Fleischner 2017 pulmonary nodule calculator
Get the Fleischner Society 2017 follow-up recommendation for an incidental lung nodule. Choose the nodule type, mean diameter, number and patient risk, then copy a report line you can paste straight into your CT chest report.
Use the mean of the long- and short-axis diameters, rounded to the nearest millimetre.
Report line
Fleischner Society 2017 follow-up recommendations
The guideline splits nodules by texture and size, and — for solid nodules — by whether the patient is low or high risk. Size is the mean diameter (average of the long and short axes). Approximate volume equivalents: <6 mm ≈ <100 mm³, 6–8 mm ≈ 100–250 mm³, >8 mm ≈ >250 mm³.
Solid nodules
| Size | Single, low risk | Single, high risk |
|---|---|---|
| <6 mm | No routine follow-up | Optional CT at 12 months |
| 6–8 mm | CT at 6–12 months, then consider CT at 18–24 months | CT at 6–12 months, then CT at 18–24 months |
| >8 mm | Consider CT at 3 months, PET-CT, or sampling | Consider CT at 3 months, PET-CT, or sampling |
For multiple solid nodules the first follow-up moves earlier to 3–6 months, and management is based on the most suspicious nodule.
Subsolid nodules (single)
| Size | Pure ground-glass | Part-solid |
|---|---|---|
| <6 mm | No routine follow-up (consider 2 & 4 yr if suspicious) | No routine follow-up |
| ≥6 mm | CT at 6–12 months to confirm persistence, then CT every 2 years to 5 years | CT at 3–6 months; if unchanged and solid component <6 mm, annual CT for 5 years |
A persistent part-solid nodule with a solid component of 6 mm or larger is highly suspicious. Multiple subsolid nodules are followed at 3–6 months, then by the most suspicious nodule.
Source: 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.