What are the American College of Chest Physicians (ACCP) treatment guidelines for solitary pulmonary nodules?

Updated: Aug 22, 2019
  • Author: Pujan H Patel, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

The most recent edition of the ACCP guidelines for the management of solitary pulmonary nodules were published in 2013. [54] Specifically, indeterminate nodules, found via any imaging modality, were addressed. They were defined as any nodule without clearly benign features (eg, intranodular fat indicative of hamartoma) or noncalcified in a benign pattern. The upper limit for the number of nodules was arbitrarily chosen as 10. The guidelines can be summarized as follows:

  • Carefully calculate pretest probability for malignancy, either through experienced clinical judgment or through a validated model (see Assessing the Probability of Malignancy, above)
  • Previous chest imaging should be reviewed and chest CT scan should be performed if the indeterminate nodule was noted on chest radiograph
  • If the lesion is solid and has been stable for at least 2 years, no further follow up is necessary
  • For lesions with a benign pattern of calcification, further testing is not necessary

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