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Shades of Gray: Subsolid Nodule Considerations and Management.

Lea Azour1, Jane P Ko1, David P Naidich1

  • 1Department of Radiology, NYU Grossman School of Medicine, New York, NY; and NYU Langone Health, New York, NY.

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Summary

Subsolid nodules on chest CT scans can be benign or malignant, posing management challenges. This review compares practice guidelines for managing these lung nodules to aid clinical decision-making.

Keywords:
American College of Chest PhysiciansBritish Thoracic SocietyFleischner Societyground-glasssubsolid

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Area of Science:

  • Radiology
  • Pulmonary Medicine
  • Oncology

Background:

  • Subsolid nodules are frequently observed in chest CT imaging.
  • These nodules present diagnostic and management complexities due to their varied nature and differential diagnoses.
  • While often indicative of lung adenocarcinoma, other conditions must be considered.

Purpose of the Study:

  • To review and compare existing practice guidelines for managing subsolid nodules detected incidentally and through screening.
  • To provide a resource to assist clinicians in selecting appropriate management strategies for subsolid nodules.
  • To highlight similarities and differences in current management algorithms.

Main Methods:

  • Comparative analysis of current clinical practice guidelines for subsolid nodule management.
  • Review of literature pertaining to subsolid nodule characteristics and diagnostic criteria.
  • Synthesis of information to identify commonalities and discrepancies among guidelines.

Main Results:

  • Existing guidelines incorporate patient-specific factors and nodule characteristics.
  • Algorithms for incidentally-detected and screening-detected nodules share common principles but have distinct features.
  • Variations in recommendations exist, necessitating careful comparison for optimal patient care.

Conclusions:

  • A comprehensive understanding of guideline variations is crucial for effective subsolid nodule management.
  • This review serves as a comparative resource to support clinical decision-making in complex cases.
  • Standardized yet adaptable approaches are needed to address the heterogeneity of subsolid nodules.