Pulmonary nodule medical therapy

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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 will mainly depend on the nodule size and growth. Other parameters, such as: location, and distribution may also be helpful for the therapeutical management of solitary pulmonary nodule. Moreover, the solitary pulmonary nodule risk assessment is useful to determine the likelihood for malignancy and prompt treatment. Surgical resection is often recommended among patients with the malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance.

Therapeutic Management

• The optimal management approach of solitary pulmonary nodule will mainly depend on the nodule size and growth.
• Other parameters, such as: location, and distribution may also be helpful for the therapeutical management of solitary pulmonary nodule.
• Moreover, the solitary pulmonary nodule risk assessment is useful to determine the likelihood for malignancy and prompt treatment.
• Surgical resection is often recommended among patients with the malignant likelihood of solitary pulmonary nodule. On the other hand, solitary pulmonary nodules with benign features are eligible for periodic CT surveillance.

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.
* 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.