Rationale:
Clinical guidelines for the follow-up of pulmonary nodules, such as those from the Fleischner Society, recommend tailoring the intensity of follow-up to the probability of malignancy. In patients with no prior history of cancer, solid nodules that show no growth over a two-year period have a very low likelihood of malignancy, whereas ground-glass nodules require longer follow-up. Frequent follow-up, such as every three months, has not been shown to improve lung cancer mortality outcomes. Excessive and prolonged monitoring exposes patients to more radiation and extends the period of uncertainty, without clear clinical benefit.
References:
- Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017 Heber MacMahon, David P. Naidich, Jin Mo Goo, Kyung Soo Lee, Ann N. C. Leung, John R. Mayo, Atul C. Mehta, Yoshiharu Ohno, Charles A. Powell, Mathias Prokop, Geoffrey D. Rubin, Cornelia M. Schaefer-Prokop, William D. Travis, Paul E. Van Schil, and Alexander A. Bankier
Radiology 2017 284:1, 228-243 - Ito M, Miyata Y, Okada M. Management pathways for solitary pulmonary nodules. J Thorac Dis. 2018;10(Suppl 7):S860–S866. doi:10.21037/jtd.2018.01.07
- Smith-Bindman R, Lipson J, Marcus R, Kim KP, Mahesh M, Gould R, Berrington de González A, Miglioretti DL. Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med. 2009;169(22):2078–86.
- Wiener RS, Gould MK, Woloshin S, Schwartz LM, Clark JA. What do you mean, a spot?: a qualitative analysis of patients’ reactions to discussions with their doctors about pulmonary nodules. Chest. 2012 Jul 17. doi: 10.1378/chest.12–1095. [Epub ahead of print].