Fleischner Society Guidelines — Pulmonary Nodules
2017 Fleischner Society guidelines for management of incidentally discovered pulmonary nodules on CT in adults ≥ 35 years.
Score interpretation
Low-risk, small solid nodule (< 6mm): No routine follow-up recommended in low-risk patients.
→ No CT follow-up required for solid nodule < 6mm in low-risk patients. High-risk patients with < 6mm nodule: optional CT at 12 months. Document in report. Advise patient.
Intermediate-risk nodule. CT follow-up at 3–6 months recommended.
→ CT chest at 3–6 months then 18–24 months if stable. 6–7mm solid: 6–12 months CT. 8–14mm solid: 3 months CT then 9 months. Subsolid 6mm: CT at 3–6 months. Refer to lung multidisciplinary team (MDT) if growing.
High-risk nodule ≥ 15mm or suspicious features: immediate further workup.
→ Urgent respiratory / thoracic MDT referral. PET-CT scan. Consider CT-guided biopsy if PET positive or growing nodule. Discuss with thoracic surgery for resection if operable and high malignancy probability. Lung cancer MDT input.
Interpretation bands for the Fleischner Criteria. Apply clinical judgement and local guidance.
References
- MacMahon H et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017.
Related
Curated clinical cross-links plus same-class fallbacks.
- Nitric Oxide (Inhaled — iNO) · Selective Pulmonary Vasodilator
- Selexipag · Pulmonary Arterial Hypertension
- Macitentan · Pulmonary Arterial Hypertension
- Cetuximab · Anti-EGFR Monoclonal Antibody — Head and Neck Cancer
- Cisplatin · Platinum Chemotherapy — Head and Neck Cancer
- Betamethasone (Antenatal Corticosteroids) · Corticosteroid (Fetal Lung Maturation)
- Acute Asthma in Adults · BTS/SIGN British Guideline on Asthma 2019; NICE NG80
- Pulmonary Embolism Assessment · NICE NG158; ESC 2019 PE Guidelines
- Acute Exacerbation of COPD (AECOPD) · NICE NG115; GOLD 2024
- Spontaneous Pneumothorax (Adult) · BTS Pleural Disease 2023
- Atypical Pneumonia (Legionella / Mycoplasma / Chlamydophila) · BTS 2023; IDSA
- COPD Exacerbation Management · NICE NG115 / GOLD 2024
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.