Nodule-pathway quality indicators

Numerator: Nodules entering a structured pathway with the minimum recommended fields completed (detection route, index CT, type, size/volume, location, risk category, recommended next step, planned follow-up, outcome).

Denominator: Nodules that should enter a structured nodule pathway — indeterminate incidental nodules and, where implemented, screen-detected nodules.

Foundational: must be adequate before downstream nodule indicators can be compared. Denmark is the only country clearly starting a dedicated registry.

Numerator: Nodule CT reports with all mandatory structured fields complete (type, size/volume, location, number, baseline/new, growth or VDT, risk category, next step, follow-up interval).

Denominator: CT reports identifying indeterminate nodules that enter a pathway or require surveillance / work-up.

Structured reporting is a prerequisite for timeliness, over-investigation, yield and complication indicators.

Numerator: Patients with indeterminate nodules who receive the follow-up CT within the guideline-defined surveillance window for their nodule type, size/volume, growth pattern and risk category.

Denominator: Patients with indeterminate nodules for whom CT surveillance is recommended.

Long planned surveillance of subsolid nodules is guideline-concordant, not delay.

Measure: Median days (with IQR) from first recorded nodule detection to definitive outcome — benign/stable discharge, escalation to work-up, or lung cancer diagnosis.

Denominator: Indeterminate nodules entering a structured follow-up or diagnostic pathway.

Reported as time-to-event, not a single proportion; subsolid-nodule surveillance is not counted as delay.

Numerator: Nodules managed according to the agreed recommendation for their type, size/volume, growth and risk category — or with a documented justified deviation.

Denominator: Indeterminate nodules with enough data to assign a guideline category.

Report concordant, justified deviation, non-concordant escalation and non-concordant under-investigation separately.

Numerator: Low-risk nodules receiving investigations beyond the guideline pathway without documented justification (PET-CT, invasive biopsy, surgery, or unusually intensive CT surveillance).

Denominator: Low-risk nodules for which surveillance or no further follow-up is recommended.

Pair with cancer yield and complications to show the benefit–harm and cost balance of the pathway.

Numerator: Invasive nodule procedures that yield a malignant diagnosis (primary lung cancer; other malignancy reported separately if agreed).

Denominator: All invasive diagnostic procedures performed for indeterminate nodules (CT-guided biopsy, bronchoscopy/navigational, EBUS for nodule work-up, surgical diagnostic biopsy).

Denominator quality is the limiting factor — the procedure indication must be recorded as "indeterminate nodule". Also report non-diagnostic and repeat-procedure rates.

Numerator: Surgical resections for indeterminate nodules where final pathology shows benign disease / no malignancy.

Denominator: All surgical resections performed for indeterminate nodules (with secondary reporting per all nodules entering the pathway).

Interpret alongside cancer yield, complications, stage shift and over-investigation.

Numerator: Invasive nodule procedures followed by a clinically significant complication within the agreed window (pneumothorax needing chest drain, major bleeding/haemoptysis, air embolism, unplanned admission, procedure-related death).

Denominator: All invasive diagnostic procedures performed for indeterminate nodules.

Best reported prospectively from the start of structured nodule/screening capture; report separate rates for any / significant complication, admission, chest drain and 30-day mortality.

Numerator: Nodule-detected lung cancers diagnosed at stage I or II (agreed TNM edition).

Denominator: All incident lung cancers identified through a nodule pathway or nodule-surveillance programme.

The stage-shift signal for screening. Stage is captured across all five registries — the weak point is the harmonised "nodule-detected" route flag. Report missing / unknown stage separately.