Solitary Pulmonary Nodule

Diagnosis

Solitary Pulmonary Nodule

History

Fleischner Guidelines for pulmonary nodules - 2017 

If solid nodule

<6mm

6-8mm

>8mm

Notes

Single

Low risk

No routine f/u

CT at 6-12 months, then consider CT at 18-24 months

Consider CT, PET/CT or biopsy at 3 months

<6mm do not require f/u, but high risk patient or nodule characteristics may warrant 12 month f/u.

High risk

Optional 12 month CT

CT at 6-12 months, then consider CT at 18-24 months

Consider CT, PET/CT or biopsy at 3 months

Multiple

Low risk

No routine f/u

CT at 3-6 months, then consider CT at 18-24 months

Use most suspicious nodule to guide management

High risk

Optional 12 month CT

CT at 3-6 months, then at 18-24 months

If partsolid (subsolid or groundglass) nodule

Sub-solid nodule

<6mm

≥6 mm

Notes

Single

Ground glass

No routine f/u

CT at 6-12 mo to confirm persistence, then q 2 years until 5 years

For suspicious nodules <6mm, consider 2 and 4 year f/u.

Part solid

No routine f/u

CT at 3-6 months to confirm persistence. If stable and <6mm solid component, then q12 months for 5 years

<6mm part solid nodules too small to be defined. Persistent part-solid nodules with >6mm solid component are highly suspicious.

Multiple

CT at 3-6 months. If stable, consider CT at 2 and 4 years

CT at 3-6 months. Subsequent management based on most suspicious nodule(s)

Multiple <6mm ground-glass nodules usually benign. May consider f/u at 2 and 4 years in high-risk patients.

 http://pubs.rsna.org/doi/full/10.1148/radiol.2017161659#

https://radiology-universe.org/2017_Fleischner_Society_Pulmonary_Nodule_Follow-Up_New_Guidelines_Recommendations/