Pulmonology · Radiology
Fleischner Society 2017 Incidental Pulmonary Nodule Guidelines calculator
Enter the published formula inputs below to calculate and interpret this score.
Clinical inputs
Allowed range: 0–120 years
The 2017 table applies at age 35 years or older. A younger patient returns the outside-guidelines result.
Allowed range: 1–100 mm
Average of the long and short axes. The score rounds that average to the nearest millimeter before the table bins. For multiple nodules, enter the most suspicious nodule.
Allowed range: 0–100 mm
Average solid-component diameter, rounded to the nearest millimeter. Used for a single part-solid nodule of 6 mm or larger. A value above the nodule diameter returns no result.
Result
6 fields remaining
Anyone can run this calculator. Sign in to save, favourite, or send the result.
Ruqelo is AI and can make mistakes. Check important information.
Clinical inputs
- Age (years)Accepted range: 0 to 120
- Lung cancer screening CT
- Immunosuppression
- Known primary cancer
- Benign morphology
- Nodule attenuation
- Number of nodules
- Solid-nodule risk
- Average nodule diameter (mm)Accepted range: 1 to 100
- Solid-component diameter (mm)Accepted range: 0 to 100
- Suspicious morphology
- Growing solid component
Primary source
MacMahon H et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. DOI: 10.1148/radiol.2017161659. PMID: 28240562. The management table was read from the MacMahon PDF hosted at radcommons.org. Size is the average of the long and short axes, rounded to the nearest millimeter. Volume equivalents in the table are under 6 mm = under 100 mm3, 6–8 mm = 100–250 mm3, and over 8 mm = over 250 mm3. Solid, single, low risk: under 6 mm no routine follow-up; 6–8 mm CT at 6–12 months then consider CT at 18–24 months; over 8 mm consider CT at 3 months, PET/CT, or tissue sampling. Solid, single, high risk: under 6 mm optional CT at 12 months; 6–8 mm CT at 6–12 months then CT at 18–24 months; over 8 mm consider CT at 3 months, PET/CT, or tissue sampling. Solid, multiple, using the most suspicious nodule: low risk under 6 mm no routine follow-up; low risk 6 mm or larger CT at 3–6 months then consider CT at 18–24 months; high risk under 6 mm optional CT at 12 months; high risk 6 mm or larger CT at 3–6 months then CT at 18–24 months. Single ground glass: under 6 mm no routine follow-up, and certain suspicious nodules under 6 mm may be followed at 2 and 4 years; 6 mm or larger CT at 6–12 months to confirm persistence, then CT every 2 years until 5 years. Single part-solid: under 6 mm no routine follow-up; 6 mm or larger with solid component under 6 mm, CT at 3–6 months then annual CT for a minimum of 5 years if unchanged; solid component 6 mm or larger, short-term CT at 3–6 months to evaluate persistence; lobulated margins or cystic components, a growing solid component, or a solid component larger than 8 mm, PET/CT, biopsy, or resection. Multiple subsolid: under 6 mm CT at 3–6 months and, if stable, consider CT at 2 and 4 years; 6 mm or larger CT at 3–6 months, then management of the most suspicious nodule. Subsolid recommendations do not use the solid-nodule risk categories. A hamartoma with internal fat and calcification, or typical granuloma calcification, has no further CT follow-up. Perifissural morphology consistent with an intrapulmonary lymph node has no follow-up CT even when the average exceeds 6 mm. The recommendations do not apply to lung cancer screening, immunosuppression, known primary cancer, or age under 35 years. Low risk is the ACCP estimate under 5%. High risk combines the ACCP intermediate and high estimates. Smoking of 30 pack-years or more and quitting within 15 years indicates high-risk status for solid nodules. (2017)
View source