Respiratory Radiology Strong — Fleischner Society 2017

Fleischner Society Guidelines — Pulmonary Nodules

2017 Fleischner Society guidelines for incidental pulmonary nodules on CT in adults ≥ 35 years. Not for lung cancer screening, immunosuppressed patients or patients with a known primary cancer.

Score interpretation

No Routine Follow-Up 1

Solid nodule(s) < 6 mm in a low-risk patient, or a single subsolid nodule < 6 mm.

→ For a suspicious single ground-glass nodule < 6 mm, consider CT at 2 and 4 years. Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

Optional CT at 12 Months 2

Solid nodule(s) < 6 mm in a high-risk patient.

→ Particularly with suspicious morphology or upper-lobe location. Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

CT at 6–12 Months, Then Consider CT at 18–24 Months 3

Single solid nodule 6–8 mm, low-risk patient.

→ Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

CT at 6–12 Months, Then CT at 18–24 Months 4

Single solid nodule 6–8 mm, high-risk patient.

→ Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

Consider CT at 3 Months, PET/CT or Tissue Sampling 5

Single solid nodule > 8 mm.

→ Discuss at the lung cancer MDT. Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

CT at 3–6 Months, Then Consider CT at 18–24 Months 6

Multiple solid nodules ≥ 6 mm, low-risk patient.

→ Use the most suspicious nodule to guide management. Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

CT at 3–6 Months, Then at 18–24 Months 7

Multiple solid nodules ≥ 6 mm, high-risk patient.

→ Use the most suspicious nodule to guide management. Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

CT at 6–12 Months to Confirm Persistence, Then Every 2 Years Until 5 Years 8

Single pure ground-glass nodule ≥ 6 mm.

→ If a solid component or growth develops, consider resection. Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

CT at 3–6 Months to Confirm Persistence; If Unchanged With Solid Part < 6 mm, Annual CT for 5 Years 9

Single part-solid nodule ≥ 6 mm.

→ A persistent part-solid nodule with a solid component ≥ 6 mm is highly suspicious — discuss at the lung cancer MDT. Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

CT at 3–6 Months; If Stable, Consider CT at 2 and 4 Years 10

Multiple subsolid nodules < 6 mm.

→ Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

CT at 3–6 Months; Then Manage by the Most Suspicious Nodule 11

Multiple subsolid nodules, any ≥ 6 mm.

→ Fleischner 2017 — not for lung cancer screening, immunosuppressed patients or known primary cancer; size = average of long and short axes.

Interpretation bands for the Fleischner Criteria. Apply clinical judgement and local guidance.

References

MacMahon H, Naidich DP, Goo JM, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017;284(1):228–243.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

Related