Incidental Pulmonary Nodules Detected on CT Images

Abstract

An incidental lung nodule on CT scan can create uncertainty for clinicians and anxiety for patients and families, given that lung cancer is the leading cause of cancer mortality in the United States. Incidental lung nodules are not uncommon. A systematic review of CT screening lung cancer trials noted that a lung nodule was detected in up to 51% of study participants. 1 More than 95% of detected nodules are benign and have a wide variety of causes, including infections, granulomatous disease, hamartomas, arteriovenous malformations, round atelectasis, and lymph nodes. Characteristics of the Guideline SourceThe Fleischner Society is an international multidisciplinary society that publishes standards, guidelines, and consensus statements on the diagnosis and treatment of chest diseases. In 2017, the society published updated guidelines for the management of incidental pulmonary nodules detected on CT images in adults aged 35 years or older (Table ). 2 The new guidelines offer more precise recommendations based on patient risk, the number of nodules (single vs multiple), and the subtyping of subsolid nodules (GGN vs partly solid); discuss additional risk factors for malignancy; and add flexibility regarding follow-up imaging (Figure).

<p>Nomogram For The Prediction Of Malignancy In Small (8–20 mm) Indeterminate Solid Solitary Pulmonary Nodules In Chinese Populations</p>

“…The incidences of solitary pulmonary nodules (SPNs) detected by thoracic computed tomography (CT) performed for lung cancer screening or other reasons are increasingly common 1,2. SPNs are classifiable into solid or subsolid types according to their CT manifestation.…”

Incidental Pulmonary Nodules Found on Shoulder Arthroplasty Preoperative CT Scans

“…It is strongly recommended that the complete chest CT use contiguous thin sections (typically 1.0 mm) with tridimensional reconstruction and archiving to determine the baseline size and characteristics of pulmonary nodules. 6 , 7 CT scans with thicker sections are less accurate due to greater volume averaging, making it more difficult to characterize and manage small nodules. 7 Current preoperative templating of aTSA and rTSA require thin slice (<1.0 mm) CT scans of the operative shoulder, which includes about two-thirds of the ipsilateral lung.…”

“…Despite over 95% of incidental pulmonary nodules being associated with benign causes such as respiratory infections, lymph nodes, atelectasis, and arteriovenous malformations, 6 nodule risk stratification for malignancy is complex and relies on size, location, density, and patient risk factors, with a 6-mm size as the common threshold for concern. 7 The 2017 Fleischner Society guidelines standardized the management of incidentally discovered pulmonary nodules on CT images, 7 but low compliance to these guidelines have been reported among radiologists.…”

Nódulo pulmonar solitario: caracterización radiológica

“…Los nódulos de bajo riesgo se definen por tener un riesgo estimado de cáncer  5% y están asociados con edad temprana y menor fumado, tamaño pequeño, márgenes regulares y ubicación en un área que no sea el lóbulo superior. Los nódulos de riesgo intermedio tienen características mixtas de bajo y alto riesgo, que pueden incluir otros factores de mayor riesgo como el enfisema y la fibrosis pulmonar, antecedentes familiares positivos y exposición conocida a carcinógenos inhalados, y se definen por presentar un riesgo estimado de cáncer de 5% a 65% (17). Algunos de los métodos predictivos validados para la determinación de la probabilidad de malignidad incluyen: (9).…”