Incidental solid pulmonary nodules are among the commonest findings a radiologist reports, and consistent follow-up prevents both missed cancers and needless scans. The Fleischner Society recommendations give a size- and risk-based framework for solid nodules in adults 35 and over, outside screening or known cancer.
For a solid nodule under 6 mm, no routine follow-up is needed in low-risk patients, with an optional 12-month CT in high-risk ones. For 6 to 8 mm, image again at 6 to 12 months, then consider 18 to 24 months. Above 8 mm, weigh CT at 3 months, PET-CT, or sampling according to risk and morphology. Subsolid nodules follow their own, longer-interval pathway.
Factor in the patient's risk — smoking, age, emphysema, upper-lobe location, spiculation — and state a clear follow-up recommendation in the report. A definite recommendation closes the loop better than listing options.
- Solid nodule under 6 mm: no routine follow-up if low-risk; optional 12-month CT if high-risk.
- Solid 6 to 8 mm: repeat CT at 6 to 12 months, then consider 18 to 24 months.
- Solid over 8 mm: consider 3-month CT, PET-CT or sampling by risk and morphology.
- Subsolid nodules follow a separate, longer-interval pathway; state a clear recommendation in the report.
Why it matters
Consistent, risk-based nodule follow-up avoids both missed cancers and a cascade of unnecessary scans from inconsistent advice.
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