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LUNG NODULES

Sommaire

Last modified: January 27, 2025

Main reference: Fleischner Society 2017

Pulmonary nodules for patients not eligible for Fleischner Society recommendations

Sommaire autre

Last modified: September 7, 2025

Main reference: Massachusetts General Hospital 2017

Population cible

Target population

  • Adults > 35 years old

  • Exclusion

    • Active neoplastic history < 5 years

    • Immunocompromised

    • Participant in a lung cancer screening program

High-risk population

  • Smoking 30 pa, cessation <15 years

  • Upper lobe nodule

  • < 5 nodules

  • Emphysema and pulmonary fibrosis

  • Women, Black and Hawaiian races

  • Family history of pulmonary neoplasia

Notes importantes

Important Notes

  • Significant progression if increase ≥2 mm on one axis of the nodule

  • Subpleural or periscissural nodules, especially if triangular and with well-defined margins = benign

  • If nodule seen on examination includes only part of the thorax, do a chest scan according to the next recommended check (rather than completing with a chest scan immediately)

Notes additionnelles

Additional Notes

  • Evaluate nodules on 1.0-1.5 mm sections

  • If there is doubt about the presence of a solid component in a subsolid nodule, the mediastinal window can be used to identify solid components

  • Nodule size is the average of its longest axis (on any plane) and its perpendicular diameter

    • In practice, the longest diameter is often used

    • More useful when nodule is oval or flat

  • Follow-up recommended as soon as there is a 1% risk of cancer

  • Mixed solid/ground glass nodules most suspicious for neoplasia

Figures

Figures

Table 1. Original summary recommendations of the Fleischner Society 2017

Table 2. Recommendations for patients not eligible for the Fleischner Society guidelines (MGH 2017)

Références et ressources

References

  1. MacMahon H, Naidich DP, Goo JM, Lee KS, Leung ANC, Mayo JR, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017 Jul;284(1):228–43. doi:org/10.1148/radiol.2017161659

  2. Miller JC, Phil D, Boas G. Management of Incidental Pulmonary Nodules Detected on Computed Tomography Images. Massachusetts General Hospital - Radiology Rounds [Internet]. 2017 July. [ Link ].

  3. Bueno J, Landeras L, Chung JH. Updated Fleischner Society Guidelines for Managing Incidental Pulmonary Nodules: Common Questions and Challenging Scenarios. RadioGraphics. 2018 Sep;38(5):1337–50 . doi:org/10.1148/rg.2018180017

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