Pulmonary nodule medical therapy: Difference between revisions
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==Therapeutic Management== | ==Therapeutic Management== | ||
Guideline treatment and management recommendations for solitary pulmonary nodule, include: | |||
*American College of Chest Physicians guidelines | |||
*Fleischner Society guidelines | |||
== | ==Follow-Up and Surveillance== | ||
*The table below summarizes the follow up recommendations for solitary pulmonary nodule according to the Fleischner Society guidelines. | |||
{| | {|style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align=center | ||
!Nodule Size (mm) | !style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" colspan="3"|{{fontcolor|#FFF|'''Recommendations for Follow-up and Management of Nodules <8 mm Detected Incidentally at Non-screening CT'''<br><SMALL>Note: Newly detected indeterminate nodule in persons 35 years of age or older.<ref>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. [http://radiology.rsnajnls.org/cgi/content/abstract/237/2/395 Guidelines for Management of Small Pulmonary Nodules Detected on CT Scans: A Statement from the Fleischner Society.] Radiology 2005 237: 395-400.</ref><br>* '''Low risk patients''': Minimal or absent history of smoking and of other known risk factors.<br>* '''High risk patients''': History of smoking or of other known risk factors.</SMALL>}} | ||
!'''Low risk''' patients | |+ | ||
!'''High risk''' patients | !style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Nodule Size (mm)}} | ||
!style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Low risk''' patients}} | |||
!style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''High risk''' patients}} | |||
|- | |- | ||
|Less than or equal to 4 | |style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|Less than or equal to 4 | ||
|No follow-up needed. | |style="padding: 5px 5px; background: #F5F5F5;"|No follow-up needed. | ||
|Follow-up at 12 months. If no change, no further imaging needed. | |style="padding: 5px 5px; background: #F5F5F5;"| Follow-up at 12 months. If no change, no further imaging needed. | ||
|- | |- | ||
|>4 - 6 | |style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|> 4 - 6 | ||
|Follow-up at 12 months. If no change, no further imaging needed. | |style="padding: 5px 5px; background: #F5F5F5;"| 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. | |style="padding: 5px 5px; background: #F5F5F5;"| Initial follow-up CT at 6 -12 months and then at 18 - 24 months if no change. | ||
|- | |- | ||
|>6 - 8 | |style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|> 6 - 8 | ||
|Initial follow-up CT at 6 -12 months and then at 18 - 24 months if no change. | |style="padding: 5px 5px; background: #F5F5F5;"| 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. | |style="padding: 5px 5px; background: #F5F5F5;"| Initial follow-up CT at 3 - 6 months and then at 9 -12 and 24 months if no change. | ||
|- | |- | ||
|>8 | |style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|> 8 | ||
|Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy | |style="padding: 5px 5px; background: #F5F5F5;"| Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy | ||
|Same at for low risk patients | |style="padding: 5px 5px; background: #F5F5F5;"| Same at for low risk patients | ||
|} | |} | ||
==References== | ==References== | ||
Revision as of 13:22, 17 March 2016
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Pulmonary Nodule Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Pulmonary nodule medical therapy On the Web |
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American Roentgen Ray Society Images of Pulmonary nodule medical therapy |
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Risk calculators and risk factors for Pulmonary nodule medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
The optimal management approach of solitary pulmonary nodule will mainly depend on the nodule size and growth. Other parameters, such as: location, and distribution may also be helpful for the therapeutical management of solitary pulmonary nodule. Moreover, the solitary pulmonary nodule risk assessment is useful to determine the likelihood for malignancy and prompt treatment. Surgical resection is often recommended among patients with the malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance.
Therapeutic Management
Guideline treatment and management recommendations for solitary pulmonary nodule, include:
- American College of Chest Physicians guidelines
- Fleischner Society guidelines
Follow-Up and Surveillance
- The table below summarizes the follow up recommendations for solitary pulmonary nodule according to the Fleischner Society guidelines.
| Recommendations for Follow-up and Management of Nodules <8 mm Detected Incidentally at Non-screening CT 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. |
||
|---|---|---|
| Nodule Size (mm) | Low risk patients | High risk patients |
| Less than or equal to 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 | Follow-up CTs at around 3, 9, and 24 months. Dynamic contrast enhanced CT, PET, and/or biopsy | Same at for low risk patients |
References
- ↑ 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.