Radiology Universe Institute
Lost SoulsLost Souls BoomerangBoomerang Pediatric AtlasPeds Atlas Ellipsoid Volume CalculatorVolumes Aortic DiameterAortic Diameter - Adult Kidney SizeKidney Size - Peds Spleen SizeSpleen Size - Peds Testicular VolumeTesticular Volume Fleishner Society Lung Nodule Follow-up Recommendations for Solid, Subsolid, and Groundglass Lung Nodules 2017Lung Nodule 2017 ContactContact

2017 Fleischner Society Pulmonary Nodule Follow-Up Guidelines and Recommendations
for Solid, Subsolid and Ground-Glass Lung Nodules

We your support: 


In 51% of cases, physicians fail to obtain the indicated follow-up exams.
Pulmonary Nodule Size Lung Nodule Type Single vs. Multiple Low Risk Patient High Risk Patient
< 6mm
(< 100mm3)
Solid Solitary

No Follow-Up

If suspicious morphology or upper lobe location, consider 12-month follow-up.
Optional CT in 12 months
Multiple

No Follow-Up

If suspicious morphology or upper lobe location, consider 12-month follow-up.
Optional CT in 12 months
Part-Solid
(Subsolid)
Solitary No Follow-Up
Multiple CT in 3 to 6 months. If unchanged, consider CT at 2 and 4 years.
Ground-Glass Solitary

No Follow-Up

If suspicious, consider follow-up at 2 and 4 years.  If grows or increasingly solid, consider resection.
Multiple CT in 3 to 6 months.  If unchanged, consider CT in 2 and 4 years.
6 to 8mm
(100-250mm3)
Solid Solitary CT in 6 to 12 months, then consider CT in 18 to 24 months. CT in 6 to 12 months, then obtain CT in 18 to 24 months.
Multiple CT in 3 to 6 months, then consider CT in 18 to 24 months CT in 3 to 6 months, then obtain CT in 18 to 24 months
Part-Solid
(Subsolid)
Solitary CT in 3 to 6 months to confirm persistance.  If unchanged and solid component below 6mm, CT annualy for 5 years. 
Persistent part-solid nodules containing a solid componment > 6mm are highly suspicious.
Multiple CT in 3 to 6 months.  Then management based on most suspicious nodule(s).
Ground-Glass Solitary CT in 6 to 12 months to confirm persitance, then CT every 2 years until 5 years.
If grows or increasingly solid, consider resection.
Multiple CT at 3 to 6 months.  Then management based on most suspicious nodule(s).
> 8mm
(< 250mm3)
Solid Solitary In 3 months consider either CT, Biopsy, or PET-CT (however, negative PET-CT does not exclude low-grade malignancy, FDG uptake may be underestimated in small nodules < 1cm, or those close to diaphragm)
Multiple CT in 3 to 6 months, then consider CT at 18 to 24 months CT in 3 to 6 months, then obtain CT at 18 to 24 months
Part-Solid
(Subsolid)
Solitary CT in 3 to 6 months to confirm persistance.  If unchanged and solid component below 6mm, CT annualy for 5 years.
Persistent part-solid nodules containing a solid componment > 6mm are highly suspicious.
Multiple CT at 3 to 6 months.  Then management based on most suspicious nodule(s).
Ground-Glass Solitary CT in 6 to 12 months to confirm persitance, then CT every 2 years until 5 years.
If grows or increasingly solid, consider resection.
Multiple CT at 3 to 6 months.  Then management based on most suspicious nodule(s).


Fleischner Society Recommendations and this table do NOT apply to:
Diameter of lung nodule is the average of the short and long axes, rounded to the whole millimeter.

Lung Cancer Risk Factors:
  • Tobacco use.
  • Family history of lung cancer.
  • Upper pulmonary lobe location of nodule.
  • Presence of emphysema.
  • Pulmonary fibrosis.
  • Older Age.
  • Female gender.
Don't let this happen to Your Patient:
Lung nodule was seen and appropriate follow-up was recommended, but follow-up imaging was not obtained, leading to progression of cancer.  Lost Souls Radiology Recommendation Tracker helps to prevent patients being lost to follow-up.



2017 Fleischner Society Lung Nodule Follow-Up Guidelines for Solid, Subsolid and Ground-glass Pulmonary Nodules

References

  • H MacMahon, DP Naidich, JM Goo, KS Lee, ANC Leung, JR Mayo, AC Mehta, Y Ohno, CA Powell, M Prokop, GD Rubin, CM Schaefer-Prokop, WD Travis, PE Van Schil, AA Bankier. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology 2017, DOI: http://dx.doi.org/10.1148/radiol.2017161659
This website is certified by Health On the Net Foundation. Click to verify. This site complies with HONcode standards for
Trustworthy Health Information - Verify