The Lung Reporting and Data System (LU-RADS) can be used to rate the risk of malignancy for s lung nodule identified on computed tomography (CT) screening. This can help to standardize how the patient is managed. It was proposed by radiologists from the Dalhousie University, University of Ottawa, McGill University, University of Toronto and University of British Columbia in Canada.
|
Findings |
Lung Nodule |
LU-RADS |
|
no nodule seen |
none |
1 |
|
nodule less than 5 mm in diameter; perifissural opacities; benign calcification (hamartoma, granuloma); core biopsy benign; solid and stable for >= 2 years; subsolid and stable for >= 5 years; round atelectasis |
benign |
2 |
|
nodule 5 to 9 mm, nonenlarging/stable for < 2 years if solid or < 5 years if subsolid |
indeterminate, small |
3, small |
|
new or baseline nodule >= 10 mm with possible inflammatory process (see below) |
indeterminate, large |
3, large |
|
nodule >= 10 mm, solid, benign features |
suspicious, low risk of malignancy |
4A |
|
opacity >= 10 mm, nonresolving subsolid, solid component <= 5 mm |
suspicious, likely in situ or minimally invasive adenoCa |
4B |
|
worrisome persistence; worrisome change; worrisome baseline (see below) |
likely malignant |
4C |
|
invasion of chest wall or mediastinum |
malignant by CT |
5 |
|
malignant pathology (from FNA, core biopsy, bronchoscopy, lung resection) |
tissue malignant |
6 |
where:
• Findings of an inflammatory process may include: new or baseline subsolid nodule, rapid development, multifocal, presence of satellite nodules, air bronchogram, ground-glass border.
• Worrisome persistence: nonresolving, partially solid nodule >= 10 mm, solid portion > 5 mm)
• Worrisome change: malignant growth rate in solid nodule or solid portion of partially solid nodule
• Worrisome baseline: lobulated or speculated, entirely solid >= 10 mm, no inflammatory clinical or CT features, no ground-glass borders.
|
LU-RADS |
Management |
|
1 |
regular screening |
|
2 |
annual screening |
|
3, small |
requires serial low-dose CT, followup per guidelines, a new nodule may justify closer followup |
|
3, large |
requires serial low-dose CT, followup in 6-12 weeks, failure to improve worrisome (reclassify as 4) |
|
4 |
risk of malignancy very high in high-risk population, refer for diagnostic studies, PET for staging, negative followup studies should prompt multi-disciplinary review |
|
5 |
rrefer for diagnostic studies, PET for staging, negative followup studies should prompt multi-disciplinary review |
|
6 |
rule out false positive, continue screening if treatment candidate and no regular CT for disease surveillance |
Specialty: Hematology Oncology, Surgery, general, Pulmonology
