Fleischner_Society_Guidelines_for_Incidental_Pulmonary_Nodules v.1

Provides guidelines for management of solid and subsolid pulmonary nodules.

Henrik Honkanen

henrik.honkanen@stud.ki.se

@Cambio CDS

The Fleischner guideline guidelines are used for management of solid and subsolid pulmonary nodules.

Use in hemodynamically stable patients with acute pulmonary embolism (PE). Use in patients ≥35 years old with incidental pulmonary nodules on CT imaging. Use most suspicious nodule as guide to management. The guideline consists of questions regarding nodule type, size, number and risk type. The combination of these will result the final recommendation. Recommendations for solid nodules: -No routine follow-up -CT at 6-12 months, then consider CT at 18-24 months -Consider CT at 3 months, PET/CT, or tissue sampling -Optional CT at 12 months -CT at 3-6 months, then consider CT at 18-24 months -CT at 3-6 months, then at 18-24 months Recommendations for subsolid nodules: -No routine follow-up -CT at 3-6 months. If stable, consider CT at 2 and 4 years -CT at 6-12 months to confirm persistence, then CT every 2 years until 5 years -CT at 3-6 months to confirm persistence. If unchanged and solid component remains <6 mm, annual CT should be performed for 5 years -CT at 3-6 months. Subsequent management based on the most suspicious nodule(s)

Do not use for lung cancer screening or in patients with known primary cancer or immunosuppression.

1. MacMahon H, Naidich DP, Goo JM, Lee KS, Leung AN, Mayo JR, Mehta AC, Ohno Y, Powell CA, Prokop M, Rubin GD. Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017. Radiology. 2017 Jul;284(1):228-43.

OBSERVATION.fleischner_society_guidelines_for_incidental_pulmonary_nodules.v0