Interpreting Results

NCCN guidelines for appended reports for low dose CT screening**

The dimensions of a nodule are measured as mean diameter = the mean of the longest diameter and its perpendicular diameter.

  • A new finding of a solid or partial solid nodule has been identified, the recommend follow-up is dependent upon the size as follows:
    <= 6 mm follow-up LDCT 1 year
    6-8 mm LDCT at 3 months
    > 8 mm consider PET Scan -> if negative repeat LDCT 3 months. If Positive refer for biopsy or excision
    Solid endobronchial lesion-> Repeat LDCT at 1 month after expectorants -> if no resolution -> Bronchscopy
    • Solid Nodule - 1st follow-up
      increase in size or PET suspicious of malignancy -> please refer to the pulmonary physician of choice for further invasive testing
      No increase in size - LDCT in 6 months
      Low Prob by PET- 3 month LDCT
      Resolution -> go back to yearly LDCT
      Solid endobroncial lesion persist-> please refer to the pulmonary physician of choice for further invasive testing
  • New ground glass opacity/GG nodule/non-solid lesions
    < 5 mm LDCT in 12 months 5-10 mm LDCT 6 months
    > 10 mm LDCT 3 months
    • Ground glass opacity/GG nodule/non-solid lesions 1st follow-up
      Resolution or stable - return to annual LDCT
      Increase in size and/or becoming more solid-> please refer to the pulmonary physician of choice for further invasive testing
  • New Radiographic finding compatible with infection or inflammation
    • If symptoms suggest infection , please treat accordingly and repeat LDCT at 4- 8 weeks
    • If no symptoms infection and solid or partially solid - will follow as solid per above
      A new finding of a solid or partially solid nodule has been identified, the recommend follow-up is dependent upon the size as follows:
      <= 4 mm follow-up LDCT 1 year
      4-6 mm LDCT at 6 months
      6-8 mm LDCT at 3 months
      > 8 mm follow-up PET Scan Solid endobronchial lesion-> Repeat LDCT at 1 month after expectorants
      Please advise us by return Fax if you wish to take other action
      • Solid Nodule - 1st follow-up
        increase in size or PET suspicious of malignancy -> please refer to the pulmonary physician of choice for further invasive testing
        No increase in size - LDCT in 6 months
        Low Prob by PET- 3 month LDCT
        Resolution -> go back to yearly LDCT
    • If no symptoms infection and ground glass or non solid
      < 5 mm LDCT in 12 months
      5-10 mm LDCT 6 months
      > 10 mm LDCT 3 months
      • Ground Glass opacity 1st follow-up
        Increase in size and/or becoming more solid-> please refer to the pulmonary physician of choice for further invasive testing
        Resolution or no change - return to annual LDCT

**source: NCCN CLINICAL PRACTICE GUIDELINES IN ONCOLOGY: LUNG CANCER SCREENING, V 2.2015 nccn.org