title: Evidence based imaging strategies for solitary pulmonary nodule.
abstract: Solitary pulmonary nodule (SPN) is defined as a rounded opacity ≤3 cm in diameter surrounded by lung parenchyma. The majority of smokers who undergo thin-section CT have SPNs, most of which are smaller than 7 mm. In the past, multiple follow-up examinations over a two-year period, including CT follow-up at 3, 6, 12, 18, and 24 months, were recommended when such nodules are detected incidentally. This policy increases radiation burden for the affected population. Nodule features such as shape, edge characteristics, cavitation, and location have not yet been found to be accurate for distinguishing benign from malignant nodules. When SPN is considered to be indeterminate in the initial exam, the risk factor of the patients should be evaluated, which includes patients' age and smoking history. The 2005 Fleischner Society guideline stated that at least 99% of all nodules 4 mm or smaller are benign; when nodule is 5-9 mm in diameter, the best strategy is surveillance. The timing of these control examinations varies according to the nodule size (4-6, or 6-8 mm) and the type of patients, specifically at low or high risk of malignancy concerned. Noncalcified nodules larger than 8 mm diameter bear a substantial risk of malignancy, additional options such as contrast material-enhanced CT, positron emission tomography (PET), percutaneous needle biopsy, and thoracoscopic resection or videoassisted thoracoscopic resection should be considered.
authors.affiliation: 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK.
authors.forename: Yi-Xiang J
authors.initials: YX
authors.lastname: Wang
authors.affiliation: 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK.
authors.forename: Jing-Shan
authors.initials: JS
authors.lastname: Gong
authors.affiliation: 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK.
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: 1 Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China ; 2 Department of Radiology, Shenzhen People's Hospital, Jinan University Second Clinical Medicine College, Shenzhen 518020, China ; 3 Department of Radiology, The University of Chicago, Chicago, IL 60637, USA ; 4 Diagnostic Imaging, The University of Sheffield, Sheffield, UK.
authors.forename: Sameh K
authors.initials: SK
authors.lastname: Morcos
keywords: Pulmonary nodule; biopsy; computerized tomography; follow-up; guideline; lung cancer; magnetic resonance imaging; positron emission tomography (PET)
references.citation: Med Phys. 2003 Jul;30(7):1602-17
references.pmid: 12906178
references.citation: Radiology. 2009 Dec;253(3):606-22
references.pmid: 19952025
references.citation: Acad Radiol. 2012 Feb;19(2):153-8
references.pmid: 22104289
references.citation: Radiology. 1984 May;151(2):289-93
references.pmid: 6324279
references.citation: N Engl J Med. 2011 Aug 4;365(5):395-409
references.pmid: 21714641
references.citation: Ann Thorac Surg. 2006 Sep;82(3):1016-20
references.pmid: 16928527
references.citation: Radiology. 1982 Jul;144(1):3-14
references.pmid: 6283592
references.citation: J Thorac Cardiovasc Surg. 1980 Sep;80(3):390-9
references.pmid: 6251316
references.citation: N Engl J Med. 2003 Jun 19;348(25):2535-42
references.pmid: 12815140
references.citation: J Thorac Cardiovasc Surg. 2012 Mar;143(3):607-12
references.pmid: 22104678
references.citation: Chest. 1999 May;115(5):1232-6
references.pmid: 10334132
references.citation: AJR Am J Roentgenol. 2007 Jan;188(1):26-36
references.pmid: 17179342
references.citation: AJR Am J Roentgenol. 2006 Apr;186(4):989-94
references.pmid: 16554568
references.citation: Eur Radiol. 2007 Feb;17(2):449-66
references.pmid: 17021707
references.citation: Radiology. 2004 Mar;230(3):619-28
references.pmid: 14739312
references.citation: AJR Am J Roentgenol. 2002 Jul;179(1):149-57
references.pmid: 12076925
references.citation: Radiology. 2004 May;231(2):453-8
references.pmid: 15128990
references.citation: AJR Am J Roentgenol. 2002 May;178(5):1053-7
references.pmid: 11959700
references.citation: Quant Imaging Med Surg. 2013 Dec;3(6):316-26
references.pmid: 24404446
references.citation: J Thorac Imaging. 1996 Summer;11(3):187-97
references.pmid: 8784732
references.citation: AJR Am J Roentgenol. 1997 Feb;168(2):325-8
references.pmid: 9016198
references.citation: Radiographics. 2010 May;30(3):685-98
references.pmid: 20462988
references.citation: Nucl Med Commun. 2009 Jun;30(6):455-61
references.pmid: 19381115
references.citation: Quant Imaging Med Surg. 2014 Jun;4(3):195-206
references.pmid: 24914421
references.citation: Quant Imaging Med Surg. 2014 Apr;4(2):68-70
references.pmid: 24834417
references.citation: Quant Imaging Med Surg. 2013 Apr;3(2):89-99
references.pmid: 23630656
references.citation: AJR Am J Roentgenol. 2000 Mar;174(3):763-8
references.pmid: 10701622
references.citation: J Natl Cancer Inst. 2003 Mar 19;95(6):470-8
references.pmid: 12644540
references.citation: Radiology. 2000 Oct;217(1):251-6
references.pmid: 11012453
references.citation: Am J Surg Pathol. 2009 Mar;33(3):462-9
references.pmid: 19092635
references.citation: Chest. 2007 Sep;132(3 Suppl):94S-107S
references.pmid: 17873163
references.citation: J Digit Imaging. 2012 Dec;25(6):771-81
references.pmid: 22710985
references.citation: AJR Am J Roentgenol. 2003 Apr;180(4):955-64
references.pmid: 12646435
references.citation: Eur J Radiol. 2014 Jan;83(1):73-8
references.pmid: 23711424
references.citation: Lancet. 1998 Apr 25;351(9111):1242-5
references.pmid: 9643744
references.citation: AJR Am J Roentgenol. 2002 Oct;179(4):833-6
references.pmid: 12239020
references.citation: JAMA. 2001 Feb 21;285(7):914-24
references.pmid: 11180735
references.citation: Eur J Radiol. 2003 Jul;47(1):29-37
references.pmid: 12810219
references.citation: Radiology. 2005 Nov;237(2):395-400
references.pmid: 16244247
references.citation: Radiology. 2002 Dec;225(3):673-83
references.pmid: 12461245
references.citation: Arch Intern Med. 1997 Apr 28;157(8):849-55
references.pmid: 9129544
references.citation: Eur J Nucl Med Mol Imaging. 2010 Jun;37(6):1087-94
references.pmid: 20140611
references.citation: J Nucl Med. 2007 Feb;48(2):214-20
references.pmid: 17268017
references.citation: Radiology. 2003 Jul;228(1):15-21
references.pmid: 12832569
references.citation: Radiol Med. 2007 Mar;112(2):157-73
references.pmid: 17361379
references.citation: Am J Hum Genet. 2004 Sep;75(3):460-74
references.pmid: 15272417
references.citation: AJR Am J Roentgenol. 1998 May;170(5):1369-73
references.pmid: 9574618
references.citation: Cancer. 1994 Oct 15;74(8):2239-44
references.pmid: 7922975
references.citation: Radiology. 2008 Jun;247(3):847-53
references.pmid: 18413885
references.citation: Br J Radiol. 2000 Dec;73(876):1252-9
references.pmid: 11205667
references.citation: Radiology. 1996 Apr;199(1):117-22
references.pmid: 8633132
references.citation: J Thorac Oncol. 2008 Apr;3(4):358-64
references.pmid: 18379353
references.citation: Am J Epidemiol. 2000 Jun 1;151(11):1091-102
references.pmid: 10873134
references.citation: Quant Imaging Med Surg. 2012 Sep;2(3):163-76
references.pmid: 23256078
references.citation: Chest. 2003 Jan;123(1 Suppl):89S-96S
references.pmid: 12527568
references.citation: Quant Imaging Med Surg. 2011 Dec;1(1):31-4
references.pmid: 23256051
references.citation: IEEE Trans Med Imaging. 2005 Sep;24(9):1138-50
references.pmid: 16156352
references.citation: Chest. 1985 May;87(5):662-7
references.pmid: 3987379
references.citation: Radiology. 1999 Aug;212(2):561-6
references.pmid: 10429718
references.citation: Radiology. 2010 Apr;255(1):218-24
references.pmid: 20308458
references.citation: Radiology. 2008 Nov;249(2):671-81
references.pmid: 18796658
references.citation: Mayo Clin Proc. 1980 Aug;55(8):475-81
references.pmid: 7401689
references.citation: Int J Cancer. 2010 Dec 15;127(12):2893-917
references.pmid: 21351269
references.citation: Acta Med Okayama. 2004 Oct;58(5):235-40
references.pmid: 15666992
references.citation: Radiology. 2004 Aug;232(2):544-53
references.pmid: 15215548
references.citation: Occup Environ Med. 2001 Mar;58(3):145-53
references.pmid: 11171926
references.citation: Radiology. 2000 Jan;214(1):73-80
references.pmid: 10644104
references.citation: Chest. 1998 Nov;114(5):1305-8
references.pmid: 9824006
references.citation: Cancer. 2001 Jul 1;92(1):153-9
references.pmid: 11443621
references.citation: Eur Radiol. 2004 Jan;14(1):86-92
references.pmid: 14615902
references.citation: Radiology. 2008 Mar;246(3):772-82
references.pmid: 18235105
references.citation: Radiology. 2004 Apr;231(1):164-8
references.pmid: 14990809
references.citation: Mayo Clin Proc. 1990 Feb;65(2):173-86
references.pmid: 2248630
references.citation: Ann Thorac Surg. 2007 Jan;83(1):209-14
references.pmid: 17184664
references.citation: Radiology. 2013 Jan;266(1):62-71
references.pmid: 23070271
references.citation: Quant Imaging Med Surg. 2014 Feb;4(1):1-3
references.pmid: 24649428
references.citation: Chest. 1981 May;79(5):610-1
references.pmid: 7226944
references.citation: J Comput Assist Tomogr. 2004 Jan-Feb;28(1):17-23
references.pmid: 14716227
references.citation: Chest. 1985 Sep;88(3):445-51
references.pmid: 4028856
references.citation: Cancer Epidemiol Biomarkers Prev. 1999 Dec;8(12):1065-9
references.pmid: 10613338
references.citation: Chest. 1987 Jun;91(6):813-6
references.pmid: 3581929
references.citation: Radiographics. 2000 Jan-Feb;20(1):43-58
references.pmid: 10682770
references.citation: Radiology. 2003 Mar;226(3):756-61
references.pmid: 12601181
references.citation: Radiology. 2004 May;231(2):440-5
references.pmid: 15128988
references.citation: Invest Radiol. 2012 Aug;47(8):457-61
references.pmid: 22717879
references.citation: Radiology. 2004 May;231(2):446-52
references.pmid: 15128989
references.citation: Radiology. 2005 Jan;234(1):274-83
references.pmid: 15537839
references.citation: J Thorac Imaging. 2011 May;26(2):90-105
references.pmid: 21508732
references.citation: Radiology. 2005 Nov;237(2):675-83
references.pmid: 16244276
references.citation: Radiology. 2000 Oct;217(1):257-61
references.pmid: 11012454
references.citation: Eur J Nucl Med Mol Imaging. 2011 Jun;38(6):1158-70
references.pmid: 21225422
references.citation: Radiology. 2008 Mar;246(3):697-722
references.pmid: 18195376
references.citation: Lancet. 1999 Jul 10;354(9173):99-105
references.pmid: 10408484
references.citation: AJR Am J Roentgenol. 2004 Nov;183(5):1209-15
references.pmid: 15505279
references.citation: J Thorac Oncol. 2011 Feb;6(2):244-85
references.pmid: 21252716
references.citation: J Natl Cancer Inst. 1984 Jun;72(6):1271-5
references.pmid: 6328090
references.citation: Radiology. 2002 Jun;223(3):798-805
references.pmid: 12034952
references.citation: Radiology. 2004 May;231(2):459-66
references.pmid: 15128991
references.citation: Radiology. 2005 Nov;237(2):684-90
references.pmid: 16244277
references.citation: Radiology. 2012 Apr;263(1):279-86
references.pmid: 22438449
references.citation: Radiographics. 2002 Oct;22 Spec No:S61-78
references.pmid: 12376601
references.citation: AJR Am J Roentgenol. 2005 Oct;185(4):979-84
references.pmid: 16177419
references.citation: Eur J Cardiothorac Surg. 2004 Dec;26(6):1211-5
references.pmid: 15541986
references.citation: Cancer. 2000 Dec 1;89(11 Suppl):2483-4
references.pmid: 11147631
references.citation: J Natl Compr Canc Netw. 2012 Feb;10(2):267-75
references.pmid: 22308519
references.citation: Chest. 1982 Apr;81(4):449-52
references.pmid: 6279361
references.citation: Radiology. 2010 Apr;255(1):199-206
references.pmid: 20123896
references.citation: Radiology. 2007 Mar;242(3):882-8
references.pmid: 17229875
references.citation: Ann Thorac Surg. 2011 Aug;92(2):428-32; discussion 433
references.pmid: 21592456
references.citation: J Comput Assist Tomogr. 1987 May-Jun;11(3):432-5
references.pmid: 3571584
references.citation: Int J Radiat Oncol Biol Phys. 1983 Oct;9(10):1467-70
references.pmid: 6313558
references.citation: Chest. 1997 Dec;112(6):1480-6
references.pmid: 9404742
references.citation: J Comput Assist Tomogr. 2004 Nov-Dec;28(6):766-75
references.pmid: 15538149
references.citation: J Nucl Med. 1998 Jun;39(6):1016-20
references.pmid: 9627336
references.citation: Radiology. 2013 Jan;266(1):304-17
references.pmid: 23070270