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 subsolid pulmonary nodules on CT scan
Parameters:
(1) number
(2) features
(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
If multiple nodules are present then the decision is based on the most suspicious nodule.
Number
Feature
Size
Management
1
ground glass
< 6 mm
1
>= 6 mm
2
part solid
< 6 mm
1
>= 6 mm
3
2 or more
NA
< 6 mm
4
>= 6 mm
5
Management
Specifics
1
no routine follow-up
2
CT at 6-12 months, then CT at 2 and 4 years. Consider resection if solid component appears or lesion grows.
3
CT at 3-6 months. If unchanged and solid component less than 6 mm then annual CT scans for next 5 years. A solid component >= 6 mm is highly suspicious.
4
CT at 3-6 months. If stable consider CT at 2 and 4 years.
5
CT at 3-6 months. Follow-up based on most suspicious nodule. A solid component >= 6 mm is highly suspicious.
Size
Volume in Paper
Actual Volume
6 mm
100 cu mm
113 cu mm
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