B111-24 Contemporary Pulmonary Nodule Evaluation and Management: A National Survey of U.S. Clinicians

Rationale The modern landscape for pulmonary nodule (PN) evaluation and management is complex, with notable recent advances in cancer risk assessment and diagnostic procedures. We sought to determine clinicians’ approaches to and perspectives on the PN diagnostic pathway. Methods Based on prior qualitative findings, we developed and administered a 51-item web-based survey in August and September 2025 to U.S. practicing physicians and advanced practice providers who evaluate and manage outpatients with PNs. Potentially eligible clinicians were identified via professional society membership or publicly available information and contacted via e-mail. Survey domains included PN risk assessment, management, and diagnostic pathway needs assessment. We used descriptive statistics to summarize results. Results Of the 1,213 individuals invited to participate, 122 (10.1%) completed the survey upon confirming eligibility. Most participants were physicians (85.2%) and practiced in academic centers (83.6%). Clinicians in general pulmonology [GP] (29.5%), interventional pulmonology [IP] (44.3%), thoracic surgery [TS] (9.0%), and other specialties [OS] (17.2%) practiced across 28 states (46.7% Northeast, 16.4% Midwest, 23.8% South, 13.1% West). While most GP (63.9%) and IP (81.5%) clinicians used clinical risk prediction models, a minority of TS (36.4%) and OS (42.9%) clinicians did (P=0.002). Among risk model-users, the Mayo Clinic (88.8%) and Brock (63.8%) models were most frequently employed. Few participants (13.1%) reported using commercial biomarkers, with blood-based biomarkers most often employed by those who used them (93.8%). While 71.3% of participants agreed that clinical risk prediction models improve patient care, only 22.1% agreed that commercial biomarkers do. When considering a hypothetical ideal risk assessment tool, more clinicians prioritized lung cancer diagnostic sensitivity (66.4%) over specificity (33.6%). Most participants were familiar with (89.3%) and primarily used (54.1%) the Fleischner Society clinical guidelines. Most reported that shared decision-making regarding PN biopsy occurred most of the time (90.2%), with bronchoscopy usually recommended first (91.0%). Only 47.5% of participants agreed they currently have the clinical resources required to provide optimal care for patients with PNs, and 86.1% agreed that risk assessment needs to be improved. When asked to prioritize opportunities for improvement, participants ranked “better PN tracking tools and resources” highest and “advances in PN biopsy techniques” lowest. Conclusion In this U.S. national survey, we observed substantial variation in PN management, with most clinicians reporting the need for additional resources required to optimally care for patients with PNs. Priorities identified include improved PN tracking tools and risk assessment, with a focus on sensitivity for diagnosing lung cancer. This abstract is funded by: Research reported in this abstract was supported by the National Cancer Institute (K08CA279881, P50CA271338) and the American Cancer Society (ACS IRG-22-150-41-IRG).