Comparative analysis of lung-RADS 2022 and Fleischner's 2017 guidelines

Area of Science:

• Pulmonary Medicine
• Radiology
• Oncology

Background:

• Pulmonary nodules are common findings on chest CT scans, posing challenges for early detection versus overdiagnosis.
• High-risk individuals often receive diagnostic CT scans outside lung cancer screening programs, leading to varied management strategies.

Purpose of the Study:

• To compare the Fleischner Society 2017 and Lung-RADS 2022 guidelines for managing single solid pulmonary nodules in high-risk adults.
• To analyze differences in follow-up recommendations for nodules of various sizes (≤5 mm, 8 mm, ≥9 mm).

Main Methods:

• Focused comparative analysis of Fleischner Society 2017 and Lung-RADS 2022 guidelines.
• Examination of follow-up recommendations for solid pulmonary nodules across size categories.

Main Results:

• Both guidelines show alignment for nodules ≤5 mm.
• Lung-RADS 2022 suggests earlier PET/CT for nodules >8 mm and a higher biopsy threshold compared to Fleischner 2017.
• Discrepancies can affect surveillance intensity, diagnostic timing, and resource allocation.

Conclusions:

• Differences in guidelines can create ambiguity for radiologists managing high-risk patients outside formal screening pathways.
• Understanding the clinical workflow context is crucial for appropriate application of each guideline framework.
• Clarifying these differences aids in reducing uncertainty and optimizing patient management.