). A spiculated border, displacement of the adjacent fissure, or a history of cancer increase the possibility of malignancy, and a follow-up examination in 6–12 months should be considered in these patients.
Incidentally Detected Lung Nodules on Incomplete Thoracic CT ScansLung nodules are commonly encountered in the portions of the lungs that are included on CT scans of the neck, heart, and abdomen, and the question often arises as to whether a complete thoracic CT examination should be performed in such instances. For most small nodules (<6 mm), we do not recommend any further investigation on the basis of the estimated low risk of malignancy (6,7). For intermediate-size (6–8-mm) nodules, we recommend follow-up CT of the complete chest after an appropriate interval (3–12 months depending on clinical risk) to confirm stability and to evaluate additional findings. If nodule stability can be demonstrated on the basis of retrospective comparison with a previous study, that may suffice. In the case of a large or very suspicious nodule, we recommend proceeding with a complete thoracic CT examination for further evaluation. Partial Thoracic CT Scans for Nodule Follow-upWe do not recommend use of partial thoracic scans for practical reasons, including the need for a technologist or radiologist to determine the appropriate range of the scan from a scout image and the possible detection of unanticipated abnormal findings that would require complete examination of the thorax to properly evaluate. ConclusionsThese guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by this society are based on new data and accumulated experience. The need to consider incidentally detected nodules as a separate well-defined component of standard clinical care is well documented. In a recent survey of thoracic CT studies obtained in adults between 2006 and 2012, more than 4.8 million people underwent at least one thoracic CT examination, with more than 1.5 million nodules identified, and a new lung cancer diagnosis was made in approximately 63 000 patients within 2 years (97). Thus, the importance of a systematic and evidence-based approach to the management of these nodules is apparent. It is anticipated that these guidelines will remain clinically relevant for many years; however, continued progress in image processing and evolving understanding of the natural history of incidentally identified nodules will likely mandate further revisions in the future. Advances in Knowledge
Implications for Patient Care
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