Incidental solitary solid pulmonary nodule evaluation

Algorithm applies to asymptomatic, immunocompetent adults, age >35 years without malignancy that is actively under treatment or follow-up. It is not designed for use in other populations or in those undergoing lung cancer screening. The clinician is expected to use his or her independent medical judgment in the context of individual circumstances and patient preferences to make adjustments, as necessary. Chest CT should be performed without contrast as contiguous thin (ie, 1 mm) images on a helical scanner using low radiation dose techniques.

CT: computed tomography; FDG: fluorodeoxyglucose; PET: positron emission tomography.
* Nodule is a well-defined opacity completely surrounded by lung parenchyma measuring <30 mm in longest dimension.
¶ Growth is defined as >2 mm increase in overall size.
Δ If the chest CT reveals findings relevant to nodule diagnosis (eg, other nodules or masses, mediastinal lymphadenopathy, or findings of pulmonary inflammation or infection), subsequent workup should be based on these findings.
◊ Nodule size is defined as the average of long and short axes in axial cross-section.
§ Likelihood of malignancy assessed either clinically or by quantitative predictive models.
¥ Timing of chest CT is relative to the date of the initial nodule detection.
‡ Another chest CT at 18 to 24 months is an option if stability of nodules is equivocal.
† FDG PET/CT is an option in patients at intermediate cancer risk or those considered high medical risk for biopsy. FDG-avid nodules proceed to tissue sampling. FDG-nonavid nodules are triaged to annual CT surveillance.
** Follow-up interval should be the same or longer than the preceding one that showed no nodule growth. In addition, longer interval is needed to demonstrate unequivocal growth for smaller nodules.

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Incidental solitary solid pulmonary nodule evaluation