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Usual Advice Is to Follow-up Small Pulmonary Nodules

July 8, 2009
Written by: , Filed in: Chest Radiology
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A study was conducted recently to evaluate the management approaches used by the international thoracic radiology community for small pulmonary nodules on CT.

Based on a survey of thoracic radiologists, most advise follow-up CT imaging for incidental small pulmonary nodules, with shorter follow-up for those with risk factors for malignancy.

The Study
This prospective study involved members of 5 international thoracic radiology societies who had submitted responses to a survey. Electronically mailed surveys were sent to 800 radiologists. Of these, 202 responded; 61% of the respondents were from the United States.

Methodology
The survey was conducted between October 2004 and February 2005.

The survey consisted of 4 main scenarios regarding a 3- to 5-mm pulmonary nodule:

  • an incidental nodule in a person <40 years old who never smoked;
  • an incidental nodule in a person >40 years old who never smoked;
  • a nodule in a person who has history of smoking;
  • a nodule in a person with a new diagnosis of extrathoracic cancer.

Results
35% of respondents stated they had a formal policy in place for the management of small pulmonary nodules.

For persons <40 years old with no risk factors for lung cancer, 50% recommended follow-up. Of these, 23% recommended short-term follow-up at 3 to 6 months, and 27% recommended 12-month follow-up; 49% recommended no follow-up. For persons >40 years old with no risk factors, 49% recommended short-term follow-up, and 30% recommended 12-month follow-up.

For nodules in patients with risk factors for lung cancer such as smoking, 70% recommended short-term follow-up and 18% recommended 12-month follow-up; 5% recommended biopsy or surgical resection.

For persons with a new diagnosis of extrathoracic cancer, 75% recommended short-term follow-up and 11% recommended biopsy or surgical resection.

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists --

 

Body Imaging: Abdominal, Thoracic and Vascular University of California, San Francisco, Department of Radiology Course Director: Judy Yee, MD This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging and interventional techniques. Click here to read more or order: Body Imaging

Conclusions
Summarizing all responders, the great propensity of chest radiologists recommended follow-up CT imaging, not biopsy or surgical resection, for small pulmonary nodules.

The follow-up period recommendation tends to be less aggressive in persons who are younger and have a lower risk of malignancy.

Reviewer’s Comments
The authors note that this survey was taken before members of the Fleischner Society had published a consensus statement providing their recommendations for the management of small pulmonary nodules.

Author: Vineet R. Jain, MD

Reference:
Jeudy J, White CS, et al. Management of Small (3–5-mm) Pulmonary Nodules at Chest CT: Global Survey of Thoracic Radiologists. Radiology; 2008; 247 (June): 847-853

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists --

 

Body Imaging: Abdominal, Thoracic and Vascular University of California, San Francisco, Department of Radiology Course Director: Judy Yee, MD This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging and interventional techniques. Click here to read more or order: Body Imaging
.

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