Evaluation of Pulmonary Nodules: Clinical Practice Consensus Guidelines for Asia

Area of Science:

• Pulmonology and Thoracic Surgery
• Clinical Practice Guidelines
• Diagnostic Imaging

Background:

• American College of Chest Physicians (CHEST) guidelines for pulmonary nodule evaluation show low adoption in Asia.
• Unique Asian patient characteristics necessitate adapted diagnostic approaches.
• Objective: Adapt CHEST guidelines for Asian practitioners evaluating pulmonary nodules.

Framework:

• Modified ADAPTE process utilized.
• Multidisciplinary Asian panel of pulmonologists and thoracic surgeons convened.
• Iterative review and redrafting ensured consensus on adapted recommendations.

Implementation:

• Asian pulmonary nodule evaluation aligns with CHEST guidelines but requires modifications.
• Consider high lung cancer risk from air pollution and adenocarcinoma in female nonsmokers.
• Acknowledge high prevalence of granulomatous and infectious causes of nodules.
• Diagnostic risk calculators for non-Asian patients may not be applicable.
• Recommend longer surveillance for pulmonary nodules than CHEST guidelines.

Implications:

• Pulmonary tuberculosis (TB) in Asia suggests reduced reliance on PET scanning.
• Prioritize nonsurgical biopsy over surgical diagnosis or surveillance.
• Adapted guidelines aim to standardize pulmonary nodule evaluation in Asia.