Table 1.
PNI-GARS
| Category | Grade Score | Imaging Features | Suggestion | Risk of Malignancy |
|---|---|---|---|---|
| Definitely benign | 0 | No pulmonary nodules OR Pure calcified nodules, nodules with fat component, spherical atelectasis, perifissural nodules | No special treatment. Annual follow-up with LDCT for high-risk groups. | - |
| Benign | I | Micronodule with any density: ≤5 mm; Solid nodules > 5 mm and unchanged ≥ 2 years; Sub solid nodules > 5 mm and unchanged ≥ 5 years, the lesions decreased (but not increase in density) or disappeared during follow-up | LDCT 12 months, and if the nodule absorbs or shrinks, there is no need to pay attention. If the nodule increases, management is proceeded as Grade II. | - |
| Probably Benign | II | 5 ~ 8 mm,partial edge smooth. | 5 ~ 6 mm, LDCT 6months; 6 ~ 8 mm, LDCT 3 months. Nodules shrink and management is proceeded as Grade I. Nodules become larger and management is proceed as Grade IIIa. Nodules are enlarged with early malignant signs, and management is proceed as Grade IV. Nodules remain unchanged, and the follow-up time was doubled. | Very low probability |
| Probably Malignant | III | 8 ~ 30 mm(≤ 30 mm); Partial solid nodules ( solid component ≤ 5 mm); Endobronchial nodules | Further examination or LDCT 1 month | - |
| IIIa | Small nodules: 8 ~ 10 mm; GradeII nodules with malignant signs such as vacuole, vascular convergence, lobulation, etc. | LDCT 1 month | Medium probability | |
| IIIb | Medium nodules: 10 ~ 20 mm;Grade IIIa nodules with malignant signs such as vacuole, vascular convergence, lobulation, etc. | Tumour markers, PET/CT(solid component ≥ 8 mm), Percutaneous lung biopsy, Bronchoscope. Thoracoscopic resection is recommended if the auxiliary examination is positive or the pulmonary nodules seriously affect the patient’s life. Nodules with early malignant signs were classified as Grade IV. Endobronchial nodules are recommended for LDCT 1 month later. If there is no change, bronchoscope is recommended. | High probability | |
| IIIc | Large nodules: 20 ~ 30 mm;Grade IIIb nodules with malignant signs such as vacuole, vascular convergence, lobulation, etc. | The same with Grade IIIb | Very high probability | |
| High Suspicious Malignant | IV | 8 ~ 30 mm, nodules with spiculation sign or vacuole, vascular convergence, lobulation, etc. which increase the probability of malignancy; Partial solid nodules(solid component > 5 mm) | Surgical resection | Malignancy confirmed by imaging |
| Malignancy Confirmed by Pathology | V | Malignant disease confirmed by pathology | - | - |
LDCT low dose computed tomography