presenting with a solitary pulmonary nodule and to identify the attributes that may influence their decision.

METHODS: We conducted a mailed survey among Canadian physicians including pulmonologists, thoracic surgeons, radiologists, and internists. Five hypothetical clinical scenarios designed to illustrate a wide spectrum of clinical situations (including nodules associated to very low, indeterminate, and high probabilities of malignancy in patients medically fit or unfit to undergo surgical resection) were submitted to each physician who had to choose among options of diagnostic procedures and to estimate the pretest probability of malignancy.

RESULTS: The survey response rate was 47%. Overall, the physicians tended to overestimate the probability of malignancy. Twenty-eight percent of the respondents would have ordered a transthoracic needle biopsy in a medically fit patient presenting with a very low probability (< 2%) of malignancy, whereas 53% would have done so in a medically fit patient presenting with a very high probability (75%) of malignancy. In a regression analysis, the significant predictors of the use of transthoracic needle biopsy were (1) the pretest probability of cancer, (2) the patient's operability, (3) specialty (pulmonologists and thoracic surgeons being less likely to order a transthoracic needle biopsy than radiologists), and (4) the respondent's gender.

CONCLUSIONS: There are widespread variations in clinical opinions among Canadian physicians regarding the use of transthoracic needle biopsy in the investigation of solitary nodules. Hypothetical transthoracic needle biopsy was often preferred when the result was unlikely to affect patient management.






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