ACR Appropriateness Criteria®
Clinical Condition: Solitary Pulmonary Nodule, Noncalcified.
Variant 1: Nodule >1 cm, low clinical suspicion for cancer.
Radiologic Exam Procedure |
Appropriateness Rating |
Comments |
CT, chest, high-resolution |
8 |
To detect occult calcifications, fat, bronchus sign, etc. |
Fine needle aspiration |
8 |
If nodule shows contrast enhancement or PET scan is positive |
PET scan |
8 |
If nodule is indeterminate on HRCT |
CT, chest, with contrast |
6 |
Probably not indicated if PET performed |
Watchful waiting with CT follow-up |
4 |
|
Appropriateness Criteria Scale
1 2 3 4 5 6 7 8 9
1 = Least appropriate 9 = Most appropriate
|
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 2: Nodule >1 cm, moderate to high clinical suspicion for cancer.
Radiologic Exam Procedure |
Appropriateness Rating |
Comments |
CT, chest, high-resolution |
8 |
To detect occult calcifications, fat, bronchus sign, etc. |
Fine needle aspiration |
8 |
If nodule shows contrast enhancement or PET scan is positive |
PET scan |
8 |
If nodule is indeterminate on HRCT |
CT, chest, with contrast |
6 |
Probably not indicated if PET performed |
Watchful waiting with CT follow-up |
2 |
|
Appropriateness Criteria Scale
1 2 3 4 5 6 7 8 9
1 = Least appropriate 9 = Most appropriate
|
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 3: Nodule <1 cm, low clinical suspicion for cancer.
Radiologic Exam Procedure |
Appropriateness Rating |
Comments |
Watchful waiting with CT follow-up |
8 |
|
CT, chest, high-resolution |
7 |
|
CT, chest, with contrast |
3 |
|
PET scan |
3 |
|
Fine needle aspiration |
2 |
|
Appropriateness Criteria Scale
1 2 3 4 5 6 7 8 9
1 = Least appropriate 9 = Most appropriate
|
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
Variant 4: Nodule <1 cm, moderate to high clinical suspicion for cancer.
Radiologic Exam Procedure |
Appropriateness Rating |
Comments |
CT, chest, high-resolution |
8 |
|
Fine needle aspiration |
6 |
|
Watchful waiting with CT follow-up |
5 |
|
CT, chest, with contrast |
4 |
|
PET scan |
2 |
|
Appropriateness Criteria Scale
1 2 3 4 5 6 7 8 9
1 = Least appropriate 9 = Most appropriate
|
Note: Abbreviations used in the tables are listed at the end of the "Major Recommendations" field.
In view of the variety of diagnostic tests available and the variable accuracy of the different diagnostic techniques, no single algorithm for work-up is generally accepted. It has been found to vary from institution to institution. This is probably appropriate given the varying prevalence of lung disease in different parts of the country, varying skill levels of operators, and varying availability of equipment.
Abbreviations
- CT, computed tomography
- HRCT, high resolution computed tomography
- PET, positron emission tomography