🔍 Pulmonary Nodule Follow-up (Fleischner 2017)
UseDecide the follow-up interval and modality for an incidental (non-screening) pulmonary nodule in patients ≥ 3…
SourceMacMahon H, et al. Guidelines for Management of Incidental Pulmonary Nodules: Fleischner Society 20…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Not for known cancer/primary tumour, immunosuppression or lung-cancer screening (use Lung-RADS for screening).
When to use
Decide the follow-up interval and modality for an incidental (non-screening) pulmonary nodule in patients ≥ 35.
How it works
Recommendations vary by solid/ground-glass/part-solid type, single vs multiple, size (< 6, 6–8, > 8 mm) and low vs high risk; measured as the average of long and short axes on thin sections.
Key points
- Not for known cancer/primary tumour, immunosuppression or lung-cancer screening (use Lung-RADS for screening).
- Solid nodules < 6 mm in low-risk patients need no routine follow-up.
- Persistent ground-glass nodules ≥ 6 mm are followed long-term (duration [pending update]).
- High-risk features include smoking, older age, emphysema/fibrosis, upper-lobe location and family history.
- Two site rules (not guideline text): low-dose CT from a health-check centre is treated as screening (Lung-RADS), while standard-dose health-check chest CT is treated as incidental (Fleischner); a trailing 5 rounds up (Lung-RADS keeps one decimal, so 5.95 mm counts as 6.0 mm; Fleischner rounds to whole millimetres, so 5.5 mm counts as 6 mm).
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Nodule type | Pure ground-glass (GGN) |
|---|---|
| Number | Single |
| Mean diameter = (long axis + short axis) / 2 | 5.5 mm |
| Risk (for solid nodules) | Low risk |
→Follow-up adviceCT at 6–12 mo
- Nodule：Pure ground-glass · single
- Mean diameter：5.5 mm (rounded per Fleischner to 6 mm)
- Advice：CT at [pending update] to confirm persistence, then follow-up [pending update]
| Nodule type | Part-solid |
|---|---|
| Number | Multiple |
| Mean diameter = (long axis + short axis) / 2 | 5.5 mm |
| Risk (for solid nodules) | High risk |
→Follow-up adviceCT at 3–6 mo
- Nodule：Part-solid · multiple
- Mean diameter：5.5 mm (rounded per Fleischner to 6 mm)
- Advice：Follow-up CT [pending update], then manage per the most suspicious nodule
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Pulmonary Nodule Follow-up (Fleischner 2017)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Pulmonary Nodule Follow-up (Fleischner 2017) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Pulmonary Nodule Follow-up (Fleischner 2017) calculated in practice? Can you show a worked example?
- Inputs: Nodule type Pure ground-glass (GGN), Number Single, Mean diameter = (long axis + short axis) / 2 5.5 mm, Risk (for solid nodules) Low risk → Result: Follow-up advice CT at 6–12 mo（Nodule: Pure ground-glass · single, Mean diameter: 5.5 mm (rounded per Fleischner to 6 mm), Advice: CT at [pending update] to confirm persistence, then follow-up [pending update]） Inputs: Nodule type Part-solid, Number Multiple, Mean diameter = (long axis + short axis) / 2 5.5 mm, Risk (for solid nodules) High risk → Result: Follow-up advice CT at 3–6 mo（Nodule: Part-solid · multiple, Mean diameter: 5.5 mm (rounded per Fleischner to 6 mm), Advice: Follow-up CT [pending update], then manage per the most suspicious nodule）