MacMahon et al updated the Fleischner Society guidelines for managing incidental pulmonary nodules seen on CT images of the chest. One category involves solid nodules while another is subsolid.
Patient selection: adult with one or more incidental solid pulmonary nodules on CT scan
Parameters:
(1) number
(2) risk
(3) size in mm (based on average of long and short axes)
average of long and short axis =
= ((long axis in mm) + (short axis in mm)) / 2
High risk features include upper lobe location and suspicious nodule morphology.
If multiple nodules are present then the decision is based on the most suspicious nodule.
Number
Risk
Size
Management
1
low
< 6 mm
1
6 to 8 mm
2
> 8 mm
3
high
< 6 mm
4
6 to 8 mm
5
> 8 mm
3
2 or more
low
< 6 mm
1
6 to 8 mm
6
> 8 mm
6
high
< 6 mm
4
6 to 8 mm
7
> 8 mm
7
Management
Specifics
1
no routine follow-up
2
CT at 6-12 months, then consider CT at 18-24 months
3
Consider CT scan at 3 months, PET/CT or tissue sampling
4
Optional CT at 12 months
5
CT at 6-12 months, then CT at 18-24 months
6
CT at 3-6 months, then consider CT at 18-24 months
7
CT at 3-6 months, then CT at 18-24 months
Size
Volume in Paper
Actual Volume
< 6 mm
< 100 cu mm
< 113 cu mm
6 to 8 mm
100 to 250 cu mm
113 to 268 cu mm
> 8 mm
> 250 cu mm
> 268 cu mm
To read more or access our algorithms and calculators, please log in or register.
