1、7/12/2022.1G Guidelines for Management of uidelines for Management of I Incidental ncidental Pulmonary Pulmonary N Nodules Detected on odules Detected on C CT images: T images: From the Fleischner Society 2017 From the Fleischner Society 2017 7/12/2022.2The Fleischner Society The Fleischner Society
2、Fewer follow-up examinations A range of times ChangeNot intended forImmunocompromised patients Primary cancers Younger than 35 years Increase the minimum threshold size7/12/2022.3The GuidelinesThe Guidelines7/12/2022.4The GuidelinesThe Guidelines7/12/2022.5General RecommendationsGeneral Recommendati
3、ons7/12/2022.6General RecommendationsGeneral RecommendationsFigure Figure 1 1: : (a) Transverse (a) Transverse 5-mm5-mm CT section CT section shows an shows an apparently pure ground-apparently pure ground-glass noduleglass nodule in the left lower lobe in the left lower lobe (arrow).(arrow). (b) Tr
4、ansverse (b) Transverse 1-mm1-mm CT section at the CT section at the same level as a reveals that this is a same level as a reveals that this is a suspicious part-solid nodulesuspicious part-solid nodule with with cystic componentscystic components (arrow). (arrow).7/12/2022.7General Recommendations
5、General RecommendationsFigure Figure 2 2: : (a) Transverse 1-mm CT section shows a (a) Transverse 1-mm CT section shows a nodular opacity nodular opacity adjacent to the minor fissure (arrow).adjacent to the minor fissure (arrow).(b) (b) Coronal Coronal reconstructed CT image shows that the opacity
6、is reconstructed CT image shows that the opacity is a a benign linear scar or lymphoid tissue benign linear scar or lymphoid tissue (arrow).(arrow).7/12/2022.8General RecommendationsGeneral Recommendations7/12/2022.9General RecommendationsGeneral Recommendations7/12/2022.10Recommendations for Solid
7、Lung Recommendations for Solid Lung NodulesNodulesThe GuidelinesThe Guidelines7/12/2022.11Recommendations for Solid Lung NodulesRecommendations for Solid Lung Nodules7/12/2022.12Recommendations for Solid Lung NodulesRecommendations for Solid Lung NodulesFigure Figure 3 3: : Resection revealed Resect
8、ion revealed invasive adenocarcinoma invasive adenocarcinoma in the right lower lobein the right lower lobe . .7/12/2022.13Recommendations for Solid Lung NodulesRecommendations for Solid Lung Nodules7/12/2022.14Recommendations for Solid Lung NodulesRecommendations for Solid Lung NodulesFigure Figure
9、 4 4: : Transverse 1-mm CT section through the right upper lobeTransverse 1-mm CT section through the right upper lobe shows a 7-mm solid nodule and doesnt increase in 2 years. shows a 7-mm solid nodule and doesnt increase in 2 years.7/12/2022.15Recommendations for Solid Lung NodulesRecommendations
10、for Solid Lung Nodules7/12/2022.16Figure Figure 5 5: : (a) Lung window and (b) soft-tissue window 1-mm transverse CT (a) Lung window and (b) soft-tissue window 1-mm transverse CT sections show a smoothly marginated solid nodule (arrow) with internal sections show a smoothly marginated solid nodule (
11、arrow) with internal fat fat and calcificationand calcification, consistent with a , consistent with a hamartomahamartoma. No further CT follow-up is . No further CT follow-up is recommended for such findings.recommended for such findings.Recommendations for Solid Lung NodulesRecommendations for Sol
12、id Lung Nodules7/12/2022.17Figure Figure 6 6: :(a) CT image shows a smoothly marginated solid nodule with (a) CT image shows a smoothly marginated solid nodule with central central calcificationcalcification, typical of a , typical of a healed granulomahealed granuloma. No further CT follow-up is .
13、No further CT follow-up is recommended for such nodules. recommended for such nodules. (b) CT image shows a smoothly marginated solid nodule with (b) CT image shows a smoothly marginated solid nodule with laminar laminar calcificationcalcification, typical of a , typical of a healed granulomahealed
14、granuloma. No further CT follow-up is . No further CT follow-up is recommended for such findings.recommended for such findings.Recommendations for Solid Lung NodulesRecommendations for Solid Lung Nodules7/12/2022.18Recommendations for Solid Lung NodulesRecommendations for Solid Lung Nodules Figure F
15、igure 7 7: :Transverse 1-mm CT section through Transverse 1-mm CT section through the left upper lobe shows a the left upper lobe shows a suspicious solid suspicious solid spiculated spiculated nodule nodule (arrow). Surgery revealed (arrow). Surgery revealed invasive invasive adenocarcinomaadenocar
16、cinoma. .7/12/2022.19Recommendations for Solid Lung NodulesRecommendations for Solid Lung Nodules Figure Figure 8 8: :Transverse 1-mm CT sections obtained 10 months apart show a highly Transverse 1-mm CT sections obtained 10 months apart show a highly suspicious pattern of suspicious pattern of prog
17、ressive thickeningprogressive thickening in the wall of a right lower in the wall of a right lower lobe cyst (arrow). Resection revealed lobe cyst (arrow). Resection revealed invasive adenocarcinomainvasive adenocarcinoma. .7/12/2022.20Recommendations for Solid Lung NodulesRecommendations for Solid
18、Lung Nodules7/12/2022.21Recommendations for Solid Lung NodulesRecommendations for Solid Lung Nodulesdepend onestimated risk7/12/2022.22Recommendations for Solid Lung NodulesRecommendations for Solid Lung Nodules Figure Figure 9 9: :CT image shows multiple solid nodules of varying size with lowerCT i
19、mage shows multiple solid nodules of varying size with lowerzone predominance (arrows) secondary to zone predominance (arrows) secondary to metastatic thyroid carcinomametastatic thyroid carcinoma. .7/12/2022.23Recommendations for Solitary Recommendations for Solitary Subsolid Lung NodulesSubsolid L
20、ung NodulesThe GuidelinesThe Guidelines7/12/2022.24Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung Nodules7/12/2022.25Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung Nodules7/12/2022.26Recommendations for Recom
21、mendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung Nodules Figure Figure 1010: :Transverse 1-mm CT sections through the right lower lobe. Transverse 1-mm CT sections through the right lower lobe. (a) A well-defined 6-mm groundglass nodule (arrow) can be seen. (a) A well-defined 6-mm
22、 groundglass nodule (arrow) can be seen. (b) Image obtained more than 2 years after a shows a subtle increase in the size of (b) Image obtained more than 2 years after a shows a subtle increase in the size of the nodule (arrow). This finding was confirmed by noting the slightly altered the nodule (a
23、rrow). This finding was confirmed by noting the slightly altered relationship to adjacent vascular structures. relationship to adjacent vascular structures. Findings are consistent with Findings are consistent with adenocarcinoma in situadenocarcinoma in situ or or minimally invasive minimally invas
24、ive adenocarcinomaadenocarcinoma, and continued yearly follow-up is recommended., and continued yearly follow-up is recommended.7/12/2022.27Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung NodulesFigure Figure 1111: : Resection revealed Resection revealed
25、adenocarcinoma in situ (7mm) adenocarcinoma in situ (7mm) in the right upper lobein the right upper lobe . .7/12/2022.28Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung NodulesFigure Figure 1212: : Resection revealed Resection revealed adenocarcinoma in si
26、tu (10mm) adenocarcinoma in situ (10mm) in the right upper lobein the right upper lobe . .7/12/2022.29Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung Nodules7/12/2022.30Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsoli
27、d Lung Nodules Figure Figure 1313: : (a) A 1-mm transverse CT image through the right midlung shows a 10-mm pure (a) A 1-mm transverse CT image through the right midlung shows a 10-mm pure ground-glass nodule (arrow). ground-glass nodule (arrow). (b) CT image in the same location as a at 15-month fo
28、llow-up shows only a very (b) CT image in the same location as a at 15-month follow-up shows only a very subtle increase in opacity. subtle increase in opacity. (c) CT image in the same location as a and b a further 10 months after b shows the (c) CT image in the same location as a and b a further 1
29、0 months after b shows the nodule has evolved into a larger part-solid nodule.nodule has evolved into a larger part-solid nodule. Surgical resection revealed stage 1A Surgical resection revealed stage 1A invasive lepidic predominant adenocarcinomainvasive lepidic predominant adenocarcinoma. .7/12/20
30、22.31Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung NodulesFigure Figure 1414: : (a) Transverse 1-mm CT section through the left upper lobe shows an indeterminate (a) Transverse 1-mm CT section through the left upper lobe shows an indeterminate 10-mm gro
31、und-glass nodule (arrow). 10-mm ground-glass nodule (arrow). (b) Follow-up CT image after 4 months shows interval resolution without treatment, (b) Follow-up CT image after 4 months shows interval resolution without treatment, consistent with a benign cause, such as consistent with a benign cause, s
32、uch as focal infectionfocal infection. .7/12/2022.32Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung Nodules7/12/2022.33Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung Nodules7/12/2022.34Recommendations for Reco
33、mmendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung NodulesFigure Figure 1515: : (a) Transverse 1-mm CT section through the right upper lobe shows a 6-mm part- (a) Transverse 1-mm CT section through the right upper lobe shows a 6-mm part-solid nodule with a solid component (arrow) s
34、maller than 4 mm. solid nodule with a solid component (arrow) smaller than 4 mm. (b) Follow-up CT section at 6-month follow-up shows complete resolution, consistent (b) Follow-up CT section at 6-month follow-up shows complete resolution, consistent with a benign cause.with a benign cause.7/12/2022.3
35、5Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung NodulesFigure Figure 1616: :(a) Transverse 1-mm CT section through the superior segment of the right lower lobe (a) Transverse 1-mm CT section through the superior segment of the right lower lobe shows a hi
36、ghly suspicious (large size, ground-glass appearance, and solid shows a highly suspicious (large size, ground-glass appearance, and solid morphology) part-solid nodule (arrow). morphology) part-solid nodule (arrow). (b) Follow-up image obtained 3 months after a shows progressive increase in the size
37、 (b) Follow-up image obtained 3 months after a shows progressive increase in the size of the solid component. of the solid component. Surgery revealed Surgery revealed invasive adenocarcinomainvasive adenocarcinoma. .7/12/2022.36Recommendations for Recommendations for Solitary Subsolid Lung NodulesS
38、olitary Subsolid Lung NodulesFigure Figure 1717: : Transverse 1-mm CT section through the right lower lobe shows a 10-mm part-solid Transverse 1-mm CT section through the right lower lobe shows a 10-mm part-solid nodule with a solid component smaller than 5 mm. nodule with a solid component smaller
39、than 5 mm. 7/12/2022.37Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung NodulesFigure Figure 1818: : Transverse 1-mm CT section through the right lower lobe shows a 11-mm part-solid Transverse 1-mm CT section through the right lower lobe shows a 11-mm part
40、-solid nodule. nodule. Follow-up image obtained 6 months after a shows progressive increase in the size of Follow-up image obtained 6 months after a shows progressive increase in the size of the solid component. the solid component. Surgery revealed Surgery revealed invasive adenocarcinomainvasive a
41、denocarcinoma. .7/12/2022.38Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung NodulesInfections7/12/2022.39Recommendations for Recommendations for Solitary Subsolid Lung NodulesSolitary Subsolid Lung NodulesFigure Figure 1919: : (a) Transverse 1-mm CT secti
42、on through the upper lobes shows multiple variablesized (a) Transverse 1-mm CT section through the upper lobes shows multiple variablesized subsolid nodules bilaterally, including at least one highly suspicious (large size, subsolid nodules bilaterally, including at least one highly suspicious (larg
43、e size, ground-glass appearance, and solid morphology) part-solid lesion in the left upper ground-glass appearance, and solid morphology) part-solid lesion in the left upper lobe (arrow). Initial follow-up would be appropriate in 36 months. lobe (arrow). Initial follow-up would be appropriate in 36
44、months. (b) A more inferior section from the same examination shows another highly (b) A more inferior section from the same examination shows another highly suspicious lobulated 10-mm ground-glass nodule in the right upper lobe (arrow), suspicious lobulated 10-mm ground-glass nodule in the right up
45、per lobe (arrow), which would also warrant follow up. which would also warrant follow up. The findings are most consistent with The findings are most consistent with multifocal primary adenocarcinomamultifocal primary adenocarcinoma. .7/12/2022.40Nodule Size and MorphologyNodule Size and Morphology7
46、/12/2022.41Nodule LocationNodule Location7/12/2022.42Nodule Growth RateNodule Growth Rate7/12/2022.43Emphysema and FibrosisEmphysema and FibrosisEmphysemaEmphysema FibrosisFibrosis 7/12/2022.44Age, Sex, Race Age, Sex, Race and Family Historyand Family History7/12/2022.45TobaccoTobacco 7/12/2022.46In
47、vasive Diagnostic Invasive Diagnostic and Therapeutic Proceduresand Therapeutic Procedures7/12/2022.47Apical ScarringApical Scarring Pleural and Subpleural apical Pleural and Subpleural apical scarring is extremely common. scarring is extremely common.A pleural-based configuration.A pleural-based co
48、nfiguration.An elongated shape.An elongated shape.Straight or Concave margins. Straight or Concave margins. The presence of similar adjacent opacities.The presence of similar adjacent opacities.7/12/2022.48Perifissural NodulesPerifissural Nodules7/12/2022.49Perifissural NodulesPerifissural NodulesFi
49、gure Figure 2020: : CT image shows a solid triangular subpleural nodule (arrow) with a linear CT image shows a solid triangular subpleural nodule (arrow) with a linear extension to the pleural surface, typical of an extension to the pleural surface, typical of an intrapulmonary lymph nodeintrapulmonary lymph node. . No CT follow-up is recommended for such findings.No CT follow-up is recommended for such findings.7/12/2022.50/10/29.51NoImage
