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Chest. 2013 May;143(5 Suppl):e93S-e120S. doi: 10.1378/chest.12-2351.

Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

Author information

1
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. Electronic address: michael.k.gould@kp.org.
2
NYU School of Medicine, New York, NY.
3
Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI.
4
Respiratory Institute, Cleveland Clinic, Cleveland, OH.
5
Mayo Medical School and Mayo Clinic, Rochester, MN.
6
The Pulmonary Center, Boston University School of Medicine, Boston, MA; Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA.

Abstract

OBJECTIVES:

The objective of this article is to update previous evidence-based recommendations for evaluation and management of individuals with solid pulmonary nodules and to generate new recommendations for those with nonsolid nodules.

METHODS:

We updated prior literature reviews, synthesized evidence, and formulated recommendations by using the methods described in the "Methodology for Development of Guidelines for Lung Cancer" in the American College of Chest Physicians Lung Cancer Guidelines, 3rd ed.

RESULTS:

We formulated recommendations for evaluating solid pulmonary nodules that measure > 8 mm in diameter, solid nodules that measure ≤ 8 mm in diameter, and subsolid nodules. The recommendations stress the value of assessing the probability of malignancy, the utility of imaging tests, the need to weigh the benefits and harms of different management strategies (nonsurgical biopsy, surgical resection, and surveillance with chest CT imaging), and the importance of eliciting patient preferences.

CONCLUSIONS:

Individuals with pulmonary nodules should be evaluated and managed by estimating the probability of malignancy, performing imaging tests to better characterize the lesions, evaluating the risks associated with various management alternatives, and eliciting their preferences for management.

Comment in

PMID:
23649456
PMCID:
PMC3749714
DOI:
10.1378/chest.12-2351
[Indexed for MEDLINE]
Free PMC Article

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