MGH NODULE MANAGEMENT GUIDELINES CHART (Download Chart .pdf)






In adults > 35 y/o, the recommended follow up of a small nodule < 4 mm is 12 and 24 months from the initial CT, to insure stability. The recommended follow up of a nodule 4-8 mm is 3, 9, and 24 months from the initial CT scan, pending stability.  In nodules > 8 mm consider evaluation by diagnostic intervention and/or FDG-PET. If intervention is contraindicated, follow up may be performed at 3, 9 and 24 months from the initial CT scan. No further CT imaging is recommended upon confirmation of stability after 24 months.

The likelihood of malignancy in adults <35 y/o is less than in older adults. In adults 18-35 y/o, without a history of malignancy, the recommended follow-up of a small nodule < 4 mm is 12 months from the initial CT scan, to insure stability. The recommended follow up of a nodule 4-8 mm is 6-12 and 24 months from the initial CT scan, pending stability.  In nodules >8 mm consider evaluation by diagnostic intervention, FDG-PET or follow up imaging. Follow up imaging may be performed at 3, 9 and 24 months from the initial CT scan. No further CT imaging is recommended upon confirmation of stability after 24 months.

Ground glass nodules are an exception and may warrant a recommendation for imaging beyond 24 months. Mixed solid/ground glass nodules are considered more suspicious for malignancy and recommended intervention may be earlier.  Nodules that show interval growth should be assessed by diagnostic intervention and/or FDG-PET.

In the setting of malignancy, close interval follow up of any nodule, with no documentation of prior existence, is recommended to exclude metastatic disease. Recommended intervals are 3, 6, 12 and 24 months from the initial CT scan.  No further CT imaging is recommended upon confirmation of stability after 24 months.  Alternatively, this nodule may be reviewed on thoracic CT scans obtained as part of an oncology treatment protocol.

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©2006 - MGH Department of Thoracic Radiology and Jo-Anne O. Shepard, MD