Incidental Pulmonary Nodules - Follow-up
NB: these guidelines are for incidental findings; recommendations for f/u of nodules found on LDCT for lung cancer screening are different as that population is high risk (see Lung-RADS classification tables online) Is it malignant? Pt characteristics: ↑Risk w/ h/o smoking, emphysema, pulmonary fibrosis, extra-thoracic cancer, asbestos exposure, age. Nodule characteristics: Quality (subsolid/ground glass>solid), size, rate of growth, borders (irregular/spiculated border>smooth border), calcification (eccentric>popcorn/concentric/diffuse), location (upper>lower lobe).
Follow up: Tailored to patient and type of nodule. Subsolid (ground glass): if <6 mm, no routine f/u. If >6 mm, CT at 6-12 months, then CT every 2 yrs until 5 yrs. Part solid: if <6mm, no routine f/u. If >6 mm, CT at 3-6 mos, then annual CT for 5 yrs if unchanged and solid component <6 mm. Solid nodules: see below.
Single solid nodule - Low risk:
< 6mm - No routine follow up
6-8mm - CT at 6-12 months, then consider CT at 18-24 months
> 8mm - Consider CT at 3 months, PET/CT, or tissue sampling
Single solid nodule - High risk:
< 6mm - Optional CT at 12 months
6-8mm - CT at 6-12 months, then CT at 18-24 months
Consider CT at 3 months, PET/CT, or tissue sampling
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