Understanding Lung Nodule Follow-up Guidelines

Physicians follow guidelines to inform lung cancer treatment options. The guidelines are developed by experts in the field and informed by data. Medical guidelines are often updated as new data is uncovered. Be sure to speak with your doctor about the most up-to-date guidelines for treating lung nodules. 

There are several lung cancer nodule follow-up guidelines in practice.

The Fleischner Society guidelines are the most referenced guidelines for managing lung nodules not found during the lung cancer screening process.

The American College of Radiology’s Lung-RADS (Lung Imaging Reporting and Data System) guides the management of nodules found through low-dose CT screening for lung cancer. 

The American College of Chest Physicians (ACCP) and the British Thoracic Society (BTS) have also produced lung nodule management guidelines.

These nodule management systems are all very similar, with each set of guidelines informed by data. The guidelines make recommendations based on a variety of factors like the size, shape and appearance of a lung nodule, the patient’s health history and lung cancer risk and if the nodule(s) has grown or changed. Recommendations for follow-up after the identification of a lung nodule may include:

• Comparing the images to another previous image (like a previous CT scan) or repeating a CT scan to see if the nodule has grown or changed.

• Repeating a low-dose CT scan in 1-3 months, 6 months or 1 year (or longer) to see if the nodule has grown or changed.

• A lung biopsy to determine if the nodule is cancerous. 

• A more detailed CT-scan to better determine if the nodule is likely to be cancer.

• A PET scan to see if the nodule lights up and if there is similar activity anywhere in the body (which could indicate cancer).

In some cases, nodules discovered outside of the lung cancer screening process may not warrant any follow-up. 

Despite the availability of evidence-based guidelines for managing lung nodules, not all patients receive guideline-based care. This can lead to poorer health outcomes for patients. 

Tips to Ensure you Receive the Best Care Possible:

• Keep all of your health records and imaging reports in one place, especially if you seek multiple opinions. Bring them with you to every appointment.
• Ensure your provider has reviewed all of your imaging scans before making a suggestion for nodule management.
• Ask your provider why they are suggesting certain next steps. Confirm their approach is guideline-based.
• Ask your provider to complete the Lung Nodule Worksheet with you. 
• If possible, seek out care from a hospital that uses a multidisciplinary care team approach. This means that all of the providers work together using evidence and their expertise to make suggestions for treating a patient’s lung nodules.

Learn more about lung nodules at Lung.org/lung-nodules.