Solitary pulmonary nodule secondary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]Maria Fernanda Villarreal, M.D. [3]
Overview
The American College of Chest Physicians (ACCP) and Fleischner Society guidelines offer a strategy to manage and follow up on pulmonary nodule.
Secondary Prevention
CT Surveillance
The American College of Chest Physicians (ACCP) recommends the following:[1]
- If less than 8 mm in size, use guidelines by the Fleischner society (see table below).
- For nodules greater than 8 mm in diameter, assess the patient's risk of complications from thoracic surgery:
- In low - moderate risk, assess the probability of cancer by a validated calculator and follow up with CT scan surveillance. A model developed at the Mayo Clinic has been the most extensively validated. An open-source version is available online.
- In high risk, assess the probability of cancer by a validated calculator and obtain non-surgical biopsy.[2]
- The table below summarizes the follow-up and surveillance recommendations for solitary pulmonary nodule according to the Fleischner Society guideline:
| Recommendations for Follow-up and Management of Nodules <8 mm Detected Incidentally at Non-screening CT |
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| Nodule Size (mm) | Low risk patients | High risk patients |
| ≤ 4 |
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| > 4 - 6 |
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| > 6 - 8 |
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| > 8 |
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- Note: Newly detected indeterminate nodule in persons 35 years of age or older.[3]
* Low risk patients: Minimal or absent history of smoking and of other known risk factors
* High risk patients: History of smoking or of other known risk factors
References
- ↑ Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP; et al. (2013). "Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines". Chest. 143 (5 Suppl): e93S–120S. doi:10.1378/chest.12-2351. PMC 3749714. PMID 23649456.
- ↑ Swensen SJ, Silverstein MD, Ilstrup DM, Schleck CD, Edell ES (1997). "The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules". Arch Intern Med. 157 (8): 849–55. PMID 9129544.
- ↑ Heber MacMahon, John H. M. Austin, Gordon Gamsu, Christian J. Herold, James R. Jett, David P. Naidich, Edward F. Patz, Jr, and Stephen J. Swensen. Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society. Radiology 2005 237: 395-400.