Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition).

  title={Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition).},
  author={Michael K. Gould and James Fletcher and Mark D Iannettoni and William R. Lynch and David E. Midthun and David P. Naidich and David E. Ost},
  volume={132 3 Suppl},
BACKGROUND Pulmonary nodules are spherical radiographic opacities that measure up to 30 mm in diameter. Nodules are extremely common in clinical practice and challenging to manage, especially small, "subcentimeter" nodules. Identification of malignant nodules is important because they represent a potentially curable form of lung cancer. METHODS We developed evidence-based clinical practice guidelines based on a systematic literature review and discussion with a large, multidisciplinary group… 

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.

Recommendations for evaluation and management of individuals with solid pulmonary nodules and those with nonsolid nodules are formulated by using the methods described in the "Methodology for Development of Guidelines for Lung Cancer" in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed.

Evaluation of the Solitary Pulmonary Nodule.

The workup for patients with solid solitary pulmonary nodules measuring 8 mm or greater in diameter, nodule measuring less than 8 mm in diameter), and subsolid nodules should be guided by the probability of malignancy, imaging results, and the risks and benefits of different management strategies.

The follow-up of solitary pulmonary nodules at Mater Dei Hospital

Whether the Fleischner Society Guidelines 3 are adhered to in the follow-up of SPNs locally is evaluated, which may delay the diagnosis of early lung cancer whilst over-evaluation may increase expenditure, radiation and also patient concern.

Evaluation and management of pulmonary nodules: state-of-the-art and future perspectives.

The authors discuss recent advances in the lung nodule management, and an algorithm for the management of indeterminate pulmonary nodules, with a focus on computed tomography (CT), which continues to be the mainstay for evaluation.

Update in the evaluation of the solitary pulmonary nodule.

  • M. TruongJ. Ko J. Erasmus
  • Medicine
    Radiographics : a review publication of the Radiological Society of North America, Inc
  • 2014
Because of the likelihood that persistent subsolid nodules represent adenocarcinoma with indolent growth, serial imaging reassessment for a minimum of 3 years and/or obtaining tissue samples for histologic analysis are recommended.

Evaluation of the solitary pulmonary nodule

Up to date review of the imaging features of both benign and malignant solitary pulmonary nodules to assist in the identification of nodules that require histological confirmation or ongoing surveillance are provided.

Radiographically Detected Solitary Pulmonary Nodule

The main purpose of this report has been to set out interim guidelines based on best-guess estimates, the authors' extensive albeit anecdotal experience, and especially currently available published data, which are intended to supplant guidelines regarding the management of solid nodules.

Pulmonary Nodules: Detection and Risk Evaluation

Several options are available in the management of an undetermined incidental pulmonary nodule, and the most appropriate choice depends on a careful evaluation of patient’s risk factors and of the characteristics of the nodule.



Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition).

The prevalence of an solitary pulmonary nodule and the prevalence of malignancy in patients with an SPN vary widely across studies and the interpretation of these variable prevalence rates should take into consideration not only the nodule characteristics but also the population at risk.

Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society.

The authors believe that the time-honored requirement to follow every small indeterminate nodule with serial CT should be revised and new guidelines are proposed for follow-up and management of small pulmonary nodules detected on CT scans.

Cost-Effectiveness of Alternative Management Strategies for Patients with Solitary Pulmonary Nodules

A decision analytic model was developed to identify the most effective approaches to diagnose and manage solitary pulmonary nodules and quantify the health effects and economic costs associated with various management strategies.

The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules.

Three clinical and 3 radiographic characteristics predicted the malignancy in radiologically indeterminate solitary pulmonary nodules (SPNs) in a clinically relevant subset of patients with SPNs that measured between 4 and 30 mm in diameter.

Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers.

Lung cancer screening with low-dose CT demonstrated a prevalence of asymptomatic cancers in 1.3% of a smoking population, including a high proportion of early tumor stages and a 20% rate of invasive procedures for benign lesions.

Solitary pulmonary nodules: clinical prediction model versus physicians.

Calibration curves revealed that physicians overestimated the probability of a malignant lesion in patients with low risk of malignant disease by the prediction rule; this finding suggests a potential for the decision rule to improve the management of patients with SPNs that are likely to be benign.

Indeterminate solitary pulmonary nodules revealed at population-based CT screening of the lung: using first follow-up diagnostic CT to differentiate benign and malignant lesions.

Follow-up CT findings were useful, and a combination of findings on initial CT and follow- up CT was optimal for differentiating benign and malignant pulmonary nodules.

PET scanning and the solitary pulmonary nodule.

  • J. Fletcher
  • Medicine
    Seminars in thoracic and cardiovascular surgery
  • 2002
Positron emission tomography with 18-Fluorodeoxyglucose (FDG-PET) can play an important role in the evaluation and management of solitary pulmonary nodules with very high negative predictive value and improved staging information when performed in association with CT, especially for nodal staging and identification of unsuspected stage IV disease.

Small Incidental Pulmonary Nodules: How Useful is Short-Term Interval CT Follow-Up?

The chance of growth in small (≤4 mm) noncalcified nodules (NCN) in patients with no previous history of malignancy or immune disorder is small; therefore, short-term follow-up imaging for nodules ≤4 mm is not necessary.

Solitary pulmonary nodules: CT assessment.

Assessment of SPNs by CT is most effective for lesions 2.0 cm or less in diameter, and for larger lesions, the frequency of benign disease was decreased, as was the percentage of benign SPNs correctly assessed as benign by CT.