NCCN Guidelines for Patients® | Lung Cancer Screening - page 22

NCCN Guidelines for Patients
: Lung Cancer Screening
Version 1.2014
Part 4: The screening process
the nodule will likely be larger or denser in 6 to 12
months. Instead of waiting, other options are a biopsy or
surgery—both of which can confirm if cancer is present.
See Part 5 on page 25 for more information.
Nodules that are larger or denser at follow-up may be
cancer. Two options are given for a nodule that was
smaller than 5 mm at baseline but increased in size or
density. First, another follow-up LDCT could be done.
If cancer is present, the nodule will most likely be even
larger or denser in 3 to 6 months. The second option
is surgery to remove the nodule and test for cancer.
For nodules that were 5 mm or larger at baseline and
have increased in size or density, surgery to remove the
nodule for testing is suggested. See Part 5 on page 25
for more information.
Multiple nodules
Second screening test
Baseline LDCT results
Non-solid nodules
Get follow-up LDCT
≤5 mm in width
in 12 months
At least one non-solid
Get follow-up LDCT
nodule >5 mm in width
in 6 months
One or more dominant
Get follow-up LDCT
nodules with solid or
in 3–6 months
part-solid portion
Some people have more than one nodule that may be
cancer. If all of the nodules are non-solid and are 5 mm
or smaller, it is recommended that you get an LDCT in
12 months. Nodules with cancer will likely be larger or
denser by then. If any non-solid nodule is larger than
5 mm at baseline, an LDCT in 6 months should be done
to assess for increases in size or density.
You may have part-solid nodules that have features
that strongly suggest there’s cancer. Such “dominant”
features include spiky or pointy edges, a “bubbly” look,
or a net-like pattern. These nodules should be assessed
again in 3 to 6 months with LDCT.
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