Persistent subsolid nodules and atypical lung cysts often represent indolent lung cancers that a multidisciplinary team elects to watch rather than treat. The American College of Radiology has updated its Appropriateness Criteria for imaging surveillance in exactly that situation.
The document applies specifically where the team has already decided on surveillance over intervention. The aim of imaging then is narrow: to detect changes significant enough to alter management, with modality chosen for accuracy and for whether a finding would actually change the decision. If the team decides treatment is needed, the workup and biopsy that follow are a diagnostic pathway, not part of surveillance.
For practice this draws a clean line between surveillance imaging and diagnostic workup, and keeps surveillance proportionate. It is a reminder to match imaging intensity to whether a result will change what is done, rather than scanning out of habit.
- Updated ACR Appropriateness Criteria cover imaging surveillance of indolent subsolid nodules and atypical lung cysts.
- They apply only once a multidisciplinary team has chosen surveillance over intervention.
- The goal of surveillance imaging is to catch changes significant enough to alter management.
- Choose modality by accuracy and by whether the finding would change the decision.
- Diagnostic workup and biopsy, if treatment is chosen, are separate from surveillance.
Why it matters
It separates surveillance from diagnostic imaging and curbs reflexive scanning that will not change the plan.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for radiology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free