Pulmonary nodule medical therapy
|
Pulmonary Nodule Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Pulmonary nodule medical therapy On the Web |
|
American Roentgen Ray Society Images of Pulmonary nodule medical therapy |
|
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 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
- 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
- Guideline treatment and management recommendations for solitary pulmonary nodule include:
- American College of Chest Physicians (ACCP) guidelines
- Fleischner Society guidelines
- The table below summarizes the follow-up and surveillance 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 |
||
|---|---|---|
| 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 |
- 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
- ↑ 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.