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Our recommendations are summarized in the Table. These are followed by graded ratings of each recommendation using the American College of Chest Physicians recommendations for evidence grading in clinical guidelines (9). Additional explanations are provided regarding the rationale for each recommendation, which is based on the consensus of a multidisciplinary team and a systematic review of the literature, further details of which are included in Appendix E1 [online]. The minimum threshold size for recommending follow-up is based on an estimated cancer risk in a nodule on the order of 1% or greater. This criterion is necessarily arbitrary, and we recognize that a higher threshold may be considered appropriate in some environments and that this threshold will ultimately depend on social and economic factors. Several general considerations regarding technical aspects of using these recommendations are also presented. Finally, in Appendix E1 (online), additional information regarding methods and risk factors is given.
Recommendations for Managing Incidentally Discovered Pulmonary NodulesGeneral RecommendationsAll CT scans of the thorax in adults should be reconstructed and archived with contiguous thin sections (≤1.5 mm, typically 1.0 mm) to enable accurate characterization and measurement of small pulmonary nodules, and routine acquisition and archiving of off-axis (coronal and sagittal) reconstructed series is strongly recommended (grade 1A; strong recommendation, high-quality evidence). Use of thick sections increases volume averaging, which effectively precludes accurate nodule characterization of small nodules, with respect to part-solid morphology and fat or calcium content, which can affect management (Figs 1–3) (10–12). Coronal and sagittal series facilitate distinction between nodules and scars (Fig 4 |
