The TSANZ Practical Guide for Clinicians in the Management of Screen- and Incidentally-Detected Nodules

The increasing adoption of lung cancer screening programs and advancements in imaging technologies has significantly increased the detection of pulmonary nodules, both incidentally and through screening. This document provides a comprehensive guide for clinicians to address the complexities of managing indeterminate pulmonary nodules (IPNs), emphasising person-centred and multidisciplinary care. IPNs are categorised based on size and morphology, with specific guidelines for malignancy risk stratification, diagnostic evaluation, and follow-up. Dedicated lung nodule evaluation teams (LNETs) and nodule multidisciplinary meetings (MDMs) play a critical role in ensuring guideline adherence, streamlining the diagnostic pathway, reducing unnecessary investigations, and improving outcomes. Structured IPN programs have demonstrated benefits in early lung cancer detection, improved detection of early-stage lung cancer, and reduced delays to treatment initiation. Effective management strategies include use of standardised reporting templates, utilising validated risk models such as the PanCan malignancy risk model and agreed protocols for follow up of IPNs. This document highlights the importance of accessing prior imaging to assess for growth and accounting for technical differences between computed tomography (CT) scans. Any nodule considered to be growing requires discussion at a nodule MDM with decision to act for tissue biopsy as appropriate. A nodule MDM will assist in optimising the safest and most efficient biopsy techniques based on nodule characteristics and risk profile. By integrating multidisciplinary expertise and adhering to evidence-based protocols, services can improve the timely diagnosis and management of IPNs, minimise over-investigation, reduce chance of overdiagnosis and ultimately enhance patient outcomes and lung cancer survival.