British Thoracic Society guidelines for the investigation and management of pulmonary nodules: accredited by NICE
Matthew E.J. Callister,David R Baldwin,Ahsan R. Akram,S Barnard,Paul Cane,J. Draffan,Kevin Franks,Fergus V. Gleeson,Richard Graham,P Malhotra,Mathias Prokop,K. Rodger,Manil Subesinghe,David A. Waller,Ian Woolhouse +14 more
TLDR
This guideline is based on a comprehensive review of the literature on pulmonary nodules and expert opinion and provides more clarity in the use of further imaging and more clarity about the place of biopsy.Abstract:
This guideline is based on a comprehensive review of the literature on pulmonary nodules and expert opinion. Although the management pathway for the majority of nodules detected is straightforward it is sometimes more complex and this is helped by the inclusion of detailed and specific recommendations and the 4 management algorithms below. The Guideline Development Group (GDG) wanted to highlight the new research evidence which has led to significant changes in management recommendations from previously published guidelines. These include the use of two malignancy prediction calculators (section ‘Initial assessment of the probability of malignancy in pulmonary nodules’, algorithm 1) to better characterise risk of malignancy. There are recommendations for a higher nodule size threshold for follow-up (≥5 mm or ≥80 mm3) and a reduction of the follow-up period to 1 year for solid pulmonary nodules; both of these will reduce the number of follow-up CT scans (sections ‘Initial assessment of the probability of malignancy in pulmonary nodules’ and ‘Imaging follow-up’, algorithms 1 and 2). Volumetry is recommended as the preferred measurement method and there are recommendations for the management of nodules with extended volume doubling times (section ‘Imaging follow-up’, algorithm 2). Acknowledging the good prognosis of sub-solid nodules (SSNs), there are recommendations for less aggressive options for their management (section ‘Management of SSNs’, algorithm 3).
The guidelines provide more clarity in the use of further imaging, with ordinal scale reporting for PET-CT recommended to facilitate incorporation into risk models (section ‘Further imaging in management of pulmonary nodules’) and more clarity about the place of biopsy (section ‘Non-imaging tests and non-surgical biopsy’, algorithm 4). There are recommendations for the threshold for treatment without histological confirmation (sections ‘Surgical excision biopsy’ and ‘Non-surgical treatment without pathological confirmation of malignancy’, algorithm 4).
Finally, and possibly most importantly, there are evidence-based recommendations about the information that people …read more
Citations
More filters
Journal ArticleDOI
Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Johan Vansteenkiste,Dirk De Ruysscher,Wilfried Eberhardt,Eric Lim,Suresh Senan,Enriqueta Felip,Solange Peters +6 more
TL;DR: The Clatterbridge Cancer Centre and Liverpool Heart and Chest Hospital, Liverpool; University of Aberdeen, Aberdeen, UK; Center for Medical Imaging, University of Groningen, Groningen; Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands; and Department of Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.
Journal ArticleDOI
Chronic obstructive pulmonary disease
Klaus F Rabe,Henrik Watz +1 more
TL;DR: Without a global political and economic effort to reduce tobacco use, to regulate environmental exposure, and to find alternatives to the massive use of biomass fuel, COPD will remain a major health-care problem for decades to come.
Journal Article
International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma
Journal ArticleDOI
European position statement on lung cancer screening
Matthijs Oudkerk,Anand Devaraj,Rozemarijn Vliegenthart,Thomas Henzler,Helmut Prosch,Claus P. Heussel,Claus P. Heussel,Gorka Bastarrika,Nicola Sverzellati,Mario Mascalchi,Stefan Delorme,David R Baldwin,Matthew E.J. Callister,Nikolaus Becker,Marjolein A Heuvelmans,Witold Rzyman,Maurizio Infante,Ugo Pastorino,Jesper Holst Pedersen,Eugenio Paci,Stephen W. Duffy,Harry J. de Koning,John K. Field +22 more
TL;DR: A risk stratification approach should be used for future lung cancer low-dose CT programmes and patients should be provided with information on the benefits and harms of screening to ensure that patients receive the most appropriate treatment.
Journal ArticleDOI
Recommendations for Measuring Pulmonary Nodules at CT: A Statement from the Fleischner Society.
Alexander A. Bankier,Heber MacMahon,Jin Mo Goo,Geoffrey D. Rubin,Cornelia M. Schaefer-Prokop,David P. Naidich +5 more
TL;DR: These recommendations for measuring pulmonary nodules at computed tomography (CT) are a statement from the Fleischner Society and incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists.
References
More filters
Journal ArticleDOI
Reduced lung-cancer mortality with low-dose computed tomographic screening.
Denise R. Aberle,Amanda M. Adams,Christine D. Berg,William C. Black,Jonathan D. Clapp,Richard M. Fagerstrom,Ilana F. Gareen,Constantine Gatsonis,Pamela M. Marcus,JoRean D. Sicks +9 more
TL;DR: Screening with the use of low-dose CT reduces mortality from lung cancer, as compared with the radiography group, and the rate of death from any cause was reduced.
Journal ArticleDOI
International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma
William D. Travis,Elisabeth Brambilla,Masayuki Noguchi,Andrew G. Nicholson,Kim R. Geisinger,Yasushi Yatabe,David G. Beer,Charles A. Powell,Gregory J. Riely,Paul Van Schil,Kavita Garg,John H. M. Austin,Hisao Asamura,Valerie W. Rusch,Fred R. Hirsch,Giorgio V. Scagliotti,Tetsuya Mitsudomi,Rudolf M. Huber,Yuichi Ishikawa,James R. Jett,Montserrat Sanchez-Cespedes,Jean-Paul Sculier,Takashi Takahashi,Masahiro Tsuboi,Johan Vansteenkiste,Ignacio I. Wistuba,Pan-Chyr Yang,Denise R. Aberle,Christian Brambilla,Douglas B. Flieder,Wilbur A. Franklin,Adi F. Gazdar,Michael K. Gould,Philip S. Hasleton,Douglas W. Henderson,Bruce E. Johnson,David A Johnson,Keith M. Kerr,Keiko Kuriyama,Jin Soo Lee,Vincent A. Miller,Iver Petersen,Victor L. Roggli,Rafael Rosell,Nagahiro Saijo,Erik Thunnissen,M. Tsao,David Yankelewitz +47 more
TL;DR: This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies.
Journal ArticleDOI
Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer
TL;DR: Compared with lobectomy, limited pulmonary resection does not confer improved perioperative morbidity, mortality, or late postoperative pulmonary function and lobectomy still must be considered the surgical procedure of choice for patients with peripheral T1 N0 non-small cell lung cancer.
Journal ArticleDOI
Early Lung Cancer Action Project: overall design and findings from baseline screening
Claudia I. Henschke,Dorothy I. McCauley,David F. Yankelevitz,David P. Naidich,Georgeann McGuinness,Olli S. Miettinen,Daniel M. Libby,Mark W. Pasmantier,June Koizumi,Nasser K. Altorki,James P. Smith +10 more
TL;DR: Low-dose CT can greatly improve the likelihood of detection of small non-calcified nodules, and thus of lung cancer at an earlier and potentially more curable stage, although false-positive CT results are common.
Journal ArticleDOI
Stereotactic Body Radiation Therapy for Inoperable Early Stage Lung Cancer
Robert Timmerman,Rebecca Paulus,James M. Galvin,Jeff M. Michalski,William L. Straube,Jeffrey D. Bradley,Achilles J. Fakiris,Andrea Bezjak,Gregory M.M. Videtic,David W. Johnstone,Jack F. Fowler,Elizabeth Gore,Hak Choy +12 more
TL;DR: Patients with inoperable non-small cell lung cancer who received stereotactic body radiation therapy had a survival rate of 55.8% at 3 years, high rates of local tumor control, and moderate treatment-related morbidity.
Related Papers (5)
Probability of Cancer in Pulmonary Nodules Detected on First Screening CT
Annette McWilliams,Martin C. Tammemägi,John R. Mayo,Heidi C. Roberts,Geoffrey Liu,Kam Soghrati,Kazuhiro Yasufuku,Simon Martel,Francis Laberge,Michel Gingras,S. Atkar-Khattra,Christine D. Berg,Kenneth R. Evans,Richard J. Finley,John Yee,John C. English,Paola Nasute,John R. Goffin,Serge Puksa,Lori Stewart,Scott Tsai,Michael R. Johnston,Daria Manos,Garth Nicholas,Glenwood D. Goss,Jean M. Seely,Kayvan Amjadi,Alain Tremblay,Paul Burrowes,Paul MacEachern,Rick Bhatia,Ming-Sound Tsao,Stephen Lam +32 more