Fleischner Society pulmonary nodule recommendations
Updates to Article Attributes
Body
was changed:
The Fleischner society pulmonary nodule recommendations are usually for follow-up and management of pulmonary nodules smaller than 8 mm detected incidentally on non-screening CT.
Solid nodules
Nodule size: less than or equal to 4 mm
- low risk patients: no follow-up needed
- high risk patients: follow-up at 12 months and if no change, no further imaging needed
Nodule size: > 4-6 mm
- low risk patients: follow-up at 12 months and if no change, no further imaging needed
- high risk patients: initial follow-up CT at 6-12 months and then at 18-24 months if no change
Nodule size: > 6-8 mm
- low risk patients: initial follow-up CT at 6-12 months and then at 18-24 months if no change
- high risk patients: initial follow-up CT at 3-6 months and then at 9-12 and 24 months if no change
Nodule size: > 8 mm
- either low or high risk patients
- follow-up CTs at around 3, 9, and 24 months
- dynamic contrast enhanced CT, PET, and/or biopsy
Note: newly detected indeterminate nodule in persons 35 years of age or older.
- low risk patients: minimal or absent history of smoking and or other known risk factors
- high risk patients: history of smoking or of other known risk factors
- if a nodule up to 8 mm is partly solid or is ground glass further follow up is required after 24 months to exclude possible slow growing adenocarcinoma (BAC)
Sub solid nodules
Will be added
Solitary pure ground-glass nodules
-
nodule size
- use reference≤ 5mm- no CT follow up required
-
nodule size > 5mm
- follow up CT at 3 months, then annual CT for at least 3 years
Solitary part-solid nodules
- initial follow-up CT at 3 months
-
if persistent and solid component <5mm
- annual CT for at least 3 years
-
if persistent and solid component ≥ 5mm
- biopsy or surgical resection
Multiple subsolid nodules
-
pure ground glass nodules ≤ 5mm
- CT at 2 and 4 years
-
pure ground glass nodules >5mm, without a dominant lesion(s)
-
initial follow-up CT at 3 months, than annual CT for
the time beingat least 3 years
-
initial follow-up CT at 3 months, than annual CT for
-
dominant nodule(s) with part-solid or solid component
- initial follow-up CT at 3 months
- if persistent, biopsy or surgical resection (especially if has >5mm solid component).
See also
-</ul><h5>Sub solid nodules</h5><p>Will be added - use reference 2 for the time being</p><h4>See also</h4><ul><li><a href="/articles/incidental-lung-nodules-1">incidental lung nodules</a></li></ul>- +</ul><h5>Sub solid nodules</h5><h6>Solitary pure ground-glass nodules</h6><ul>
- +<li>nodule size ≤ 5mm<ul><li>no CT follow up required</li></ul>
- +</li>
- +<li>nodule size > 5mm<ul><li>follow up CT at 3 months, then annual CT for at least 3 years</li></ul>
- +</li>
- +</ul><h6>Solitary part-solid nodules</h6><ul>
- +<li>initial follow-up CT at 3 months</li>
- +<li>if persistent and solid component <5mm<ul><li>annual CT for at least 3 years</li></ul>
- +</li>
- +<li>if persistent and solid component ≥ 5mm<ul><li>biopsy or surgical resection</li></ul>
- +</li>
- +</ul><h6>Multiple subsolid nodules</h6><ul>
- +<li>pure ground glass nodules ≤ 5mm<ul><li>CT at 2 and 4 years</li></ul>
- +</li>
- +<li>pure ground glass nodules >5mm, without a dominant lesion(s)<ul><li>initial follow-up CT at 3 months, than annual CT for at least 3 years</li></ul>
- +</li>
- +<li>dominant nodule(s) with part-solid or solid component<ul>
- +<li>initial follow-up CT at 3 months</li>
- +<li>if persistent, biopsy or surgical resection (especially if has >5mm solid component).</li>
- +</ul>
- +</li>
- +</ul><h4>See also</h4><ul><li><a href="/articles/incidental-lung-nodules-1">incidental lung nodules</a></li></ul>