title: Evaluation of Pulmonary Nodules: Clinical Practice Consensus Guidelines for Asia.
abstract: BACKGROUND
  American College of Chest Physicians (CHEST) clinical practice guidelines on the evaluation of pulmonary nodules may have low adoption among clinicians in Asian countries. Unique patient characteristics of Asian patients affect the diagnostic evaluation of pulmonary nodules. The objective of these clinical practice guidelines was to adapt those of CHEST to provide consensus-based recommendations relevant to practitioners in Asia.
  
  
  METHODS
  A modified ADAPTE process was used by a multidisciplinary group of pulmonologists and thoracic surgeons in Asia. An initial panel meeting analyzed all CHEST recommendations to achieve consensus on recommendations and identify areas that required further investigation before consensus could be achieved. Revised recommendations were circulated to panel members for iterative review and redrafting to develop the final guidelines.
  
  
  RESULTS
  Evaluation of pulmonary nodules in Asia broadly follows those of the CHEST guidelines with important caveats. Practitioners should be aware of the risk of lung cancer caused by high levels of indoor and outdoor air pollution, as well as the high incidence of adenocarcinoma in female nonsmokers. Furthermore, the high prevalence of granulomatous disease and other infectious causes of pulmonary nodules need to be considered. Therefore, diagnostic risk calculators developed in non-Asian patients may not be applicable. Overall, longer surveillance of nodules than those recommended by CHEST should be considered.
  
  
  CONCLUSIONS
  TB in Asia favors lesser reliance on PET scanning and greater use of nonsurgical biopsy over surgical diagnosis or surveillance. Practitioners in Asia are encouraged to use these adapted consensus guidelines to facilitate consistent evaluation of pulmonary nodules.
authors.affiliation: Pulmonary Medicine Department, Zhongshan Hospital, Fudan University, Shanghai Respiratory Research Institute, Shanghai, China. Electronic address: bai.chunxue@zs-hospital.sh.cn.
authors.forename: Chunxue
authors.initials: C
authors.lastname: Bai
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Choi
authors.affiliation: Respiratory Medicine, United Christian Hospital, Kwun Tong, Hong Kong SAR, China.
authors.forename: Chung Ming
authors.initials: CM
authors.lastname: Chu
authors.affiliation: Respiratory Medicine and Critical Care Medicine, Singapore General Hospital, Singapore.
authors.forename: Devanand
authors.initials: D
authors.lastname: Anantham
authors.affiliation: Respiratory Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China.
authors.forename: James
authors.initials: J
authors.lastname: Chung-Man Ho
authors.affiliation: Minimally Invasive and Robotic Thoracic Surgery, Medanta The Medicity, Gurgaon, India.
authors.forename: Ali Zamir
authors.initials: AZ
authors.lastname: Khan
authors.affiliation: Thoracic Surgery, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jang-Ming
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
authors.forename: Shi Yue
authors.initials: SY
authors.lastname: Li
authors.affiliation: Respiratory Medicine, Bangkok Hospital Medical Center, Bangkok Hospital Group, Bangkok, Thailand.
authors.forename: Sawang
authors.initials: S
authors.lastname: Saenghirunvattana
authors.affiliation: Minimally Invasive Thoracic Surgery Centre, Hong Kong SAR, China.
authors.forename: Anthony
authors.initials: A
authors.lastname: Yim
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology; D000397:Air Pollution; D016902:Air Pollution, Indoor; D001208:Asia; D001706:Biopsy; D006099:Granuloma / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000473:pathology; D000072078:Positron Emission Tomography Computed Tomography; D017410:Practice Guidelines as Topic; D015272:Pulmonary Medicine; D013902:Radiography, Thoracic; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000473:pathology; D013903:Thoracic Surgery; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000473:pathology; D047368:Tumor Burden
keywords: Asia; diagnosis; lung neoplasms; peripheral pulmonary nodules; solitary pulmonary nodules