title: 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.
abstract: OBJECTIVE
  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 &gt; 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.
authors: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. Electronic address: michael.k.gould@kp.org.
authors: Michael K
authors: MK
authors: Gould
authors: NYU School of Medicine, New York, NY.
authors: Jessica
authors: J
authors: Donington
authors: Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, MI.
authors: William R
authors: WR
authors: Lynch
authors: Respiratory Institute, Cleveland Clinic, Cleveland, OH.
authors: Peter J
authors: PJ
authors: Mazzone
authors: Mayo Medical School and Mayo Clinic, Rochester, MN.
authors: David E
authors: DE
authors: Midthun
authors: NYU School of Medicine, New York, NY.
authors: David P
authors: DP
authors: Naidich
authors: 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.
authors: Renda Soylemez
authors: RS
authors: Wiener
mesh_terms: D001706:Biopsy; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D049268:Positron-Emission Tomography; D013902:Radiography, Thoracic; D018570:Risk Assessment; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D014057:Tomography, X-Ray Computed
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