Objective: We surveyed the members of the Society of Thoracic Radiology regarding their interpretation of and management decisions for very small (3-5 mm) pulmonary nodules-"ditzels"-noted on CT.
Subjects and methods: A survey consisting of 13 case scenarios in which ditzels were encountered on CT examinations was mailed to the 406 members of the Society of Thoracic Radiology. Statistical analysis was performed to determine associations between responses, years of experience, location in an endemic region of granulomatous disease, and location at a lung or a general cancer center.
Results: One hundred fifty-one surveys (37%) could be included in the analysis. The most common response was "short-term follow-up." As the likelihood of malignancy increased, the response of "recommend biopsy" or "considered malignant or metastatic" increased. Those radiologists located in an area considered endemic for granulomatous disease were more likely to consider an incidental ditzel benign and to recommend follow-up, whereas those in a nonendemic area were more likely to recommend biopsy. In the cases in which years of experience had an influence, the less experienced respondents were more likely to choose "nothing, considered benign" or short-term follow-up than biopsy.
Conclusion: The most common response was short-term follow-up, with less aggressive recommendations in cases with a lower likelihood of malignancy and more aggressive recommendations in cases with a higher likelihood of malignancy. Location in an area considered endemic for granulomatous disease and years of experience influenced decisions.