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Lung nodules: size still matters

Anna Rita Larici, Alessandra Farchione, Paola Franchi, Mario Ciliberto, Giuseppe Cicchetti, Lucio Calandriello, Annemilia del Ciello, Lorenzo Bonomo
European Respiratory Review 2017 26: 170025; DOI: 10.1183/16000617.0025-2017
Anna Rita Larici
Institute of Radiology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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  • For correspondence: annarita.larici@unicatt.it
Alessandra Farchione
Institute of Radiology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Paola Franchi
Institute of Radiology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Mario Ciliberto
Institute of Radiology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Giuseppe Cicchetti
Institute of Radiology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Lucio Calandriello
Institute of Radiology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Annemilia del Ciello
Institute of Radiology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Lorenzo Bonomo
Institute of Radiology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Abstract

The incidence of indeterminate pulmonary nodules has risen constantly over the past few years. Determination of lung nodule malignancy is pivotal, because the early diagnosis of lung cancer could lead to a definitive intervention. According to the current international guidelines, size and growth rate represent the main indicators to determine the nature of a pulmonary nodule. However, there are some limitations in evaluating and characterising nodules when only their dimensions are taken into account. There is no single method for measuring nodules, and intrinsic errors, which can determine variations in nodule measurement and in growth assessment, do exist when performing measurements either manually or with automated or semi-automated methods. When considering subsolid nodules the presence and size of a solid component is the major determinant of malignancy and nodule management, as reported in the latest guidelines. Nevertheless, other nodule morphological characteristics have been associated with an increased risk of malignancy. In addition, the clinical context should not be overlooked in determining the probability of malignancy. Predictive models have been proposed as a potential means to overcome the limitations of a sized-based assessment of the malignancy risk for indeterminate pulmonary nodules.

Abstract

Size and growth rate remain the main determinants of nodule management http://ow.ly/mtDB30gugUg

Footnotes

  • Number 4 in the Series “Radiology” Edited by Nicola Sverzellati and Sujal Desai

  • Previous articles in this series: No. 1: Walsh SLF. Multidisciplinary evaluation of interstitial lung diseases: current insights. Eur Respir Rev 2017; 26: 170002. No. 2: Elicker BM, Kallianos KG, Henry TS. The role of high-resolution computed tomography in the follow-up of diffuse lung disease. Eur Respir Rev 2017; 26: 170008. No. 3: Robbie H, Daccord C, Chua F, et al. Evaluating disease severity in idiopathic pulmonary fibrosis. Eur Respir Rev 2017; 26: 170051.

  • Conflict of interest: None declared.

  • Provenance: Commissioned article, peer reviewed.

  • Received March 17, 2017.
  • Accepted October 28, 2017.
  • Copyright ©ERS 2017.

ERR articles are open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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Vol 26 Issue 146 Table of Contents
European Respiratory Review: 26 (146)
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Lung nodules: size still matters
Anna Rita Larici, Alessandra Farchione, Paola Franchi, Mario Ciliberto, Giuseppe Cicchetti, Lucio Calandriello, Annemilia del Ciello, Lorenzo Bonomo
European Respiratory Review Dec 2017, 26 (146) 170025; DOI: 10.1183/16000617.0025-2017

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Lung nodules: size still matters
Anna Rita Larici, Alessandra Farchione, Paola Franchi, Mario Ciliberto, Giuseppe Cicchetti, Lucio Calandriello, Annemilia del Ciello, Lorenzo Bonomo
European Respiratory Review Dec 2017, 26 (146) 170025; DOI: 10.1183/16000617.0025-2017
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  • Article
    • Abstract
    • Abstract
    • Introduction: the “size” of the problem
    • Size and malignancy
    • Size changes: the growth rate
    • Size measurements: methods and limitations
    • Factors influencing nodule measurement variations
    • Effect of measurement variations on nodule growth
    • Subsolid nodules: special considerations
    • Integrating clinical and nodule characteristics: risk prediction models
    • Size and follow-up recommendations
    • Conclusions
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

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  • Respiratory clinical practice
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