Table 1.
Current (Pre-COVID-19) Guidelines for the Evaluation of Solid Lung Nodules
| Nodule | CHEST4 | The Fleischner Society5 | Lung-RADS7,a | BTS6 |
|---|---|---|---|---|
| < 6 mm (100 mm3) | LR: ≤ 4 mm optional follow-up > 4-6 mm, 12-mo follow-up HR: ≤ 4 mm, 12-mo follow-up > 4-6 mm, 6- to 12-mo follow-up |
LR: no follow-up HR: optional 12 mo |
RTAS (category 2) For new 4-6 mm, 6 mo (category 3) |
< 5 mm: no follow-up 5-6 mm: 12 mo, 24 mo if stable on diameter, discharge if stable volume, option for further surveillance or evaluation if > 400-d VDT, evaluate if ≤ 400-d VDT |
| ≥ 6 to < 8 mm (100-250 mm3) | LR: 6- to 12-mo follow-up HR: 3- to 6-mo follow-up |
LR: 6-12 mo (3-6 mo if multiple), then consider at 18-24 mo HR: 6-12 mo (3-6 mo if multiple), then 18-24 mo |
6 mo (category 3) 3 mo if new (category 4A) |
3 mo then 12 mo after baseline if VDT > 400 d, then as < 6 mm |
| ≥ 8 mm (250 mm3) | < 5% risk, then surveillance in 3 mo 5%-65% risk, then PET/CT scan ± nonsurgical biopsy > 65% risk then proceed directly to treatment after staging and physiology testing |
Consider CT scan at 3 mo, PET/CT scan, or tissue sampling | For 8-15 mm, 3 mo (category 4A) ≥ 15, ≥ 8, and new or growing, further evaluation (category 4B) |
Assess using Brock model < 10% risk, then surveillance as above > 10% risk, then PET/CT scan and Herder model (< 10% surveillance, > 70% consider resection |
BTS = British Thoracic Society; CHEST = the American College of Chest Physicians; COVID-19 = coronavirus disease 2019; HR = high-risk; LR = low-risk; Lung-RADS = Lung CT Screening Reporting and Data System; RTAS = return to annual screening; VDT = volume doubling time.
a
Lung-RADS was designed to be used in the context of screen-detected lung nodules.