Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice
Background. The latest version of the Fleischner Society guidelines for management of incidental pulmonary nodules was published in 2017. The main purpose of these guidelines is to reduce the number of unnecessary computed tomography (CT) examinations during the follow-up of small indeterminate nodu...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Radiology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2019/7218258 |
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| author | Andrea Borghesi Silvia Michelini Giorgio Nocivelli Mario Silva Alessandra Scrimieri Stefania Pezzotti Roberto Maroldi Davide Farina |
| author_facet | Andrea Borghesi Silvia Michelini Giorgio Nocivelli Mario Silva Alessandra Scrimieri Stefania Pezzotti Roberto Maroldi Davide Farina |
| author_sort | Andrea Borghesi |
| collection | DOAJ |
| description | Background. The latest version of the Fleischner Society guidelines for management of incidental pulmonary nodules was published in 2017. The main purpose of these guidelines is to reduce the number of unnecessary computed tomography (CT) examinations during the follow-up of small indeterminate nodules. Objective. The present study aimed to evaluate the performance of these guidelines for management of solid indeterminate pulmonary nodules (SIPNs) ≤ 250 mm3. Materials and Methods. During a 7-year period, we retrospectively reviewed the chest CT scans of 672 consecutive patients with SIPNs. The study sample was selected according to the following inclusion criteria: solitary SIPN; diameter ≥ 3 mm; volume ≤ 250 mm3; two or more CT scans performed with the same scanner and same acquisition/reconstruction protocol; thin-section 1-mm images in DICOM format; histologic diagnosis or follow-up ≥ 2 years; and no oncological history. Applying these criteria, a total of 27 patients with single SIPNs ≤ 250 mm3 were enrolled. For each SIPN, the volume and doubling time were calculated using semiautomatic software throughout the follow-up period. For each SIPN, we applied the Fleischner Society guidelines, and the recommended management was compared to what was actually done. Results. A significant volumetric increase was detected in 5/27 (18.5%) SIPNs; all growing nodules were observed in high-risk patients. In these SIPNs, a histologic diagnosis of malignancy was obtained. Applying the Fleischner Society recommendations, all five malignant nodules would have been identified. None of the SIPNs < 100 mm3 in low-risk patients showed significant growth during the follow-up period. The application of the new guidelines would have led to a significant reduction in follow-up CT examinations (Hodges-Lehmann median difference, -2 CT scans; p = 0.0001). Conclusion. The application of the updated Fleischner Society guidelines has been shown to be effective in the management of SIPNs ≤ 250 mm3 with a significant reduction in radiation dose. |
| format | Article |
| id | doaj-art-e01b0eb9b3d44fbe8baf470ad37eb621 |
| institution | Kabale University |
| issn | 2090-1941 2090-195X |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Radiology Research and Practice |
| spelling | doaj-art-e01b0eb9b3d44fbe8baf470ad37eb6212025-02-03T07:24:33ZengWileyRadiology Research and Practice2090-19412090-195X2019-01-01201910.1155/2019/72182587218258Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical PracticeAndrea Borghesi0Silvia Michelini1Giorgio Nocivelli2Mario Silva3Alessandra Scrimieri4Stefania Pezzotti5Roberto Maroldi6Davide Farina7Department of Radiology, University and Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, ItalyDepartment of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124 Brescia, ItalyDepartment of Radiology, University and Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, ItalySection of Radiology, Department of Medicine and Surgery, University of Parma, Pad. Barbieri, Via Gramsci 14, 43126 Parma, ItalyDepartment of Radiology, University and Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, ItalyDepartment of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124 Brescia, ItalyDepartment of Radiology, University and Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, ItalyDepartment of Radiology, University and Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, ItalyBackground. The latest version of the Fleischner Society guidelines for management of incidental pulmonary nodules was published in 2017. The main purpose of these guidelines is to reduce the number of unnecessary computed tomography (CT) examinations during the follow-up of small indeterminate nodules. Objective. The present study aimed to evaluate the performance of these guidelines for management of solid indeterminate pulmonary nodules (SIPNs) ≤ 250 mm3. Materials and Methods. During a 7-year period, we retrospectively reviewed the chest CT scans of 672 consecutive patients with SIPNs. The study sample was selected according to the following inclusion criteria: solitary SIPN; diameter ≥ 3 mm; volume ≤ 250 mm3; two or more CT scans performed with the same scanner and same acquisition/reconstruction protocol; thin-section 1-mm images in DICOM format; histologic diagnosis or follow-up ≥ 2 years; and no oncological history. Applying these criteria, a total of 27 patients with single SIPNs ≤ 250 mm3 were enrolled. For each SIPN, the volume and doubling time were calculated using semiautomatic software throughout the follow-up period. For each SIPN, we applied the Fleischner Society guidelines, and the recommended management was compared to what was actually done. Results. A significant volumetric increase was detected in 5/27 (18.5%) SIPNs; all growing nodules were observed in high-risk patients. In these SIPNs, a histologic diagnosis of malignancy was obtained. Applying the Fleischner Society recommendations, all five malignant nodules would have been identified. None of the SIPNs < 100 mm3 in low-risk patients showed significant growth during the follow-up period. The application of the new guidelines would have led to a significant reduction in follow-up CT examinations (Hodges-Lehmann median difference, -2 CT scans; p = 0.0001). Conclusion. The application of the updated Fleischner Society guidelines has been shown to be effective in the management of SIPNs ≤ 250 mm3 with a significant reduction in radiation dose.http://dx.doi.org/10.1155/2019/7218258 |
| spellingShingle | Andrea Borghesi Silvia Michelini Giorgio Nocivelli Mario Silva Alessandra Scrimieri Stefania Pezzotti Roberto Maroldi Davide Farina Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice Radiology Research and Practice |
| title | Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice |
| title_full | Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice |
| title_fullStr | Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice |
| title_full_unstemmed | Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice |
| title_short | Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice |
| title_sort | solid indeterminate pulmonary nodules less than or equal to 250 mm3 application of the updated fleischner society guidelines in clinical practice |
| url | http://dx.doi.org/10.1155/2019/7218258 |
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