Fleischner Society Guidelines for Incidental Pulmonary Nodules

Choose the appropriate features. For nodule size, use the average of long and short axes and round to the nearest millimeter. Solid nodules: Size Single Multiple Low risk* High risk* Low risk* High risk* <6 mm (<100 mm3) No routine follow-up Optional CT at 12 months No routine follow-up Optional CT at 12 months 6-8 mm (100-250 mm3) CT at 6-12 months, then consider CT at 18-24 months CT at 6-12 months, then CT at 18-24 months CT at 3-6 months, then consider CT at 18-24 months CT at 3-6 months, then at 18-24 months >8 mm (>250 mm3) Consider CT at 3 months, PET/CT, or tissue sampling Consider CT at 3 months, PET/CT, or tissue sampling CT at 3-6 months, then consider CT at 18-24 months CT at 3-6 months, then at 18-24 months Subsolid nodules: Size Single Multiple Ground glass Part solid <6 mm (<100 mm3) No routine follow-up No routine follow-up CT at 3-6 months. If stable, consider CT at 2 and 4 years ≥6 mm (≥100 mm3) 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) *Risk level is determined by clinical judgment, and all relevant risk factors should be considered, including: Nodule size, morphology, location, multiplicity, growth rate, presence of emphysema, and evidence of fibrosis. Age, race, sex, and family history of lung cancer. Smoking status and exposure to other inhaled carcinogens.