Transient subsolid nodules usually represent infection or alveolar hemorrhage. To differentiate between transient or persistent subsolid nodules a follow-up CT should be obtained. Previously, it was recommended to repeat imaging after 3 months, however, this interval has been increased to 12 months. Because of the slower growth rate, the total follow-up period for persistent subsolid nodules has been increased to 5 years.

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In higher-risk patients, a follow-up CT scan should be considered optional. The change may not seem like much. For reference, the cumulative risk of cancer caused by lung cancer screening over 10 years with low-dose CT has been estimated at 1 in 2, The Fleischner Society considers patients high-risk if they have a significant past smoking history or other known risk factors see below , and low-risk if they lack these factors.

Importantly, characteristics of both the nodule and the patient contribute to the risk assessment. Previous editions of the guidelines advised the third CT scan as standard.

Scanning earlier than 12 months is not advised, because such small nodules, if malignant, rarely advance in stage over 12 months, whereas a short-term follow-up examination showing no apparent change may provide false reassurance. The reasoning is similar to the previous section smaller nodules tend to be slower growing ; scanning too early may provide false reassurance in the interval before the next scan. What About Subsolid Nodules? The management of subsolid and ground glass pulmonary nodules is reviewed here.

For multiple nodules mm, all patients low- or high-risk are advised to get a follow-up chest CT in months. The most suspicious-looking nodule should guide management and risk stratification. High-risk factors include older age, heavy smoking, larger nodule size, irregular or spiculated margins, and upper lobe location. Subjects with intermediate risk share both high- and low-risk characteristics.

Their guidelines on the radiographic management of incidentally discovered pulmonary nodules have defined the standard of care. The Fleischner Society Guidelines have never been prospectively validated.


Fleischner 2017 guideline for pulmonary nodules




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