Evaluation of the incidental solid pulmonary nodule in adults

Nodule size (mm)	Low (<5%) cancer risk	High (>65%) or moderate (5 to 65%) cancer risk
Solitary
<6	No routine follow-up	Optional CT at 12 months
6 to 8	CT at 6 to 12 months, then consider CT at 18 to 24 months	CT at 6 to 12 months, then CT at 18 to 24 months
>8	CT at 3 months, then at 9 and 24 months	FDG PET/CT, biopsy or resection
Multiple (evaluation based on largest nodule)
<6	No routine follow-up	Optional CT at 12 months
≥6	CT at 3 to 6 months, then consider CT at 18 to 24 months	CT at 3 to 6 months, then CT at 18 to 24 months

Not applicable to patients age <35 years, in lung cancer screening, with immunosuppression, known pulmonary disease or symptoms or active primary cancer.
Chest CT performed without contrast as contiguous 1 mm sections using low dose technique.
Growing or FDG-avid nodules should undergo biopsy or resection. Growth is defined as >1.5 mm increase.
Nodules unchanged for >2 years are benign.

CT: computed tomography; FDG: 18-fluorodeoxyglucose; PET: positron emission tomography.

Adapted with permission from: MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT Images: From the Fleischner Society. Radiology 2017; 284:228. Copyright © 2017 Radiological Society of North America.

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Evaluation of the incidental solid pulmonary nodule in adults