Incidental solitary subsolid 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.
* 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, increase in attenuation or appearance or enlargement of a solid component.
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.
§ Ground glass nodules >20 mm are managed with resection in some cases.
¥ Timing of chest CT is relative to the date of the initial nodule detection.
‡ If solid portion of nodule is >8 mm and if clinical suspicion for malignancy is high, this CT can be deferred and the clinician may proceed to the next step with the assumption of a persistent non-enlarging, part-solid nodule.
† If nodule is persistent but not growing and the solid portion is >8 mm, FDG PET/CT is an option. FDG-avid nodules proceed to tissue sampling. FDG non-avid nodules are triaged to annual CT surveillance.

Graphic 113778 Version 2.0

خرید پکیج

Incidental solitary subsolid pulmonary nodule evaluation