Comparison of Fleischner, Lung-RADS and ACCP guideline management of pGGN detected at baseline screening or incidental scans
| Fleischner | ACCP | Lung-RADS | |
|---|---|---|---|
| Baseline scan | |||
| <5 mm | No follow-up if solitary, but if multiple, perform interval CT at 2 and 4 years | No follow-up | See below |
| >5 mm | Interval CT at 3 months, then annual for minimum 3 years (for solitary and multiple nodules) | Annual CT surveillance for minimum 3 years (follow-up at 3 months if >10 mm) | |
| <20 mm | As above | Category 2 (benign): interval CT at 12 months | |
| ≥20 mm | Category 3 (probably benign): interval CT at 6 months | ||
| Interval scan | |||
| New nodule | |||
| <20 mm | As for baseline scan | If >10 mm and persistent or growing favour resection | Category 2 (benign): interval CT at 12 months |
| ≥20 mm and stable or slow growth | Category 3 (probably benign): interval CT at 6 months | ||
| Persistent nodule | Annual CT surveillance for a minimum of 3 years Favour excision if nodule >10 mm or multiple pGGN with a persistent dominant nodule Biopsy noted to have low yield | >20 mm and stable or slowly growing=category 2 (benign): interval CT at 12 months | |
N.B. Lung-RADS is for CT screening scans only.
ACCP, American College of Chest Physicians; pGGN, pure ground glass nodules; RADS, Reporting and Data System.