The increased detection of incidental small pulmonary nodules on multidetector computed tomography has driven attempts to refine the characterization and management of such nodules. A variety of methods have been developed to measure the size and biological activity of nodules to help define their nature, but these have limitations. Several clinical trials have assessed the efficacy of low-dose computed tomography screening for lung cancer and offer some insights into these limitations; however, they also provide evidence that refines existing nodule management strategies. This article reviews the size-based and functional measurement methods that can be used to predict the likelihood of malignancy in noncalcified solid pulmonary nodules and discusses their incorporation into existing algorithms for nodule management. The issue of multiple nodules and the optimum frequency and duration of follow-up are explored.
*Department of Radiology, Royal Brompton Hospital
§Department of Radiology, St George’s Hospital, London
†Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham
‡Roy Castle Lung Cancer Research Programme, The University of Liverpool Cancer Research Centre, Institute of Translational Medicine, Liverpool, UK
The authors declare no conflicts of interest.
Reprints: Arjun Nair, MBChB, MRCP, FRCR, Department of Radiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK (e-mail: firstname.lastname@example.org).