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Fleischner society pulmonary nodule recommendations

 

Recommendations for Follow-up and Management of Nodules Smaller than 8 mm Detected Incidentally at Nonscreening 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.