Management pathways for solitary pulmonary nodules

Abstract

Pulmonary nodules are often detected during the clinical course of several diseases or through routine screening. Various guidelines have proposed management algorithms for suspicious solitary nodules in lung cancer. Generally, solitary pulmonary nodules are managed according to nodule appearance and risk of lung cancer using low-dose, thin section computed tomography (CT). Liquid biopsy is promising for diagnosis, therapeutic-monitoring and follow-up in lung cancer; however, diagnosis and management pathways based on genetic examination alone have not been established. Management of solitary pulmonary nodules should be carried out by a multidisciplinary team and tissue biopsy is necessary for the diagnosis of lung cancer. Genetic analysis via liquid biopsy is warranted in addition to more established techniques in pulmonary nodule management.

Keywords: Lung nodule; guideline; screening.

Figure 1

Summary of radiological and pathological diagnostic pathways for multiple pulmonary nodules by IASLC SPFC proposal. *, histological subtype is estimated for adenocarcinoma. In multiple squamous-cell carcinoma cases, cytologic/stromal features must be estimated. AIS, adenocarcinoma in situ; MIA, minimally invasive adenocarcinoma; LPA, lepidic predominant adenocarcinoma; SCC, squamous cell carcinoma; GG/L, ground glass/lipidic.