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Health Dictionary

Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Pulmonary nodule medical therapy

Introduction

Overview

Overview

The optimal management approach of solitary pulmonary nodule mainly depends on the nodule size and growth. Other parameters, such as location and distribution may also be helpful. Surgical resection is often recommended among patients with a malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance.

Medical Therapy

Medical Therapy

  • The optimal management approach of solitary pulmonary nodule mainly depends on the nodule size and growth.
  • Other parameters, such as location and distribution may also be helpful.
  • The solitary pulmonary nodule risk assessment is useful to determine the likelihood of malignancy and prompt treatment.
  • Surgical resection is often recommended among patients with a malignant likelihood of solitary pulmonary nodule.
  • On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance.

Management Strategies

The algorithm below summarizes the different management strategies for patients with pulmonary nodule:

Solid solitary pulmonary nodule
< 8mm
 
Solid solitary pulmonary nodule
> 8mm
 
 
 
Subsolid/part-solid nodule
 
 
 
Multiple
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Non-enhanced CT scan (NECT)
*Frequency depends on individual risk assesment
 
Malignancy risk assessment
 
< 5mm
 
> 5mm
 
Each nodule should be assessed individually*
CT surveillance and biopsy accordingly
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 Intermediate Risk
Positron emission tomography
If positive, request biopsy or surgical excision
If negative, serial CT scans*
High Risk
Biopsy
or
Surgical excision
 
CT Surveillance
Every 3 months
 
No additional work-up
 
 
 
 
 
 
Follow-Up and Surveillance

Follow-Up and Surveillance

  • Guideline treatment and management recommendations for solitary pulmonary nodule include:
  • The table below summarizes the follow-up and surveillance recommendations for solitary pulmonary nodule according to the Fleischner Society guideline:
Recommendations for Follow-up and Management of Nodules <8 mm
Detected Incidentally at Non-screening CT
Nodule Size (mm) Low risk patients High risk patients
≤ 4
  • No follow-up needed
  • Follow-up at 12 months
  • If no change, no further imaging needed
> 4 – 6
  • Follow-up at 12 months
  • If no change, no further imaging needed
  • Initial follow-up CT at 6 -12 months and then at 18 – 24 months if no change
> 6 – 8
  • Initial follow-up CT at 6 -12 months and then at 18 – 24 months if no change
  • Initial follow-up CT at 3 – 6 months and then at 9 -12 and 24 months if no change
> 8
Note: Newly detected indeterminate nodule in persons 35 years of age or older.[1]
* Low risk patients: Minimal or absent history of smoking and of other known risk factors
* High risk patients: History of smoking or of other known risk factors
References

References

  1. ↑ Heber MacMahon, John H. M. Austin, Gordon Gamsu, Christian J. Herold, James R. Jett, David P. Naidich, Edward F. Patz, Jr, and Stephen J. Swensen. Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society. Radiology 2005 237: 395-400.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]