Solitary pulmonary nodule secondary prevention: Difference between revisions
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{{Solitary pulmonary nodule}} | {{Solitary pulmonary nodule}} | ||
{{CMG}} {{AE}}{{Sab}}{{MV}} | |||
==Overview== | |||
The [[American College of Chest Physicians|American College of Chest Physicians (ACCP)]] and Fleischner Society guidelines offer a strategy to manage and follow up on pulmonary nodule. | |||
==Secondary Prevention== | |||
===CT Surveillance=== | |||
The [[American College of Chest Physicians|American College of Chest Physicians (ACCP)]] recommends the following:<ref name="pmid23649456">{{cite journal| author=Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP et al.| title=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. | journal=Chest | year= 2013 | volume= 143 | issue= 5 Suppl | pages= e93S-120S | pmid=23649456 | doi=10.1378/chest.12-2351 | pmc=PMC3749714 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23649456 }} </ref> | |||
* If less than 8 mm in size, use [[Medical guideline|guidelines]] by the Fleischner society (see table below). | |||
* For nodules greater than 8 mm in [[diameter]], assess the [[Patient|patient's]] risk of [[Complication (medicine)|complications]] from [[thoracic surgery]]: | |||
** In low - moderate risk, assess the probability of [[cancer]] by a validated calculator and follow up with [[Computed tomography|CT scan]] surveillance. A model developed at the [[Mayo Clinic]] has been the most extensively validated. An open-source version is [https://openrules.ocpu.io/home/www/pulmnodule.html available online]. | |||
** In high risk, assess the probability of [[cancer]] by a validated calculator and obtain non-surgical biopsy.<ref name="pmid9129544">{{cite journal| author=Swensen SJ, Silverstein MD, Ilstrup DM, Schleck CD, Edell ES| title=The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. | journal=Arch Intern Med | year= 1997 | volume= 157 | issue= 8 | pages= 849-55 | pmid=9129544 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9129544 }} </ref> | |||
*The table below summarizes the follow-up and surveillance recommendations for solitary pulmonary nodule according to the Fleischner Society [[Medical guideline|guideline]]: | |||
{|style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align=center | |||
!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 <br> Detected Incidentally at Non-screening CT'''}} | |||
|+ | |||
!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}} | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|≤ 4 | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
* No follow-up needed | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
* Follow-up at 12 months | |||
* If no change, no further [[imaging]] needed | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|> 4 - 6 | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
* Follow-up at 12 months | |||
* If no change, no further [[imaging]] needed | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
* Initial follow-up [[Computed tomography|CT]] at 6 -12 months and then at 18 - 24 months if no change | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|> 6 - 8 | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
* Initial follow-up [[Computed tomography|CT]] at 6 -12 months and then at 18 - 24 months if no change | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
* Initial follow-up [[Computed tomography|CT]] at 3 - 6 months and then at 9 -12 and 24 months if no change | |||
|- | |||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;"|> 8 | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
* Follow-up [[Computed tomography|CT]] at around 3, 9, and 24 months | |||
* Dynamic [[Contrast medium|contrast]] enhanced [[Computed tomography|CT]], [[Positron emission tomography|PET]], and/or [[biopsy]] | |||
|style="padding: 5px 5px; background: #F5F5F5;"| | |||
* Same at for low risk [[Patient|patients]] | |||
|} | |||
:<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 factor|risk factors]]<br>* '''High risk patients''': History of [[smoking]] or of other known [[Risk factor|risk factors]]</SMALL> | |||
==References== | ==References== |
Latest revision as of 03:46, 2 July 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sabawoon Mirwais, M.B.B.S, M.D.[2]Maria Fernanda Villarreal, M.D. [3]
Overview
The American College of Chest Physicians (ACCP) and Fleischner Society guidelines offer a strategy to manage and follow up on pulmonary nodule.
Secondary Prevention
CT Surveillance
The American College of Chest Physicians (ACCP) recommends the following:[1]
- If less than 8 mm in size, use guidelines by the Fleischner society (see table below).
- For nodules greater than 8 mm in diameter, assess the patient's risk of complications from thoracic surgery:
- In low - moderate risk, assess the probability of cancer by a validated calculator and follow up with CT scan surveillance. A model developed at the Mayo Clinic has been the most extensively validated. An open-source version is available online.
- In high risk, assess the probability of cancer by a validated calculator and obtain non-surgical biopsy.[2]
- 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 |
|
|
> 4 - 6 |
|
|
> 6 - 8 |
|
|
> 8 |
|
- Note: Newly detected indeterminate nodule in persons 35 years of age or older.[3]
* 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
- ↑ Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP; et al. (2013). "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. 143 (5 Suppl): e93S–120S. doi:10.1378/chest.12-2351. PMC 3749714. PMID 23649456.
- ↑ Swensen SJ, Silverstein MD, Ilstrup DM, Schleck CD, Edell ES (1997). "The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules". Arch Intern Med. 157 (8): 849–55. PMID 9129544.
- ↑ 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.