The Fleischner Society developed guidelines for managing a patient with a small pulmonary nodule detected on a CT scan.
(1) age > 35 years
(2) incidental nodule found on CT scan of the chest
(1) length of the lesion in mm
(2) wideth of the lesion in mm
(3) low vs high risk patient
size of the lesion in mm =
= ((length) + (width)) / 2
High risk patients:
(1) history of smoking (other than minimal)
(2) history of lung cancer in a first degree relative
(3) exposure to asbestos
(4) exposure to uranium
(5) exposure to radon
Size in mm
Management of a Low Risk Patient
<= 4 mm
4.1 to 6 mm
Follow-up CT at 12 months. If unchanged then no further follow-up.
6.1 to 8 mm
Follow-up CT at 6-12 months. If no change then follow-up at 18-24 months.
> 8 mm
Follow-up at 3, 9 and 24 months (see note).
• Follow-up for a nodule > 8 mm may include dynamic contrast-enhanced CT, PET and/or biopsy.
Management of a High Risk Patient
Follow-up CT at 12 months. If unchanged then no further follow-up (see below).
Follow-up CT at 6-12 months. If no change then follow-up at 18-24 months (see below).
Follow-up CT at 3-6 months. If no change then follow-up at 9-12 months and at 24 months (see below).
Follow-up at 3, 9 and 24 months (as above).
• The recommendations for a high risk patient in the first and second categories is the same as the second and third categories for a low risk patient respectively.
• A high risk patient with a nonsolid ground glass or partly solid nodule should have a longer follow-up to exclude an indolent adenocarcinoma.
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Purpose: To evaluate a patient with a solitary lung nodule using the guidelines of the Fleischner Society.
Specialty: Pulmonology, Hematology Oncology