Fleischner Society Pulmonary Nodule Follow-up Guidelines
Determines follow-up recommendations for incidentally detected pulmonary nodules and ground-glass opacities based on size, number, and risk factors. Used for INCIDENTAL nodules outside screening programs.
Single solid nodule, <6mm
Management: Low risk: no follow-up. High risk: optional 12-month CT
Single solid nodule, 6-8mm
Management: Low risk: CT at 6-12 months. High risk: CT at 6-12 months, then 18-24 months
Single solid nodule, >8mm
Management: CT at 3 months, consider PET-CT or biopsy
Multiple solid nodules, most <6mm
Management: Low risk: no follow-up. High risk: 12-month CT
Multiple solid nodules, at least one >=6mm
Management: CT at 3-6 months, then 18-24 months (based on most suspicious nodule)
Single ground-glass nodule, <6mm
Management: No follow-up needed
Single ground-glass nodule, >=6mm
Management: CT at 6-12 months, then every 2 years (5 years)
Single part-solid nodule
Management: CT at 3-6 months; consider biopsy if solid component >=6mm or growing
This classification system is intended for clinical decision support. Final diagnosis and treatment decisions rest with the clinician.