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Factors that influence the management of nodules 8 to 30 mm in size

Factors that influence the management of nodules 8 to 30 mm in size
Factor Level CT scan surveillance PET imaging Nonsurgical biopsy VATS wedge resection
Clinical probability of lung cancer Very low (<5%) ++++ – – –
Low-moderate + +++ ++ +
High (<65%) – (± staging) ++ ++++
Surgical risk Low ++ ++ ++ +++
High ++ +++ ++ –
Biopsy risk Low – ++ +++ +++
High ++ +++ – +
High suspicion of active infection or inflammation – – ++++ ++
Values and preferences Desires certainty – + +++ ++++
Risk averse to procedure-related complications ++++ +++ ++ –
Poor adherence with follow-up – – +++ ++++
Selection of modality (surveillance or biopsy) will depend on patient values and preferences; please refer to the UpToDate topic on diagnostic evaluation and management of the solitary pulmonary nodule for more details. Nonsurgical biopsy usually refers to image-guided or endoscopic biopsy.
CT: computed tomography; PET: positron emission tomography; VATS: video-assisted thorascopic surgery.
Reproduced from: Gould MK, Donington J, Lynch WR, et al. 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. Chest 2013; 143:e93S. Table used with the permission of Elsevier Inc. All rights reserved.
Graphic 93548 Version 3.0

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