🫁 Pulmonary Nodule Smart Manager · Follow-up & Surgical Decision
UseUse to classify by Lung-RADS (screening) or Fleischner (incidental), refine follow-up with the Chinese 2024 c…
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SourceMacMahon H, et al. Guidelines for Management of Incidental Pulmonary Nodules: From the Fleischner S…
Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Score + version; reference only — not a substitute for care · no HIS write
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
Clinical takeaway
(original synthesis · not guideline verbatim)
When to use
Use to classify by Lung-RADS (screening) or Fleischner (incidental), refine follow-up with the Chinese 2024 consensus, and gauge the surgical window and procedure.
How it works
Screening → Lung-RADS category by type/size/solid component. Incidental → Fleischner by type and size.
Key points
- (original synthesis · not guideline verbatim)
- Pure GGN is prone to PET false-negatives and a long doubling time does not exclude indolent adenocarcinoma.
- Solid-component size and growth are the core invasiveness markers driving escalation.
- China reference line: the China National Lung Cancer Screening Guideline with LDCT (2025 Version), read side by side with Lung-RADS. This tool's screening categories follow Lung-RADS v2022.
- This tool does not calculate by those criteria.
- Quality control (Oncology Society of Chinese Medical Association, 2026): target mean effective dose for LDCT < 1 mSv; use iterative or deep-learning reconstruction where available; AI reads must be reviewed by a radiologist (false negatives occur in central and mediastinal lesions).
- 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)
References
- [Guideline / primary source]MacMahon H, et al. Guidelines for Management of Incidental Pulmonary Nodules: From the Fleischner Society 2017. Radiology 2017.
- [Guideline / primary source]Chinese Expert Group on Early Diagnosis and Treatment of Lung Cancer; China Lung Oncology Group. China National Lung Cancer Screening Guideline with Low-dose Computed Tomography (2025 Version) [in Chinese]. Zhongguo Fei Ai Za Zhi 2025;28(12):887-895. doi:10.3779/j.issn.1009-3419.2025.102.43
- [Guideline / primary source]Oncology Society of Chinese Medical Association. Oncology Society of Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2026 edition) [in Chinese]. Zhonghua Zhong Liu Za Zhi 2026;48(9):1023-1059. doi:10.3760/cma.j.cn112152-20260511-00228
- Saji H, et al. Segmentectomy versus lobectomy in small-sized peripheral NSCLC (JCOG0802/WJOG4607L). Lancet 2022.
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.
| Detection scenario | Checkup/incidental (Fleischner) |
|---|---|
| Nodule type | Part-solid |
| Mean diameter = (long axis + short axis) / 2 | 9 mm |
| Solid-component diameter (required for part-solid) | 5 mm |
| Lung-cancer risk | Low risk |
| Compared with prior CT | Stable on follow-up |
| Number | Single |
| Location (affects procedure) | Peripheral (outer 1/3) |
→Conclusion[Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text. · follow-up primary
- Classification：[Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text. (malignancy probability low-intermediate)
- (1) Follow-up strategy：CT at 3–6 months to confirm persistence; → annual CT for 5 years.
- (2) Diagnostic approach：Serial thin-section CT follow-up primary; upgrade if enlarging or a solid component appears. Markers (CEA/Cyfra21-1/SCC/ProGRP) may be tracked but not as a sole basis.
| Detection scenario | Checkup/incidental (Fleischner) |
|---|---|
| Nodule type | Solid |
| Mean diameter = (long axis + short axis) / 2 | 9 mm |
| Solid-component diameter (required for part-solid) | 5 mm |
| Lung-cancer risk | Low risk |
| Compared with prior CT | Baseline/first detection |
| Number | Single |
| Location (affects procedure) | Peripheral (outer 1/3) |
→Conclusion[Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text. · surgical-assessment window
- Classification：[Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text. (malignancy probability ~3%+, assess by probability)
- (1) Follow-up strategy：Enter active assessment: choose one of CT at 3 months / PET-CT / tissue sampling.
- (2) Diagnostic approach：non-surgical biopsy — peripheral nodules CT-guided transthoracic needle biopsy (TTNB), central/needing mediastinal staging use bronchoscopy + EBUS-TBNA; indeterminate nodules (highly suspected early cancer but biopsy inconclusive) → MDT + shared decision-making.
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Pulmonary Nodule Smart Manager · Follow-up & Surgical Decision?
- 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 Smart Manager · Follow-up & Surgical Decision 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 Smart Manager · Follow-up & Surgical Decision calculated in practice? Can you show a worked example?
- Inputs: Detection scenario Checkup/incidental (Fleischner), Nodule type Part-solid, Mean diameter = (long axis + short axis) / 2 9 mm, Solid-component diameter (required for part-solid) 5 mm, Lung-cancer risk Low risk, Compared with prior CT Stable on follow-up, Number Single, Location (affects procedure) Peripheral (outer 1/3) → Result: Conclusion [Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text. · follow-up primary（Classification: [Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text. (malignancy probability low-intermediate), (1) Follow-up strategy: CT at 3–6 months to confirm persistence; → annual CT for 5 years., (2) Diagnostic approach: Serial thin-section CT follow-up primary; upgrade if enlarging or a solid component appears. Markers (CEA/Cyfra21-1/SCC/ProGRP) may be tracked but not as a sole basis.） Inputs: Detection scenario Checkup/incidental (Fleischner), Nodule type Solid, Mean diameter = (long axis + short axis) / 2 9 mm, Solid-component diameter (required for part-solid) 5 mm, Lung-cancer risk Low risk, Compared with prior CT Baseline/first detection, Number Single, Location (affects procedure) Peripheral (outer 1/3) → Result: Conclusion [Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text. · surgical-assessment window（Classification: [Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text. (malignancy probability ~3%+, assess by probability), (1) Follow-up strategy: Enter active assessment: choose one of CT at 3 months / PET-CT / tissue sampling., (2) Diagnostic approach: non-surgical biopsy — peripheral nodules CT-guided transthoracic needle biopsy (TTNB), central/needing mediastinal staging use bronchoscopy + EBUS-TBNA; indeterminate nodules (highly suspected early cancer but biopsy inconclusive) → MDT + shared decision-making.）