Management of Incidental Pulmonary Nodules Detected on CT

Guidelines From the Fleischner Society (2017)

Fleischner
How many nodules have you identified?
How is the composition of the nodule?
Attention: Use the most suspicious nodule to guide management. Follow-up intervals may vary according to size and risk.
Are there any solid nodules?
How is the clinical risk of the patient for malignancy?
See below for factors related to risk for malignancy.
Attention: For part-solid nodules, measurements should be based on the solid component.
Recommendation:

No routine follow-up is needed.


Nodules <6 mm do not require routine follow-up in low-risk patients.
Recommendation:

No routine follow-up is needed.


In certain suspicious ground glass nodules smaller than 6 mm, consider follow-up at 2 and 4 years.
Recommendation:

No routine follow-up is needed.


In practice, part-solid nodules cannot be defined as such until their diameter is at least 6 mm. Nodules smaller than 6 mm do not usually require follow-up.
Recommendation:

CT at 6–12 months, then consider CT at 18–24 months


Recommendation:

CT at 6–12 months, then CT at 18–24 months


Recommendation:

CT at 3–6 months, then consider CT at 18–24 months


Recommendation:

CT at 3–6 months, then at 18–24 months


Recommendation:

Optional CT at 12 months.


Recommendation:

CT at 3-6 months, if stable consider CT and 2 and 4 years.


Multiple <6 mm pure ground-glass nodules are usually benign but consider follow-up in selected patients at high risk at 2 and 4 years.
Recommendation:

CT at 6–12 months to confirm persistence, then CT every 2 years until 5 years.


If solid component(s) or growth develops, consider resection.
Recommendation:

CT at 3–6 months to confirm persistence. If the nodule is unchanged and solid component remains,6 mm, annual CT should be performed for 5 years.


Persistent part-solid nodules with solid components smaller than 6 mm should be considered highly suspicious.
Recommendation:

CT at 3–6 months. Subsequent management based on the most suspicious nodule(s).


Recommendation:

Consider CT at 3 months, PET/CT, or tissue sampling.


Solid nodules larger than 8mm in diameter need CT, PET/CT, or tissue sampling irrespective of patient's clinical risk status.

Share your thoughts

Your email address will not be published. Required fields are marked *