TY - JOUR
T1 - Management of the solitary pulmonary nodule
AU - Nasim, Faria
AU - Ost, David E.
N1 - Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Purpose of reviewWe review the categorization and management of solitary pulmonary nodules.Recent findingsThe National Comprehensive Cancer Network guidelines were updated in 2018 and the revised Fleischner Society guidelines were published in 2017. The revised Fleischner Society guidelines published in 2017 have less frequent follow-up recommendations for incidentally detected pulmonary nodules with longer intervals between subsequent CT scans. The updated 2018 version of National Comprehensive Cancer Network lung cancer screening guidelines provide recommendations for screen-detected nodules based on a patient's risk of cancer. New molecular assays may be of use in patients with a pretest probability of malignancy less than 50%. When these tests indicate low risk, a strategy of follow-up CT imaging may be feasible, avoiding unnecessary invasive testing. However, further clinical utility studies are needed in this area.SummaryManagement options for pulmonary nodules include watchful waiting with follow-up CT imaging, PET imaging, or further invasive testing based on probability of malignancy. With a low estimated risk of malignancy in an incidentally detected solitary pulmonary nodule, longer intervals between follow-up CT scans are recommended for patients. For patients at high risk for malignancy or those with nodules of at least 8mm, either incidentally, screen detected, or symptom driven, a diagnostic biopsy is necessary to establish the cause of a solitary pulmonary nodule.
AB - Purpose of reviewWe review the categorization and management of solitary pulmonary nodules.Recent findingsThe National Comprehensive Cancer Network guidelines were updated in 2018 and the revised Fleischner Society guidelines were published in 2017. The revised Fleischner Society guidelines published in 2017 have less frequent follow-up recommendations for incidentally detected pulmonary nodules with longer intervals between subsequent CT scans. The updated 2018 version of National Comprehensive Cancer Network lung cancer screening guidelines provide recommendations for screen-detected nodules based on a patient's risk of cancer. New molecular assays may be of use in patients with a pretest probability of malignancy less than 50%. When these tests indicate low risk, a strategy of follow-up CT imaging may be feasible, avoiding unnecessary invasive testing. However, further clinical utility studies are needed in this area.SummaryManagement options for pulmonary nodules include watchful waiting with follow-up CT imaging, PET imaging, or further invasive testing based on probability of malignancy. With a low estimated risk of malignancy in an incidentally detected solitary pulmonary nodule, longer intervals between follow-up CT scans are recommended for patients. For patients at high risk for malignancy or those with nodules of at least 8mm, either incidentally, screen detected, or symptom driven, a diagnostic biopsy is necessary to establish the cause of a solitary pulmonary nodule.
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U2 - 10.1097/MCP.0000000000000586
DO - 10.1097/MCP.0000000000000586
M3 - Review article
C2 - 30973358
AN - SCOPUS:85067376624
SN - 1070-5287
VL - 25
SP - 344
EP - 353
JO - Current opinion in pulmonary medicine
JF - Current opinion in pulmonary medicine
IS - 4
ER -