{ "schemaVersion": 2, "eyebrow": "Pulmonology", "title": "Pulmonary Nodule Follow-Up Thresholds", "summary": "Choose the management pathway before applying a size cutoff: Fleischner thresholds apply to incidental CT nodules, whereas Lung-RADS governs screening findings. Nodule attenuation, size, multiplicity, prior stability, growth, and pretest malignancy probability determine surveillance, PET/CT, tissue sampling, or surgical diagnosis.", "seoDescription": "Physician guide to incidental and screening pulmonary nodule follow-up thresholds, CT intervals, PET/CT use, malignancy risk, and biopsy escalation.", "clinicalQuestion": "Which pulmonary nodules require no follow-up, CT surveillance, PET/CT, biopsy, or surgical diagnosis?", "specialty": "Pulmonology", "audience": "U.S. physicians and medical trainees", "tags": [ "pulmonary nodule follow-up", "Fleischner Society", "Lung-RADS", "incidental pulmonary nodule", "subsolid nodule", "PET CT", "Brock model" ], "keyTakeaways": [ "First classify the detection context: Fleischner recommendations apply to incidentally detected nodules, while Lung-RADS is specific to lung cancer screening examinations.[2][19]", "For incidental solid nodules, a 6 mm threshold separates most nodules needing no routine follow-up from those requiring interval CT; management then varies with patient risk, multiplicity, and size.[19][23]", "For a solid nodule larger than 8 mm, choose 3-month CT, PET/CT, or tissue sampling according to malignancy probability and procedural fitness rather than size alone.[8][19][23]", "Persistent subsolid nodules warrant a different pathway from solid nodules because pure ground-glass and part-solid morphology carry distinct biologic behavior and surveillance needs.[16][19]", "Retrieve prior imaging before ordering new testing: documented stability and absence of growth can avert invasive evaluation, whereas growth substantially increases concern for malignancy.[9][10]" ], "sections": [ { "id": "choose-the-correct-management-system", "eyebrow": "Initial branch point", "heading": "Use Fleischner for incidental nodules and Lung-RADS for screening CT", "intro": "Do not apply screening categories to a nodule found incidentally on diagnostic CT.", "paragraphs": [ "Determine whether the nodule was detected on an incidental CT or within a formal low-dose CT screening program. Fleischner 2017 guidance addresses incidentally discovered nodules and deliberately distinguishes this population from screening cohorts, whereas Lung-RADS was created for individuals undergoing lung cancer screening.[1][19]", "Before assigning a follow-up interval, review all available prior chest CT, CT angiography, cardiac CT, and upper-abdominal CT images. Growth on serial imaging shifts management toward malignancy evaluation; a calcified nodule with an organized central, laminated, or popcorn pattern that remains static for more than 2 years is generally considered benign.[9][10]", "Request thin-section CT characterization when attenuation is uncertain. A lesion that appears pure ground glass on 5-mm sections may prove solid or calcified on 1-mm reconstructions, which changes the applicable threshold and surveillance pathway.[20]" ], "bullets": [ "Document maximum diameter, solid versus pure ground-glass versus part-solid attenuation, number of nodules, location, margin morphology, and any measurable solid component before selecting a pathway.[11][19]", "Incorporate patient-level risk into incidental-nodule decisions, including tobacco exposure and other clinical risk factors; Fleischner follow-up recommendations vary by low- versus high-risk status.[5][19][23]", "For a screening CT reported with Lung-RADS, follow the assigned category and obtain comparison imaging before final classification when prior complete lung imaging exists.[23]" ], "subsections": [], "table": { "caption": "Detection context determines which reporting and follow-up framework applies.[2][19][23]", "columns": [ "Clinical context", "Primary framework", "Immediate action" ], "rows": [ [ "Nodule found incidentally on diagnostic chest, cardiac, abdominal, trauma, or angiographic CT", "Fleischner incidental-nodule guidance.[19]", "Characterize on thin-section CT, compare prior imaging, then apply morphology, size, multiplicity, and patient-risk thresholds.[19][20]" ], [ "Nodule found during an established low-dose CT lung cancer screening program", "Lung-RADS.[1][23]", "Use the Lung-RADS category-specific interval; obtain and compare prior imaging when needed before final classification.[23]" ] ] } }, { "id": "incidental-solid-nodule-thresholds", "eyebrow": "Incidental solid nodules", "heading": "Apply 6 mm and 8 mm thresholds to incidental solid nodules", "intro": "Size directs surveillance intensity, but malignancy probability directs PET/CT, biopsy, or resection.", "paragraphs": [ "For a solitary incidental solid nodule smaller than 6 mm, no routine CT follow-up is recommended in a low-risk patient; in a high-risk patient, CT at 12 months is optional. This threshold reflects the low estimated cancer risk for nodules below 6 mm, generally less than 1%.[9][23]", "For a solitary solid nodule measuring 6-8 mm, obtain follow-up CT at 6-12 months and again at 18-24 months. In patients with malignancy risk factors, a more intensive schedule of CT at 3-6 months, 9-12 months, and 24 months has been suggested.[23]", "For an incidental solid nodule larger than 8 mm, do not default to prolonged surveillance. At approximately 3 months, choose repeat CT, FDG-PET/CT, or tissue sampling based on pretest probability, nodule morphology, patient fitness for curative treatment, and whether a tissue diagnosis will alter management.[8][19][23]" ], "bullets": [ "Multiple incidental solid nodules smaller than 6 mm generally require no routine follow-up in low-risk patients; a 12-month CT is optional in high-risk patients.[23]", "For multiple solid nodules with at least one nodule 6-8 mm, obtain CT at 3-6 months, then consider CT at 18-24 months.[23]", "For multiple solid nodules with at least one nodule larger than 8 mm, obtain CT at 3-6 months and consider CT at 18-24 months; base escalation on the most suspicious lesion rather than the largest lesion alone.[23]" ], "subsections": [ { "heading": "When a solid nodule exceeds 8 mm", "paragraphs": [ "Estimate clinical probability of malignancy before PET/CT or biopsy. ACCP guidance supports PET/CT when clinical cancer risk is 5%-65%; PET interpretation is probability-dependent, with false-negative results more consequential in high-risk patients and false-positive results more problematic in low-risk patients.[2][4]", "Proceed toward surgical diagnosis or excision rather than relying on a negative or equivocal noninvasive test when pretest probability is high and the patient is an operative candidate. ACCP-based summaries divide 8-30 mm solid nodules into low-, moderate-, and high-probability groups: low probability permits serial low-dose CT, moderate probability permits PET or serial CT, and high probability favors surgical diagnosis by biopsy or excision.[23]", "Use nonsurgical biopsy when pathology is needed before treatment or when surgery is not an appropriate direct option. A nondiagnostic biopsy does not exclude cancer unless the specimen establishes a specific benign diagnosis; unresolved nodules may still require surgical resection.[2][24]" ], "bullets": [ "Low pretest probability for an 8-30 mm solid nodule: low-dose CT at 3-6, 9-12, and 18-24 months is an option.[23]", "Moderate pretest probability: obtain PET/CT or use serial CT surveillance when the expected test result will change management.[23]", "High pretest probability: refer for surgical diagnostic evaluation when the patient is a candidate for definitive resection.[23][24]" ] } ], "table": { "caption": "Incidental solid pulmonary nodule follow-up thresholds.[19][23]", "columns": [ "Nodule pattern and size", "Low-risk patient", "Higher-risk patient or escalation condition" ], "rows": [ [ "Single solid nodule <6 mm", "No routine follow-up.[23]", "Optional CT at 12 months.[23]" ], [ "Single solid nodule 6-8 mm", "CT at 6-12 months; consider CT at 18-24 months.[23]", "CT at 6-12 months and 18-24 months; some ACCP-based schedules use 3-6, 9-12, and 24 months with risk factors.[23]" ], [ "Single solid nodule >8 mm", "At about 3 months, consider CT, PET/CT, or tissue sampling after probability assessment.[19][23]", "Use PET/CT for estimated clinical risk 5%-65%; high probability and operability favor surgical diagnosis.[2][23]" ], [ "Multiple solid nodules with largest 6-8 mm", "CT at 3-6 months; consider CT at 18-24 months.[23]", "CT at 3-6 months and 18-24 months.[23]" ], [ "Multiple solid nodules with largest >8 mm", "CT at 3-6 months; consider CT at 18-24 months.[23]", "CT at 3-6 months and 18-24 months; escalate based on the most suspicious nodule.[23]" ] ] } }, { "id": "subsolid-nodule-thresholds", "eyebrow": "Subsolid nodules", "heading": "Confirm persistence before committing to long-term subsolid surveillance", "intro": "Pure ground-glass and part-solid nodules require separate thresholds from solid nodules.", "paragraphs": [ "Classify a subsolid nodule as pure ground glass or part solid on thin-section CT before setting the interval. The Fleischner subsolid guidance was developed separately because these nodules have more variable management and are linked to the peripheral adenocarcinoma spectrum.[16][18][20]", "For a pure ground-glass nodule smaller than 6 mm, no routine follow-up is recommended. For a pure ground-glass nodule 6 mm or larger, obtain CT at 6-12 months to confirm persistence, then repeat CT every 2 years until 5 years if it persists.[23]", "For a part-solid nodule 6 mm or larger, obtain CT at 3-6 months to confirm persistence. If persistent and the solid component remains smaller than 6 mm, perform annual CT for 5 years; a growing solid component or a solid component 6 mm or larger should prompt diagnostic evaluation rather than continued routine surveillance.[23]" ], "bullets": [ "For multiple subsolid nodules smaller than 6 mm, obtain CT at 3-6 months; if stable, consider CT at 2 and 4 years.[23]", "For multiple subsolid nodules with at least one nodule 6 mm or larger, obtain CT at 3-6 months and manage according to the most suspicious lesion.[23]", "Do not treat a subsolid lesion as stable solely because a short interval CT is unchanged; persistent lesions are followed longer than solid nodules under Fleischner-based schedules.[23]" ], "subsections": [ { "heading": "Features that override a routine surveillance plan", "paragraphs": [ "A newly enlarging nodule, increasing solid component, or development of suspicious morphology should move the patient from surveillance to PET/CT, biopsy, or surgical evaluation according to lesion size, probability of malignancy, and treatment candidacy. Growth is strongly associated with malignancy, although slow-growing subsolid lesions may require prolonged observation to establish behavior.[9][23]", "Use serial volumetric assessment when available and technically consistent. One volume-doubling time corresponds to an approximately 26% increase in diameter; most lung cancers have volume-doubling times up to 400 days, while volume-doubling time below 100 days is associated with the highest malignancy risk.[9]" ], "bullets": [] } ], "table": { "caption": "Fleischner-based follow-up for incidental subsolid nodules.[23]", "columns": [ "Nodule type", "Size threshold", "Follow-up action" ], "rows": [ [ "Single pure ground-glass", "<6 mm", "No routine follow-up.[23]" ], [ "Single pure ground-glass", "≥6 mm", "CT at 6-12 months to confirm persistence, then every 2 years until 5 years.[23]" ], [ "Single part-solid", "<6 mm", "No routine follow-up.[23]" ], [ "Single part-solid", "≥6 mm with solid component <6 mm after persistence confirmed", "CT at 3-6 months, then annual CT for 5 years.[23]" ], [ "Single part-solid", "Persistent with growing solid component or solid component ≥6 mm", "Diagnostic evaluation rather than routine surveillance.[23]" ] ] } }, { "id": "screening-lung-rads-thresholds", "eyebrow": "Screening CT", "heading": "Use Lung-RADS intervals for nodules found in screening programs", "intro": "Lung-RADS is a screening reporting system, not an incidental-nodule surveillance schedule.", "paragraphs": [ "For Lung-RADS category 1 or 2 findings, continue annual low-dose CT screening. Category 3 findings require repeat low-dose CT at 6 months. These category-specific intervals should replace ad hoc application of incidental-nodule schedules in a screening program.[23]", "For Lung-RADS category 4A, obtain low-dose CT at 3 months or PET/CT when the solid component exceeds 8 mm. For categories 4B and 4X, proceed with diagnostic chest CT with or without contrast, PET/CT, biopsy, or repeat low-dose CT at 1 month according to the imaging finding and probability of malignancy.[23]", "A new nodule can carry different implications than a baseline finding. Screening algorithms therefore incorporate baseline versus interval-detected status rather than relying solely on an absolute diameter threshold.[1]" ], "bullets": [ "Classify category 0 only after obtaining comparison with prior complete lung imaging when available.[23]", "Use PET/CT selectively for screening-detected lesions with a solid component larger than 8 mm; PET/CT does not replace diagnostic evaluation when clinical and imaging suspicion remain high.[4][23]", "For category 4B or 4X, arrange diagnostic workup rather than simply returning the patient to annual screening.[23]" ], "subsections": [], "table": { "caption": "Lung-RADS follow-up intervals for screening-detected nodules.[23]", "columns": [ "Lung-RADS category", "Recommended next step" ], "rows": [ [ "0", "Compare with prior complete lung imaging before final classification.[23]" ], [ "1 or 2", "Continue annual low-dose CT.[23]" ], [ "3", "Low-dose CT at 6 months.[23]" ], [ "4A", "Low-dose CT at 3 months or PET/CT if the solid component is >8 mm.[23]" ], [ "4B or 4X", "Diagnostic chest CT with or without contrast, PET/CT, biopsy, or repeat low-dose CT at 1 month.[23]" ] ] } }, { "id": "risk-based-escalation-and-surveillance", "eyebrow": "Escalation decisions", "heading": "Use probability, growth, and treatment candidacy to select PET/CT, biopsy, or resection", "intro": "The purpose of follow-up is to avoid both delayed cancer diagnosis and unnecessary invasive testing.", "paragraphs": [ "For nodules larger than 8 mm or otherwise suspicious lesions, calculate or explicitly estimate pretest malignancy probability before choosing PET/CT, nonsurgical biopsy, or surgery. The Brock model incorporates age, sex, family history, emphysema, nodule size, nodule type, upper-lobe location, spiculation, and nodule count; risk models are intended to reduce false-positive diagnostic pathways.[11][12]", "A BTS-style pathway illustrates actionable risk strata: for nodules larger than 8 mm or 300 mm3, calculate Brock risk; risk below 10% supports CT surveillance, while risk of 10% or greater prompts PET/CT and post-PET Herder reassessment. Herder risk below 10% supports surveillance, risk above 70% supports excision or nonsurgical treatment, and 10%-70% requires individualized selection among image-guided biopsy, surveillance, and excisional biopsy.[21][22]", "Interpret PET/CT in the context of pretest probability rather than as a binary exclusion test. High-risk patients are vulnerable to harmful false reassurance from a false-negative PET/CT, while low-risk patients are vulnerable to unnecessary procedures after false-positive uptake.[4]" ], "bullets": [ "Favor CT surveillance when the probability of malignancy is low and the lesion has no concerning interval growth.[4][21][23]", "Obtain tissue when diagnosis will change treatment selection, when direct resection is not appropriate, or when a specific benign process is plausible and can be established histologically.[2][24]", "Refer for surgical diagnostic evaluation when malignancy probability is high, the patient is operable, and noninvasive testing would not safely reduce uncertainty.[23][24]", "Assess fitness and patient preferences before invasive testing because guideline-based management explicitly weighs surveillance, nonsurgical biopsy, and surgical resection against their respective harms.[8][21]" ], "subsections": [], "table": { "caption": "Risk-based escalation for a suspicious pulmonary nodule.[2][4][21][22][23]", "columns": [ "Risk or finding", "Test or management step", "How the result changes action" ], "rows": [ [ "Low malignancy probability; no documented growth", "CT surveillance at the morphology- and size-specific interval.[21][23]", "Continue surveillance unless growth, new solid component, or suspicious morphology develops.[9][23]" ], [ "Estimated clinical malignancy risk 5%-65%", "FDG-PET/CT is supported by ACCP guidance.[2]", "Integrate PET result with pretest probability; do not treat a negative PET/CT as definitive in a high-risk nodule.[4]" ], [ "Brock risk ≥10% in BTS-style pathway", "Obtain PET/CT and reassess risk with the Herder model.[21][22]", "Herder risk <10% supports surveillance; 10%-70% permits biopsy, surveillance, or excision; >70% supports excision or nonsurgical treatment.[21][22]" ], [ "High malignancy probability and surgical candidacy", "Surgical diagnostic biopsy or excision.[23][24]", "Avoid delaying definitive diagnosis with low-yield sequential testing when management would remain surgical.[24]" ] ] } } ], "faq": [], "references": [ { "number": 1, "title": "Pulmonary nodules and CT screening: the past, present and future", "detail": "thorax.bmj.com", "url": "https://thorax.bmj.com/content/thoraxjnl/early/2016/02/26/thoraxjnl-2015-208107.full.pdf", "authors": "thorax.bmj.com", "host": "thorax.bmj.com" }, { "number": 2, "title": "Biopsy decision for intermediate–high-risk lung nodules is ...", "detail": "bmjopenrespres.bmj.com", "url": "https://bmjopenrespres.bmj.com/content/12/1/e002553", "authors": "bmjopenrespres.bmj.com", "host": "bmjopenrespres.bmj.com" }, { "number": 3, "title": "Pulmonary nodules and CT screening: the past, present and future | Thorax", "detail": "thorax.bmj.com", "url": "https://thorax.bmj.com/content/71/4/367", "authors": "thorax.bmj.com", "host": "thorax.bmj.com" }, { "number": 4, "title": "British Thoracic Society guidelines for the investigation and ... - 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PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "http://www.ncbi.nlm.nih.gov/pubmed/23070270", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 19, "title": "Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/full/10.1148/radiol.2017161659", "authors": "pubs.rsna.org", "host": "pubs.rsna.org" }, { "number": 20, "title": "Recommendations for the Management of Subsolid Pulmonary Nodules Detected at CT: A Statement from the Fleischner SocietyRadiology", "detail": "pubs.rsna.org", "url": "http://pubs.rsna.org/doi/pdf/10.1148/radiol.12120628", "authors": "pubs.rsna.org", "host": "pubs.rsna.org" }, { "number": 21, "title": "2 The diagnostic tests | EarlyCDT Lung for assessing risk of lung cancer in solid lung nodules | CLONE OF DG46: EarlyCDT Lung for assessing risk of lung cancer in solid lung nodules | Consultations | NICE", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/consultations/1128/1/the-diagnostic-tests", "authors": "www.nice.org.uk", "host": "www.nice.org.uk" }, { "number": 22, "title": "[PDF] EarlyCDT Lung for assessing risk of lung cancer in solid lung nodules", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/HTG611/documents/514", "authors": "www.nice.org.uk", "host": "www.nice.org.uk" }, { "number": 23, "title": "Solitary Pulmonary Nodule - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK556143", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 24, "title": "[Solitary pulmonary nodule on CT - observation or surgical resection?] - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/22753287", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Pulmonary nodules and CT screening: the past, present and future", "detail": "thorax.bmj.com", "url": "https://thorax.bmj.com/content/thoraxjnl/early/2016/02/26/thoraxjnl-2015-208107.full.pdf", "authors": "thorax.bmj.com", "host": "thorax.bmj.com", "snippet": "More recent guidelines, published by the American College of Chest Physicians (ACCP),35 generally mirror the Fleischner guidelines with little change to follow-up recommendations (table 1). The Fleischner Society have recently responded to the problem of the subsolid nodule by publishing a further s", "score": 0.635879 }, { "number": 2, "title": "Biopsy decision for intermediate–high-risk lung nodules is ...", "detail": "bmjopenrespres.bmj.com", "url": "https://bmjopenrespres.bmj.com/content/12/1/e002553", "authors": "bmjopenrespres.bmj.com", "host": "bmjopenrespres.bmj.com", "snippet": "The investigation of high-risk pulmonary nodules suspicious for lung cancer on CT scan is a common reason for referral to thoracic medicine departments.1 2 Efficient investigation of nodules is therefore of great importance and studies that define the best combination and/or order of investigations ", "score": 0.4574039 }, { "number": 3, "title": "Pulmonary nodules and CT screening: the past, present and future | Thorax", "detail": "thorax.bmj.com", "url": "https://thorax.bmj.com/content/71/4/367", "authors": "thorax.bmj.com", "host": "thorax.bmj.com", "snippet": "The British Thoracic Society (BTS) published new guidelines on the investigation and management of pulmonary nodules in July 2015 following a comprehensive review of the evidence, with a third of the references cited from 2012 or later.39 Importantly, recommendations differ substantially from the ea", "score": 0.61251885 }, { "number": 4, "title": "British Thoracic Society guidelines for the investigation and ... - Thorax", "detail": "thorax.bmj.com", "url": "https://thorax.bmj.com/content/70/Suppl_2/ii1", "authors": "thorax.bmj.com", "host": "thorax.bmj.com", "snippet": "After assessment of the risk of malignancy on the basis of clinical and initial radiological characteristics, some people will have pulmonary nodules with a low risk of malignancy and will therefore be suitable for CT surveillance rather than further imaging or biopsy. The overall aim of this approa", "score": 0.59061456 }, { "number": 5, "title": "Fleischner Society Guideline Recommendations for Incidentally Detected Pulmonary Nodules and the Probability of Lung Cancer", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1546144022005646", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "## Visual Abstract\n\nImage 5\n1. Download: Download high-res image (386KB)\")\n2. Download: Download full-size image\n\n## Key Words\n\nLung nodule\n\n; \n\npulmonary nodule\n\n; \n\nlung cancer quality practice guidelines\n\n Previous article in this issue\n Next article in this issue\n\n## Introduction\n\nApprox", "score": 0.6811549 }, { "number": 6, "title": "Creating an Incidental Pulmonary Nodule Safety-Net Program", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0012369221000337", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "the primary care provider and the patient. Improvements with consistent use of Fleischner guidelines in scan reports by radiologists and increased ownership in informing patients of incidental nodules by ED and trauma providers have occurred. As the frequency of chest CT imaging is increasing, the n", "score": 0.55420566 }, { "number": 7, "title": "Guidelines for the Evaluation of Pulmonary Nodules ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1546144020311194", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017 ... subsolid pulmonary nodules detected at CT ...Read more", "score": 0.52583206 }, { "number": 8, "title": "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", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0012369213602913", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Solid Nodules Measuring ≤ 8 mm in Diameter\n\nOn the basis of observations from lung cancer screening trials, the attenuation of nodules may be characterized as solid or subsolid. Subsolid nodules can be further classified as part-solid or pure ground glass (defined as focal densities in which und", "score": 0.43885794 }, { "number": 9, "title": "Lung nodules : Annals of Thoracic Medicine", "detail": "journals.lww.com", "url": "https://journals.lww.com/aotm/fulltext/2019/14040/lung_nodules__a_comprehensive_review_on_current.2.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "A growing lung nodule is highly likely to be a malignant one. Individuals with incidentally discovered nodules must always be instructed to present prior imaging studies for comparison, if available, and depending on the time interval, nodule stability practically abolishes the need for any further ", "score": 0.48850358 }, { "number": 10, "title": "Calcified post-tuberculosis nodule at an unusual site : Journal of Clinical and Scientific Research", "detail": "journals.lww.com", "url": "https://journals.lww.com/jcsr/fulltext/2023/12001/calcified_post_tuberculosis_nodule_at_an_unusual.17.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Title: Calcified post-tuberculosis nodule at an unusual site : Journal of Clinical and Scientific Research\nA tuberculoma often develops during the healing process of pulmonary TB as a persistent lesion usually with smooth or well-defined margins and 20%–30% of them may have nodular or diffuse calcif", "score": 0.459586 }, { "number": 11, "title": "Comparison of the Brock model and LU-RADS in... : Indian Journal of Cancer", "detail": "journals.lww.com", "url": "https://journals.lww.com/indianjcancer/fulltext/2025/04000/comparison_of_the_brock_model_and_lu_rads_in.3.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Title: Comparison of the Brock model and LU-RADS in... : Indian Journal of Cancer\nThe Brock model is a predictive model that shows good accuracy for determining likelihood of malignancy in pulmonary nodules, but both have not been validated and compared in sub-solid pulmonary nodules (SSNs); thus, t", "score": 0.71040785 }, { "number": 12, "title": "Lung cancer risk prediction models based on pulmonary nodules: A ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/1759-7714.14333", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Pulmonary nodules risk prediction models were developed to reduce the high false-positive rate of lung cancer screening.", "score": 0.50432175 }, { "number": 13, "title": "Malignancy risk stratification for solitary pulmonary nodule: A clinical ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/jebm.12476", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "In several lung cancer screening studies, such as the NLST, nodules with a diameter larger than 4 mm were considered to be likely malignant. But", "score": 0.4928966 }, { "number": 14, "title": "Development and Internal Validation of a Patient‐Level Diagnostic ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/full/10.1111/1759-7714.70358", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Recent work continues to refine pulmonary nodule triage using data-driven risk-stratification systems [20]. Multimodal biomarker models have", "score": 0.39705023 }, { "number": 15, "title": "Using a risk model for probability of cancer in pulmonary nodules", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdf/10.1111/1759-7714.13991", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Our study shows that decision tree analyses can be applied to screen individuals for early lung cancer with CT.", "score": 0.38055226 }, { "number": 16, "title": "Recommendations for the Management of Subsolid Pulmonary Nodules Detected at CT: A Statement from the Fleischner Society", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/10.1148/radiol.12120628", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "Title: Recommendations for the Management of Subsolid Pulmonary Nodules Detected at CT: A Statement from the Fleischner Society\n# Recommendations for the Management of Subsolid Pulmonary Nodules Detected at CT: A Statement from the Fleischner Society. This report is to complement the original Fleisc", "score": 0.7325349 }, { "number": 17, "title": "Updated Fleischner Society Guidelines for Managing Incidental Pulmonary Nodules: Common Questions and Challenging ScenariosRadioGraphics", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/abs/10.1148/rg.2018180017", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "The new guidelines for managing incidental pulmonary nodules published by the Fleischner Society in 2017 reflect an improved understanding of the risk factors and biologic features of lung cancer. Guidelines for management of small pulmonary nodules detected on CT scans: a statement of the Fleischne", "score": 0.72605723 }, { "number": 18, "title": "Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "http://www.ncbi.nlm.nih.gov/pubmed/23070270", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Title: Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society - PubMed\nSkip to main page content. An official website of the United States government. **The .gov means it’s official.**. The **https://** ensures that you are connecting", "score": 0.7208996 }, { "number": 19, "title": "Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017", "detail": "pubs.rsna.org", "url": "https://pubs.rsna.org/doi/full/10.1148/radiol.2017161659", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "Title: Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017 | Radiology\n# Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. The Fleischner Society Guidelin", "score": 0.5513086 }, { "number": 20, "title": "Recommendations for the Management of Subsolid Pulmonary Nodules Detected at CT: A Statement from the Fleischner SocietyRadiology", "detail": "pubs.rsna.org", "url": "http://pubs.rsna.org/doi/pdf/10.1148/radiol.12120628", "authors": "pubs.rsna.org", "host": "pubs.rsna.org", "snippet": "# Recommendations for the Management of Subsolid Pulmonary Nodules Detected at CT: A Statement from the Fleischner Society. ## Get full access to this article. View all available purchase options and get full access to this article. Figure 1: Use of thick versus thin sections for accurate characteri", "score": 0.49948794 }, { "number": 21, "title": "2 The diagnostic tests | EarlyCDT Lung for assessing risk of lung cancer in solid lung nodules | CLONE OF DG46: EarlyCDT Lung for assessing risk of lung cancer in solid lung nodules | Consultations | NICE", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/consultations/1128/1/the-diagnostic-tests", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "## 2 The diagnostic tests\n\n### Clinical need and practice\n\n2.1 In the NHS, lung nodules are managed in line with the British Thoracic Society's guidelines for the investigation and management of pulmonary nodules (2015). The guideline recommends the same diagnostic approach for nodules detected inci", "score": 0.57293844 }, { "number": 22, "title": "[PDF] EarlyCDT Lung for assessing risk of lung cancer in solid lung nodules", "detail": "www.nice.org.uk", "url": "https://www.nice.org.uk/guidance/HTG611/documents/514", "authors": "www.nice.org.uk", "host": "www.nice.org.uk", "snippet": "and management of pulmonary nodules (2015). The guideline recommends the same diagnostic approach for nodules detected incidentally, due to symptomatic presentation, or through routine screening. People with nodules below 5 mm in diameter or 80 mm3 in volume are discharged without follow up. CT surv", "score": 0.5677694 }, { "number": 23, "title": "Solitary Pulmonary Nodule - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK556143", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Follow-up recommendations according to the Lungs-RADs classification are as follows:\n\n Nodules classified as a Lung-RADS Category 0 must be compared to the previous complete lung imaging before being classified.\n Patients with category 1 and 2 findings may continue with yearly low-dose CT scan.\n Tho", "score": 0.7125728 }, { "number": 24, "title": "[Solitary pulmonary nodule on CT - observation or surgical resection?] - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/pubmed/22753287", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "An official website of the United States government. **The .gov means it’s official.**. Federal government websites often end in .gov or .mil. sharing sensitive information, make sure you’re on a federal. official website and that any information you provide is encrypted. ## Save citation to file. #", "score": 0.4400126 } ], "publishedAt": "2026-09-15T18:15:05.458255+00:00", "updatedAt": "2026-09-15T18:15:05.458255+00:00", "readingMinutes": 7, "slug": "pulmonary-nodule-follow-up-thresholds" }