The Fleischner Society has published new guidelines for the management of incidental pulmonary nodules detected on CT images. The updated guidelines reflect new data in the field and are based on the consensus of a multidisciplinary group comprised of experienced thoracic radiologists, pulmonologists, surgeons, pathologists and other specialists. The guidelines apply to incidental nodules found in adults ≥ 35 years and should not be used in persons < 35, patients at risk for infection due to an immunocompromised state, individuals being screened for lung cancer or people with a known history of a primary cancer.
Significant changes to the previous Fleischner guidelines include an increase in the minimum size of solid nodules that warrant routine follow-up (minimum threshold now 6mm instead of 4mm). In addition, fewer follow-up CTs are recommended for solid nodules that have remained stable in size. In the case of sub-solid nodules, the total duration of follow-up recommended has been increased to 5 years.
The new recommendations are geared toward reducing unnecessary follow-up CT scans that expose patients to unwarranted doses of radiation. The guidelines indicate that no routine follow-up is needed for nodules < 6 mm in low risk patients unless there are multiple nodules that are sub-solid in appearance. Utilization of a low-radiation technique is recommended when chest CTs are performed for the follow-up of lung nodules to limit radiation exposure.
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